SEPTEMBER 2024LIFE SCIENCES REVIEW8IN MY OPINIONIN MY OPINIONUPOINT-OF-CARE TESTING FOR INFECTIOUS DISEASES ­ NOW AND IN THE NEAR FUTUREBy Gorm Lisby, Section Chief, Department of Clinical Microbiology, Amager og Hvidovre Hospitalntil recently, reliable testing for an acute infection by molecular methods required the patient to be seen by a physician, sampled and the sample to be sent to a microbiology laboratory for testing with a typical total turn-around time to result of more than 24 hours. If a faster result was requested, immunology-based lateral flow near patient testing with results within minutes was an option for some infections, such as Influenza and RSV. However, this came at the cost of inferior sensitivity and specificity compared to molecular-based testing, as highlighted during the COVID-19 pandemic. We are now facing the most disruptive paradigm shift since the dawn of clinical microbiology--moving rapid molecular testing out of the controlled environment of the diagnostic laboratory and close to the patient--the so-called "Point-of-Care" (PoC) diagnostics. This has been made possible by development of a new generation of molecular diagnostic tests that are easy to use, have performance equal to gold standard laboratory-based molecular tests and will provide a result in less than 30 minutes. The current PoC tests still require sample processing on an analytical instrument by a trained healthcare individual, but in the near future, a swab may be analyzed directly by the patient on a single-use cartridge powered by e.g., a cellphone battery. The impact on clinical patient management, patient awareness and antibiotic stewardship is not yet fully understood, but the potential is huge but not yet fulfilled. Better use of institutional contact isolation facilities and reduced use of antibiotics has been documented, and increased patient understanding and awareness may improve antibiotic stewardship even further. The relatively high initial cost per assay as well as the lack of prospective Gorm Lisby
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