Physicians ID Gaps in Infectious Disease Testing
Despite the deployment of new technologies, physicians report unmet diagnostic needs in the field of infectious disease, according to a study published in the January issue of Diagnostic Microbiology and Infectious Disease. Surveyed physicians specifically say there is a need for improved tests to identify drug-resistant organisms, while acknowledging that emerging high-complexity testing must be […]
Despite the deployment of new technologies, physicians report unmet diagnostic needs in the field of infectious disease, according to a study published in the January issue of Diagnostic Microbiology and Infectious Disease. Surveyed physicians specifically say there is a need for improved tests to identify drug-resistant organisms, while acknowledging that emerging high-complexity testing must be judiciously used. Microbiology laboratories are undergoing rapid transformation with the employment of new diagnostic technologies, including broad-range polymerase chain reaction (PCR), next-generation sequencing, and matrix-assisted laser desorption/ionization time of flight mass spectrometry. However, even with these advancements in diagnostic methods, notable gaps remain in test development for rapid, point-of-care tests, those using direct from specimen analysis, and the ability to maintain high levels of accuracy across a wide range of disease syndromes. Researchers surveyed infectious disease physicians who were members of the Emerging Infections Network to evaluate perceptions of “unmet” needs (defined as either testing not available in the respondent's clinical practice or situations when test results are not available in a clinically meaningful timeframe). In addition to ranking unmet needs related to certain syndromes (central nervous system infection, community-acquired pneumonia, febrile neutropenia, infectious diarrhea, culture-negative endocarditis) and six pathogens (drug resistant gram-negative bacilli, methicillin-resistant Staphylococcus aureus, drug-resistant Mycobacterium tuberculosis, molds, influenza, and HIV resistance), respondents were questioned about the impact of antimicrobial resistance identification, test performance, and complexity of interpretation of test results. Based on 700 responses, the most important pathogen-specific unmet diagnostic need was the prompt identification of drug-resistant aerobic gram-negative bacilli (mean score, 4.33 out of 5). Culture-negative endocarditis was the clinical syndrome ranked most highly as in need of improved diagnostics, followed closely by infectious diarrhea. Other syndromes identified as needing improved diagnostics included osteomyelitis/septic arthritis, prosthetic joint infections/orthopedic hardware infections, and hospital- or ventilator-associated pneumonia. Topping physicians' wish lists for a new test not currently available were a pathogen-based test for respiratory infection (lower and upper respiratory tract); one that could distinguish viral from bacterial infection; and a test for antibiotic resistant organisms, including aerobic-gram negative bacilli and staphylococci. "In several cases, tests ranked highly as ‘unmet’ needs (for example, rapid resistance testing for staphylococci, testing panel for infectious diarrhea) were actually commercially available or close to receiving [U.S.] Food and Drug Administration approval at the time the survey was given," writes lead author Anne Blaschke from University of Utah, Salt Lake City. "Lack of availability may be due to the complexity of the testing strategies, the economics of the laboratory, or the absence of outcome data that could be used to support adoption of new tests." Recognizing the increased cost and complexity associated with new diagnostic technologies, roughly two-thirds of respondents felt that some testing is becoming too difficult for non-infectious disease physicians, and 79 percent report the need for stewardship for particularly complicated or expensive tests. Multiplex molecular respiratory panels, broad-range PCR testing, and antigen-based tests for fungal infection were selected as tests that should be restricted or require prior approval.