Microbiology in particular is reliant upon technological developments, from humble beginnings with the optical microscope and staining techniques to modern fluorescent, atomic force and electron microscopes, and whole-genome sequencing.

Clinical microbiology stands at the threshold of a diagnostic revolution. Consumables have been the mainstay of microbiology laboratories for the past century and will likely remain so for decades to come. With improved good manufacturing practice facilities being set up globally, microbiological testing of a product, environment, and equipment has become obligatory. Therefore, usage of microbiology consumables has increased. This has opened new avenues for the microbiology culture market. Switching consumables suppliers becomes difficult for established market players due to the need for validated products and procedures for testing. The market has grown significantly in the last few decades in terms of demand in various end-user industries. Academia, clinical research organizations, and commercial end-user industries such as pharmaceutical, cosmetics, and food and beverage are providing impetus to the microbiology consumables market.

Owing to current pressures and its manual nature, clinical microbiology is experiencing unprecedented changes and evolving at a rapid pace. Fusing innovative technologies with practice is critical in the evolution of clinical diagnostics. Microbiologists will begin to derive ensuing benefits from improved efficiency of laboratory workflow, expedited generation of results, and enhanced characterization of microbial isolates as the clinical microbiology laboratory becomes more automated, more digital, and more reliant on informatics tools.

Technological Developments

Technological advancement has never been faster than it is currently; there are now more companies employing more staff and making use of more information than there have ever been previously.

The innovations in automation have enabled the shift of testing from centralized laboratories to settings closer to the patient, such as hospital labs. The next transformation in molecular testing, allowing for pathogen detection and identification is the point-of-care testing (POCT). As diagnostic testing has advanced, access to rapid, reliable POCT for the diagnosis of infectious diseases became essential in support of initial diagnosis, defining antimicrobial/antiviral administration, and narrowing evolving clinical differentials. The advent of new technologies, such as mass spectrometry, liquid transport media, molecular techniques, and automated identification and susceptibility systems, has begun to simplify and allow for much greater standardization of the microbiology laboratory.

Automated instruments. New technologies combined with high-resolution digital imaging and robotics have allowed microbiology to accomplish the impossible, i.e., to become automated. Automated chemistry laboratories dependent on robotic processes are the standard in both academic and large community hospital settings. Diagnostic microbiology manufacturers are betting that robotics will be used for specimen processing, plate reading, and organism identification in the near future. They are touted as being more efficient, rapid, and accurate than standard processes. Certain features, such as image collection, are highly innovative. They need fewer skilled workers, higher throughput, and greater efficiency.

Liquid-based microbiology. The liquid-based microbiology line brings previously challenging specimens into liquid format in ready-to-use standard-size plastic containers, optimal for automation in microbiology. This standardization helps to streamline specimen processing, allowing busy laboratories the ability to automate upfront processing and offer expanded testing capabilities.

Next-generation sequencing (NGS). The advent of next-generation sequencing methods has clearly increased the pace with which one can get genome sequences from all possible sources. The high-throughput feature of NGS enables the recovery of pathogen genomes from non-cultured samples, and offers the potential for highly accurate pathogen identification and rapid clinical diagnoses. The ability to obtain affordable sequence data has aided NGS technology to expand not only in the large research centers but also into many smaller labs. Next-generation lateral flow immunoassays incorporating digital output of results have entered the market, with reports of enhanced sensitivity and specificity for influenza and group A streptococcus.

Tissue microarray. The tissue microarray format provides opportunities for digital imaging acquisition, image processing, and database integration. Advances in digital imaging help to alleviate previous bottlenecks in the research pipeline, permit computer image scoring, and convey telepathology opportunities for remote image analysis. The tissue microarray industry now includes public and private sectors with varying degrees of research utility and offers a range of potential tissue microarray applications in basic research, prognostic oncology, and drug discovery.

Spatial-temporal transformation. A method of spatial-temporal transformation to provide flow cytometers with cell-imaging capabilities is being developed. The method uses mathematical algorithms and a spatial filter as the only hardware needed to give flow cytometers imaging capabilities. Instead of CCDs or megapixel cameras found in imaging systems, one can obtain high-quality image of fast-moving cells in a flow cytometer using PMT detectors, thus obtaining high throughput in manners fully compatible with existing cytometers

Digital records and remote image sharing. Full laboratory automation and digital microbiology are trending topics high on a lot of laboratories' list. Bringing the laboratory to the patient's bedside is an important benefit of digital microbiology. With laboratory consolidation, often the laboratory is no longer close to the patient's bedside. If a physician wants to go to the laboratory for consultation and to discuss a result, it is no longer possible to walk down the hall and speak to microbiology personnel.

Digital microbiology allows the laboratory to share the image of a culture plate and/or of the Gram stain with the physician, who may be in a remote location. This is a practice currently used in some European laboratories that have adopted full lab automation of the microbiology laboratory. Laboratory personnel can provide key patient information and consultation to clinicians faster to expedite patient treatment and improve care.

Road Ahead

In the coming year, some areas of clinical testing may be more likely than others to benefit from advances in lab automation systems. The microbiology laboratory has lagged behind the rest of the industry in terms of automation. The fully automated molecular platforms that are emerging into the marketplace will be the game changers in terms of acceptance of molecular methods in many laboratories.

Technologies will continue to evolve, allowing faster, more sensitive, and less expensive methods for pathogen surveillance and discovery. Increasing usage of point-of-care testing and personalized medicine, a new range of condition-specific markers and tests with advances in genomics and proteomics, and increasing investment in emerging countries are creating new opportunities.

Despite technological advances in research laboratories, translation of these advances into clinical microbiology laboratories has been few. In order to keep pace with the advances and the increasing resistance, the thrust of every microbiology laboratory would be on how best one can deliver a rapid result. The future of rapid diagnosis would be to look at a syndromic approach and tailor the tests accordingly. Improving the diagnostic accuracy of tests should be a goal of the manufacturers and education of personnel on the use and interpretation of these tests must be in the domain of microbiologists.

10 Diagnostic Imaging Trends for 2018



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