An overview of point-of-care testing for infections in critically ill patients

ABSTRACT

Introduction

Molecular diagnostic systems for point-of-care (POC) testing are nowadays routinely used and are part of many labs. Although often intended for bedside use outside of the microbiology lab, there is still room for expansion.

Areas covered

This review discusses the two techniques that are currently the most widespread, real-time polymerase-chain reaction (RT-PCR) and loop-mediated isothermal amplification (LAMP). An overview is provided of the various manufacturers and products as well as the evidence and current use in clinical practice. The article further sheds light on some newer techniques, such as CRISPR-based diagnostics and lab-on-a-chip, which are still in development.

Expert opinion

With many new platforms and techniques still in the pipeline and their potential currently not yet fully exploited, we expect the use of molecular POC testing to increase in the years to come. However, even when used in hospital – in lab, the main advantages of the tests being fast and easy to perform already provide significant benefits in terms of patient outcome.

KEYWORDS:

• POC testing
• real-time polymerase chain reaction (RT-PCR)
• loop-mediated isothermal amplification (LAMP)
• CRISPR-based diagnostics
• lab-on-a-chip

Article highlights

• Rapid molecular tests are increasingly developed and should meet the WHO ASSURED criteria. This means they should be affordable, sensitive, specific, user-friendly, rapid and robust, equipment-free and deliverable to end-users.

• Diagnostic companies have developed rapid (multiplex) molecular panels in the previous years.

• Panel compositions are highly different between companies. Most applications are intended for respiratory samples.

• The main advantages of the rapid molecular panels may not be fully reached yet. Bed-side application is rather rare and the clinical impact on shorter and better targeted antimicrobial therapies needs to be further studied.

• With many new platforms and techniques still in the pipeline and their potential currently potential not yet fully exploited, the authors anticipate the increased use of molecular POC testing in the forthcoming years.

Declaration of interest

J De Waele has served as a consultant for Menarini, Merck Sharp and Dohme, Pfizer, ThermoFisher and Viatris (fees and honoraria paid to institution). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

J De Waele is supported by a Senior Clinical Research Grant from the Research Foundation, Flanders (FWO, Ref. 1881020N)