Improved Outcomes Via Integrated Molecular Diagnostics and Biofilm Targeted Therapeutics

Abstract

Molecular diagnostics are validated clinical tools available today for most all clinicians. Given the expanded microbial census they elucidate with DNA-level certainty, a new microbial reality has emerged making interpretation pivotal to advancing outcomes. Regarding chronic infection, there is little consensus for interpretation, even from traditional culture. To advance outcomes, the authors propose an escalating chronic infection protocol leveraging multiple concurrent strategies. A pivotal aspect, directing multiple legs of the protocol, is the diagnostic objectivity and accuracy of molecular diagnostics.

Using the combination of polymerase chain reaction and pyrosequencing (PCR:PSEQ) applied to chronic wounds, clinical outcomes are highlighted in a chronic infection example. Absolute healing rates for microbial DNA guided topical treatments including antibiotics and antibiofilm agents were approximately twice that of culture directed therapy (p<0.001). Further, median days to closure were 177 days for culture directed therapy versus 28days for microbial DNA guided topical treatments (p<0.001).

Absent of cultivation biases and limitations, PCR:PSEQ accurately identifies all known bacteria, yeast, and fungi. While the utility of PCR:PSEQ has become relatively established for chronic wounds, the use of these methods for any chronic infection is warranted whenever the comprehensive microbial contribution is clinically relevant to interventional strategy.