Future of Applied Microbiology in Critical Care

Sepsis is one of the most commonly encountered clinical entities in the intensive care unit. Despite that, the diagnosis and management of sepsis are challenging due to the lack of a clear and practical definition. In this chapter, we go over the hurdles of obtaining a positive diagnostic test in a suspected septic patient. Timely initiation and correct choice of antimicrobials are vital to reducing sepsis-related mortality. As such, the problem of culture-negative sepsis is highlighted with its potential consequences. This includes delays in the identification of organisms and their antimicrobial resistance patterns, prolonged antimicrobial therapy, longer hospital stays, and missing alternative diagnoses. The advances in the early detection of organisms and the detection of resistance/virulence patterns are summarized. These include matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry (MALDI-TOF MS) and Nucleic Acid Amplification Test (NAAT) technologies with several subtypes and applications in the fields of bacteriology, mycology, virology, and mycobacterial. While these new technologies are promising with earlier detection time and high diagnostic accuracy, more research is needed to further define their exact role and utility in the diagnosis and management of sepsis in critically ill patients.