b'How should molecular laboratories approach choicesHow has COVID-19 affected how we think about about syndromic testing versus more targetedsyndromic testing?molecular testing? Its allowed us to move forward with home testing, which I think a big part is going to be the patient population and whatwasnt really a thing before COVID-19. COVID-19 has a unique their needs are. We also need to factor in available staffing.presentation, where patients can be asymptomatic or severely ill. Laboratories at many community hospitals often dont reallyUsually for other viruses, youre going to be symptomatic.have the staff to perform high complexity PCR testing. Instead,But COVID-19 has allowed us to think outside the box when syndromic testing allows them to offer more complete molecularit comes to testing. Just consider saliva testing, which is not testing, where they may not have capability otherwise. something you would normally think about as a matrix for In our laboratory, we have the capacity and infrastructure torespiratory infections. But we have found with COVID-19 that it perform moderately complexed syndromic testing as well as highactually works quite well.complexity molecular tests. We therefore decide which test to use based on the needs of the patient population, workflow, andWhat else do you want our readers to know on how a particular test would be implemented as part of a routinethis topic?workup in our lab. I think its important to emphasize that syndromic testing must For example, lets look at the meningitis panel. We felt it wasbe part of a multidisciplinary approach. That means relying on important enoughand such a critical disease that affects ourlaboratory experts to guide both utilization and interpretation of pediatric patient populationthat we implemented the syndromicresults. Because these test systems are so easy to use, that can panel at a 24/7 approach. Thats better for our pediatric patienteasily forgotten or underestimated.population than waiting for single-target PCR that would take aIts critical we have these laboratory experts guiding clinicians in couple of days to get back. the nuances of how we can best use this technology. As we get into more highly complicated types of molecular testing, thats What do you think well see in the future when it comesgoing to be even more critical.to syndromic testing?There likely will be more syndromic testing for other conditionspossibly urinary tract infections, maybe pharyngitis causing bacteria and viruses.I can also see increased testing in communities as more of a point-of-care type of approach. You could get a panel doneReferences right at a physicians office, which could stop a provider from1. Miller MB. Opinion on syndromic panel-based testing in clinical microbiology. Clin Chem 2020;66:42-4.prescribing an antibiotic for a viral illness. However, this is also2. Bard JD and McElvania E. Panels and syndromic testing in clinical microbiology. where emphasis on diagnostic stewardship would be critical. Clin Lab Med 2020;40:393-420.Jennifer Dien Bard, PhD, D(ABMM), F(CCM)Dr. Jennifer Dien Bard directs the Clinical Microbiology and Virology Laboratory at Childrens Hospital Los Angeles. Her research interests include the development of novel, non-culturebased methods (e.g., molecular techniques) to improve the detection of microbiological agents associated with infections, as well as improving the detection and exploration of emerging mechanisms of antimicrobial resistance and the development of improved susceptibility testing for bacterial and fungal agents.19 Molecular testing thermofisher.com/infectiousdisease Contents'