Pathogen nucleic acid detection exhibits faster turnaround times and higher sensitivity compared with blood culture. When antibiotics are present, blood cultures experience higher false-negative rates. In contrast, nucleic acid tests may detect pathogens irrespective of antimicrobial therapy. Thus, future point-of-care nucleic acid-based detection devices could play a role in revolutionizing pathogen detection in critically ill patients. To properly optimize clinical use, pathogen nucleic acid tests should have the capacity to quantitate pathogen DNA, be miniaturized with simplified preanalytical and postanalytical processing components, and reduce net operating costs or provide clear-cut clinical outcome benefits. These 3 elements will foster a new generation of nucleic acid tests for use at the point of need and facilitate a paradigm shift to point-of-care pathogen detection with evidence-based treatment and real-time quantitative monitoring of patients with sepsis.
Keywords: analytical sensitivity; blood culture; cost-effectiveness; loop-mediated isothermal amplification; low resource; point of care; polymerase chain reaction; quantitative nucleic acid testing.