Toward Rapid Sepsis Diagnosis and Patient Stratification: What's New From Microbiology and Omics Science

Abstract

Early etiological diagnosis and characterization of host response to infection are becoming central in sepsis recognition and management. Still, limitations in conventional diagnosis and patient stratification contribute to the high mortality rates among septic patients, despite new antimicrobials and resuscitation agents. Novel microbiological techniques and omics analyses have led to the development of several tests that are now commercially available or in the pipeline as rapid diagnostic tools. We first reviewed emerging assays for the etiological diagnosis of sepsis starting directly from whole blood, assays based on target-specific polymerase chain reaction or metagenomics. We then investigated results of different omics approaches for both bedside diagnosis of immune dysfunction and detection of patient "signatures" associated with different clinical outcomes or potential response to individualized therapies. Finally, we considered how these novel laboratory tools might be translated into clinical practice, noting that they perform best when integrated within antimicrobial stewardship programs.

Keywords: antimicrobial stewardship; bloodstream infection; host gene expression; metagenomics; point-of-care diagnostics; precision medicine.