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Neue mikrobiologische Diagnostikverfahren

Chancen und Limitierungen

Advances in diagnostic microbiology

Opportunities and limitations

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Zusammenfassung

Auch aufgrund der Ausbreitung multiresistenter Erreger gewinnt eine rasche und zuverlässige mikrobiologische Diagnostik an Bedeutung. Der zeitnahe Erregernachweis und die zugehörige Empfindlichkeitsprüfung sind nicht nur entscheidende Basis zur optimalen Behandlung bei Vorliegen komplexer Resistenzmechanismen, sondern auch notwendige Voraussetzung zur Deeskalation kalkulierter Therapieregime. Somit ist die Mikrobiologie auch integraler Bestandteil von Antibiotic-Stewardship(ABS)-Programmen. Traditionelle Ansätze mikrobiologischer Diagnostik sind durch eine methodeninhärente Langsamkeit gekennzeichnet. Die Zeitspanne bis zum Vorliegen von aussagekräftigen Resultaten beträgt 48 h oder sogar länger und dies beeinflusst schließlich auch die Dauer nichtindizierter oder ungeeigneter Antibiotikatherapien. Die fortlaufende Verbesserung verfügbarer Methoden sowie die Implementierung völlig neuartiger Technologien haben in den vergangenen Jahren zu einer fundamentalen Veränderung mikrobiologischer Analytik geführt. Diese Methoden verbessern nicht nur Sensitivität und Spezifität, sondern führen auch zu einer deutlich schnelleren Verfügbarkeit von Ergebnissen. Diese neuen diagnostischen Methoden sollen hier hinsichtlich ihrer potenziellen Bedeutung für die klinische Infektiologie kritisch beleuchtet werden.

Abstract

In the light of ever increasing problems related to the emergence of multidrug-resistant bacteria, rapid microbiological diagnostics are of growing importance. Timely pathogen detection and availability of susceptibility data are essential for optimal treatment, but are even more crucial for de-escalation of broad spectrum empiric therapies. Medical microbiology is, thus, an integral part of antimicrobial stewardship programs. Traditional microbiological techniques for species identification and susceptibility testing rely on bacterial growth and are, thus, characterized by inherent slowness. Time-to-report is usually 48 h or longer, and typically delays optimization of therapeutic regimens. Constant improvement of available techniques (e. g., molecular methods) and introduction of novel methods (e. g., matrix-assisted laser desorption ionization time-of-flight [MALDI–ToF] mass spectrometry) have fundamentally changed diagnostic procedures. As a consequence, sensitivity and specificity as well as time-to-report have been dramatically improved. In this manuscript, key methodological advances in medical microbiology are discussed, emphasizing consequences for daily management of infectious disease patients.

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Authors and Affiliations

  1. Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland

    F. P. Maurer &  H. Rohde

  2. Antibiotic Stewardship Team, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland

    F. P. Maurer

  3. MVZ Labor Dr. Fenner und Kollegen, Bergstraße 14, 20095, Hamburg, Deutschland

    M. Hentschke

Authors
  1. F. P. Maurer
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  2. M. Hentschke
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  3. H. Rohde
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Correspondence to H. Rohde.

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Interessenkonflikt

F. P. Maurer, M. Hentschke und H. Rohde geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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T. Welte, Hannover, K.-F. Bodmann, Eberswalde

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Maurer, F.P., Hentschke, M. & Rohde, H. Neue mikrobiologische Diagnostikverfahren. Med Klin Intensivmed Notfmed 112, 199–205 (2017). https://doi.org/10.1007/s00063-017-0275-z

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  • DOI: https://doi.org/10.1007/s00063-017-0275-z

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