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Chapter 22 : Future Trends in Diagnosis of Infections in the Immunocompromised Population
Category: Clinical Microbiology
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The focused and unique health care management of the immunocompromised patient has grown significantly over the last several decades. Biomarkers of the immune response, such as procalcitonin (PCT), are evolving in clinical utility for the diagnosis of severe bacterial infections such as sepsis, for prediction of sepsis complications, and for therapeutic follow-up. Microbial and fungal infections are among the most common causes of high morbidity and mortality in critically ill patients in the United States; mortality rates can exceed 80%. Several molecular platforms are slated to play a role in advancing the diagnostic capabilities of clinical laboratories. Only time, cost-benefit studies, and practical evidence-based reviews can reveal the ultimate utility of these methods for diagnosis of infections in the immunocompromised population. Rapid testing for genetic resistance markers is an emerging clinical practice that can not only identify the potential for drug resistance but also help distinguish ambiguous breakpoints associated with susceptibility testing. Biomarkers of the immune response, such as PCT, are useful for the diagnosis of severe bacterial infections such as sepsis, for prediction of sepsis complications, and for therapeutic follow-up. Immunocompromised patients are a unique population, for which extreme measures may be required to make relevant diagnoses, prevent infection, or prevent overuse of health care resources.