Effect of Culture-Independent Diagnostic Tests on Future Emerging Infections Program Surveillance - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC
Volume 21, Number 9—September 2015
Emerging Infections Program
Emerging Infections Program
Effect of Culture-Independent Diagnostic Tests on Future Emerging Infections Program Surveillance
The Centers for Disease Control and Prevention (CDC) Emerging Infections Program (EIP) network conducts population- and laboratory-based surveillance for foodborne, health care–associated, respiratory, and invasive bacterial pathogens of public health importance. The main objectives of surveillance are to 1) measure disease burden and monitor disease trends over time, 2) evaluate the impact of public health interventions, 3) track microbiological and molecular characteristics of pathogens, and 4) detect emerging infectious disease threats. EIP data are used for national projections of disease incidence and formulation of national public health policy for prevention and control of disease. Central to accomplishing these objectives is accurate laboratory detection of the pathogens under surveillance.
In the field of microbiology, culture remains the standard for detection of most organisms, but in clinical settings, detection of pathogens is increasingly reliant on culture-independent diagnostic tests (CIDTs). CIDTs include antigen-based tests and molecular tests. The most commonly used molecular tests are the nucleic acid amplification tests, which include PCR. In clinical settings, most CIDTs have several advantages over culture. Foremost, CIDT results can be obtained more rapidly than culture, a feature that can be critical for clinical decision-making. Additionally, CIDTs may require less technical expertise to perform. Although initial adoption of these newer technologies can be expensive, costs generally decline over time, particularly those associated with labor.
CIDTs have the potential to improve estimates of disease burden because 1) they may be more sensitive than culture, 2) their relative ease of use may increase the number of patients tested, 3) they may enable detection of organisms for which there are currently no practical laboratory tests, and 4) they may increase the ability to detect polymicrobial infections. However, incorporating CIDTs into public health surveillance presents several challenges. Interpreting trends in disease incidence can be difficult because of changes to testing practices and surveillance case definitions. Although also true for culture, detection of molecular material may not reflect the presence of a living microbe and true disease, especially when detected from nonsterile body sites. At least for now, it is generally more difficult to assess microbiological and molecular characteristics, such as pathogen subtypes and antimicrobial drug resistance and genotypes, without bacterial isolates. Addressing these and other factors that affect estimates of disease burden and the characterization of infectious pathogens is critical for public health surveillance systems and clinical decision-making. EIP sites have a long history of close collaboration between CDC, state and local public health departments, academia, and clinical laboratories, making them uniquely positioned to help chart the course in addressing these concerns. Because many infections are already being diagnosed by use of CIDTs and more CIDTs will probably be developed and used in the near future, a path for addressing these issues is urgently needed. This article provides an overview of current testing practices for pathogens under EIP surveillance and addresses how EIPs plan to advance their core objectives in the face of this dynamic diagnostic environment.
Dr. Langley is a medical epidemiologist in the Respiratory Diseases Branch at CDC and medical director of ABCs.
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Suggested citation for this article: Langley G, Besser J, Iwamoto M, Lessa FC, Cronquist A, Skoff TH, et al. Effect of culture-independent diagnostic tests on future Emerging Infections Program surveillance. Emerg Infect Dis. 2015 Sep [date cited]. http://dx.doi.org/10.3201/eid2109.150570