b'Do you see any advances in testing on the horizon,Whats next for clinical laboratorians when it comes or do you expect to see more innovation on theto antimicrobial resistance?engineering side? More people in medicine are now aware of the laboratorys Its hard to say. I never would discount the idea that some brilliantcontribution, which helps. It used to be that the laboratory person will come up with something really clever. But for at leastwould go to the administration to ask for support every time it the last 15 years, its been incremental advances along the samesaw an opportunity to implement a new technology or program lines, and I expect that to continue for the next 5 to 10 years. that could positively impact patient care. Now, through our I do think that whole genome sequencing and next-generationantimicrobial stewardship program, its a group effort. In fact, it is sequencing will potentially give us new tools, and well probablysometimes a pull from the clinical side rather than a push from see some of that make its way into mainstream laboratories.the laboratory.Its not standard of care in most places right now. But beingTechnology advances are a good thing, but then the able to understand and sequence an organisms entire genome,interpretation gets a little bit more difficult. For next-generation and use that to predict its antibiotic susceptibility, could besequencing, for example, it might be like in traditional molecular enormously powerful. diagnostics, where the laboratory director or an attending The question is, can we get results quickly enough? And ispathologist reviews results as they go out. These results are understanding the genetic makeup of an organism going to allowcomplex and need to be explained.laboratories to reliably predict its in vitro susceptibility profile andIts possible that this will extend to microbiology as well, as be useful for patient care? For some organisms, it works great.we see more complex data coming out related to individual For others, its a little less predictive. organisms. Because when we start to get more of this data, it will likely need to be interpreted in a way that is similar to complex genetic tests.References1. Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis [published correction appears in Lancet. 2022 Oct 1;400(10358):1102]. Lancet. 2022;399(10325):629-655. doi:10.1016/S0140-6736(21)02724-02. Centers for Disease Control and Prevention (2019) Antibiotic resistance threats in the United States, 2019. doi:10.15620/cdc:825323. Nelson RE, Hatfield KM, Wolford H, et al. National estimates of healthcare costs associated with multidrug-resistant bacterial infections among hospitalized patients in the United States. Clin Infect Dis. 2021;72(Suppl 1):S17-S26. doi:10.1093/cid/ciaa1581Thomas Kirn, MD, PhDDr. Thomas Kirn is a professor in the Department of Pathology and Laboratory Medicine at the Robert Wood Johnson Medical School at Rutgers University. His general research focuses on microbial pathogenesis and molecular techniques for infectious disease diagnostics. Current studies include investigation of a novel, rapid method for identification of S. aureus in positive blood cultures, and the elucidation of the molecular mechanisms that contribute to C. difficile pathogenesis.22 Molecular testing thermofisher.com/infectiousdisease Contents'