From the Research
Performing Antibiotic Resistance (ABR) PCR testing for bacterial infections requires adherence to specific steps and College of American Pathologists (CAP) requirements, with the most critical aspect being the implementation of a comprehensive quality management system, as highlighted in recent studies 1. The process begins with proper specimen collection, ensuring appropriate sample types are obtained based on the suspected infection site.
- Specimens must be transported to the laboratory under conditions that maintain sample integrity, typically at 2-8°C if testing cannot be performed immediately.
- Sample preparation involves extraction of bacterial DNA using validated methods, followed by PCR amplification targeting specific antibiotic resistance genes. The CAP requires laboratories to implement a comprehensive quality management system, including:
- Regular proficiency testing
- Proper documentation of procedures
- Validation of all testing methods before clinical implementation
- Equipment calibration and maintenance must be performed regularly and documented Internal quality controls must be included with each test run, including positive and negative controls to ensure test validity.
- The laboratory must establish reference ranges and interpretive criteria for each resistance marker tested.
- Personnel performing the testing must be properly trained and competent, with documentation of their qualifications. Result reporting should include clear interpretation of detected resistance markers and their clinical significance.
- The laboratory must participate in CAP proficiency testing programs specific to molecular microbiology and maintain records of performance, as emphasized in studies such as 2 and 1. This structured approach ensures accurate detection of antibiotic resistance genes, allowing clinicians to make informed decisions about appropriate antimicrobial therapy, ultimately improving patient outcomes by enabling targeted treatment of resistant infections. Key considerations in ABR PCR testing include the focus on detecting pathogens or resistance determinants not covered by guideline-recommended treatment regimens, as discussed in 1, and the potential for PCR-based diagnostics to supplement but not replace blood culture, as noted in 2 and 1.