Culture-Independent Bacterial Population Analysis - Clinical Implications for Respiratory and Other Infections

Despite efforts to quell the rising tide of antimicrobial resistance, national trends show disturbing increases in the rate of resistance of clinically relevant microorganisms. The primary basis for this trend is inappropriate or insufficient antimicrobial treatment, which is often due to a lack of rapid diagnostic tools and dependence on time-consuming culturebased approaches for pathogen detection and resistance profiling. Microbial ecologists have long made use of cultureindependent methods to detect unculturable or difficult to culture organisms. More recently, these tools have become more sophisticated and have been applied to a variety of clinical disease and infection states, revealing considerably greater microbial community diversity than previously assumed. Initial reports have revealed that complex microbial communities exist in disparate sites of the body and that shifts in community composition correlate with states of health and disease. Administration of broad-spectrum antibiotics has a pronounced impact on microbial community composition and plays a significant role in the development of antibiotic-resistant organisms. Use of these novel culture-independent approaches has proven invaluable to improving our understanding of microbial community dynamics and presents an enormous potential for rapid diagnosis and temporal monitoring of antimicrobial efficacy. Application of such a technology in a clinical setting could lead to quicker, more accurate diagnosis resulting in a more appropriate therapeutic administration, thus reducing or possibly even reversing the current precipitous rise in antimicrobial resistance.