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Infectious Diseases Q3 2021

The future for precision medicine and clinical microbiology

iStock / Getty Images Plus / Kkolosov

Maurizio Sanguinetti

President, ESCMID

By translating basic biological knowledge to medical insights, precision medicine aims to  treat each patient as a single entity.

Precision medicine enters into a close union with personalised medicine to identify a patient’s biological alteration. Recent evidence show that precision medicine and personalised medicine may be applied to clinical microbiology.

A breakthrough advancement in molecular diagnostics has consisted in the development of “clinical syndrome-specific” panels designed to assist the diagnosis of bloodstream, respiratory, gastrointestinal and central nervous system infections, which detect pathogens directly from clinical samples. 

Such panels represent a paradigm shift in both clinical microbiology and clinical practice, as they allow a rapid turnaround time while offering a broad spectrum of identifiable microorganisms, which potentially improves patient care. 

Modern medicine has to increase its efforts towards a diagnosis and/or treatment adapted to the single individual. 

Establishing precision therapy 

Failure to detect the causative agent due to the use of insensitive methods is known to delay the initiation of appropriate treatment, which impacts the potential spread of the disease in the community. 

For example, sepsis-associated bloodstream infections are a major cause of mortality in hospitalised patients, with increasing hospitalisations for severe sepsis in chronic and/or immunocompromised individuals. 

In sepsis, symptoms and tissue/organ damage are generally due to an inadequate host response to the infection, whereas proper functioning of the immune system depends on the right balance between pro and anti-inflammatory responses. 

Recognising the phase in which the patient currently is, would allow to establish a precision therapy that counteracts the inflammatory response imbalance. In turn, this would amplify the efficacy of antibiotic therapy directed to the infecting microorganism. 

How precision medicine effects microbiota

Precision medicine in clinical microbiology can have its effects even regarding the human microbiota. Culture methods are the fulcrum of clinical microbiology being able to provide valuable information on both the phenotype and the genotype of individual microorganisms. 

However, these methods are not convenient or reliable for studying body sites inhabited with hundreds or thousands of microbial species. Fortunately, for diagnostic purposes, a consensus about normality, unless there is a “signature” or “fingerprint” that can be associated with a given disease, is not essential.

The future for precision medicine

Here, we presented non-exhaustive examples of precision medicine in clinical microbiology to personalise the diagnosis of infectious diseases and with it the treatment of infected patients. Modern medicine has to increase its efforts towards a diagnosis and/or treatment adapted to the single individual. 

To date, new diagnostic or therapeutic precision paradigms, including the use of syndromic-centred diagnoses and antimicrobial therapies, hold the promise to maintain human health. In the future, collaboration between academic laboratories and pharmaceutical companies will be helpful to overcome the challenges of precision medicine tool development.

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