Development of Clinical Microbiology

Clinical microbiology examines the relationship between macro- and microorganisms under pathological circumstances. It focuses on isolating and detecting infectious organisms' features. They can then be monitored and treated in patients.

FREMONT, CA: In an era in which drug-resistant bacteria are emerging and mutating, clinical microbiology is more critical than ever. Detecting infectious germs is crucial for developing new medicines, as these bacteria complicate drug therapy.

In the past, the clinical microbiology laboratory used traditional culture methods, agar plates, and single-tubed biochemicals to identify bacteria and conventional cell culture to cultivate viruses. It was necessary to conduct intensive antibiotic susceptibility testing based on disc diffusion and broth dilution to distinguish susceptible strains of bacteria from resistant strains. Results were seldom available promptly due to the time required for testing, which hindered clinical decision-making.

Microbiology laboratories have undergone significant changes in recent years. Today's clinical microbiology laboratory is dramatically different from those of the 1920s and 1930s due to ingenuity and invention. Automation and molecular diagnostic techniques have revolutionized the sector, yet conventional culture techniques and antimicrobial susceptibility tests remain mainstays. The introduction of "complete laboratory automation" allows clinical microbiologists to cut specimen processing time, increase culture consistency, and shorten turnaround time. Automated specimen processing standardizes plating and streaking. Digital imaging systems fitted to "smart incubators" can collect photographs of plates at predetermined intervals to reduce interruptions during incubation. These photos can then be utilized for further cultural development. Automated colony recognition software (artificial intelligence) can also improve cultural interpretation.

Identification of organisms and susceptibility tests has also evolved. "Rapid" enzymatic assays have replaced the usage of biochemicals in a single tube. Creating smaller multitest media and kits marked significant progress in organism identification. Automated instruments have been developed for phenotypic antimicrobial susceptibility testing and organism identification by utilizing this miniaturization process, which allows technicians to perform tasks previously performed manually by technical personnel and reduces the time, required acquiring results. MALDI-TOF (matrix-assisted laser desorption ionization-time of flight) mass spectrometry has improved the clinical microbiology laboratory's capacity to detect organisms.Other commercial manual and automated phenotypic identification technologies are substantially slower and offer less accurate, less cost-effective organism identifications.

In turn, this expedites patient diagnosis and eventually improves health treatment.

In clinical microbiology, molecular techniques have significantly shifted the paradigm from conventional laboratory methods that rely on phenotypic expression to molecular methods for rapid identification of infectious agents. However, automation has dramatically affected how clinical microbiologists can contribute to patient care in the past few years. It all began with the discovery of DNA by Watson, Crick, and colleagues. It only gathered momentum with Kary Mullis' introduction of polymerase chain reaction (PCR), a technology that can rapidly create many copies of a DNA sequence.

Molecule techniques have revolutionized infectious disease diagnosis and evolution since the discovery of PCR. Initial PCR tests could detect and identify specific species, but they were extremely labor intensive and could only be conducted by people proficient in molecular procedures. New automated, sample-to-answer testing systems and nucleic acid amplification technologies may now generate speedy results for many organisms causing the infection through syndromic panels with minimal test setup. These systems are simple to use and decrease in price. Some tests can even be performed at the point of care by clinical microbiologists with adequate training. This has led to the ability to diagnose infections of previously undetected and difficult-to-detect pathogens in real-time, influencing patient care decisions. This technique was crucial to the clinical microbiology laboratory's ability to respond to SARS-CoV-2 testing needs. In addition, molecular approaches allow for the discovery of numerous antibiotic resistance genes, providing critical information for therapy decisions more quickly than conventional antimicrobial susceptibility testing.

The clinical microbiology laboratory will continue to develop and is prepared to meet the challenges of the twenty-first century. In the clinical microbiology laboratory, next-generation sequencing and whole genome sequencing as a reliable and helpful method for organism identification, detection of resistance genes, and detection of organisms in clinical specimens will undoubtedly increase.

Microbiologists and other laboratory specialists have been integral healthcare team members since the beginning of the 20th century. Clinical microbiology laboratories and laboratory workers play a vital role in patient care as a result of the recent pandemic. Microbiologists must maintain an open line of communication with clinical colleagues to stress our importance to the patient care team to remain at the forefront of innovation.