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New technologies in microbiology and their potential impact on paediatric practice
  1. Manjusha Narayanan
  1. Department of Microbiology, Infection Prevention and Control, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK
  1. Correspondence to Dr Manjusha Narayanan, Consultant Microbiologist, Department of Microbiology, Infection prevention and control, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK; manjusha.narayanan{at}nuth.nhs.uk

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Introduction

Reliable microbiological diagnosis of infections for almost 50–60 years has been limited to culture of clinical specimens for bacteria, fungi, virus, microscopy for parasites and on rare occasion cultivation of parasites. Rapid methods that do not use culture, cultivation or serological processes have gained popularity in the last decade because they are believed to expedite infection diagnoses. However, as with traditional methods, the diagnosis of infections solely based on any rapid laboratory tests without the combination of predefined clinical criteria can be very misleading,1 and their overuse can add to healthcare costs with potentially no significant impact on patient care.2

Diagnosis of bloodstream infection in neonates and children is challenging when the current blood culture (BC) positivity rate is between 30% and 40%, and median time to machine positivity around 15 hours. Final results from full identification and sensitivity tests can take up to 72 hours. Drawing a higher volume of blood to improve the positive pick-up rate can be difficult in young patient groups.3 Hence, it would make sense to have a short turnaround time (TAT) for microbiological results with improved laboratory methods for children presenting with sepsis.

Hospital attendances for medical paediatric emergency are usually from a handful of common presentations. The most appropriate method for reducing admission is not known and unbiased evidence with good methodological quality is lacking.4 In this context, confidently ruling out infection can be more important than confirming it.

New technologies that can provide rapid and reliable diagnosis for common infectious conditions could potentially have an overall impact on paediatric practice. For example, in the UK, around one in 11 children receives specialist outpatient care in hospital and around one in 10–15 is admitted for inpatient care every year. Twenty-six per cent of all those attending Accident &Emergency are children.

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