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• W2997447560 abstract "Mobile microbiology is a globally evolving concept with potential to reduce the morbidity and mortality associated with infectious diseases [[1]Cohen-Bacrie S. Ninove L. Nougairede A. Charrel R. Richet H. Minodier P. et al.Revolutionizing clinical microbiology laboratory organization in hospitals with in situ point-of-care.PLoS One. 2011; 6e22403Crossref PubMed Scopus (60) Google Scholar]. This CMI edition issues a collection of four narrative reviews that offer insights into recent achievements providing short- and long-term future perspectives of different approaches with the aim to achieve reliable and rapid near-to-patient or point-of-care (POC) microbiological diagnostics using mobile microbiological laboratories. So far, the use of molecular methods in the context of mobile microbiology has focused on diagnosing emerging viral infections, allowing early implementation of disease control measurements and timely initiation of clinical care. However, only limited attention has been paid to the diagnosis of other infectious diseases. The first review in this CMI issue [[2]Židovec Lepej S. Poljak M. Portable molecular diagnostic instruments in microbiology: current status.Clin Microbiol Infect. 2020; 26: 411-420Abstract Full Text Full Text PDF Scopus (11) Google Scholar] discusses the suitability of eight portable diagnostic molecular instruments—commercially available or in the launching stage—that were evaluated in the context of a mobile microbiology concept. Technical feature analysis, environmental requirements and results of major validation studies of eight portable instruments show potential for mobile microbiology applications for various patients and settings, ranging from primary care to emergency care in tertiary centres. Particularly encouraging is that several instruments are suitable for extreme environmental conditions. Further developments should provide a broader range of assays per instrument, multiplexing, reducing the frequency of invalid results and price-cutting. Smartphones are mobile phones that perform many of the functions of a computer and usually have touchscreen interfaces, internet access and operating systems. About 80% of the world population will use smartphones by 2020 [[3]Koydemir H.C. Ozcan A. Mobile phones create new opportunities for microbiology research and clinical applications.Future Microbiol. 2017; 12: 641-644Crossref PubMed Scopus (13) Google Scholar], offering an ideal interface for different portable medical instruments. The second review in this CMI issue [[4]Ong D.S.Y. Poljak M. Smartphones as mobile microbiological laboratories.Clin Microbiol Infect. 2020; 26: 421-424Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar] discusses smartphone use as instrumental interfaces, dongles, microscopes, test result readers (bright-field, colorimetric and fluorescence measurements) and distinct portable POC platforms when combined with amplification methods, such as loop-mediated isothermal amplification. Due to wireless connectivity, smartphones may facilitate epidemiological studies to create spatiotemporal disease prevalence maps. The current analytical performance of most smartphone-based POC tests is not optimal. Careful validations comparing performance with established diagnostic standards in clinical settings are required to improve smartphone-based POC tests further. Despite the current shortcomings, further progress will foster worldwide implementation of smartphone-based POC platforms and tests as mobile microbiological laboratories in the near future. Drones are autonomous or remotely controlled multipurpose aerial vehicles driven by aerodynamic forces capable of carrying a payload. In a decade, the use of drones gradually spread from initially exclusive military use into other areas, including various health-care settings [[5]Rosser Jr., J.C. Vignesh V. Terwilliger B.A. Parker B.C. Surgical and medical applications of drones: a comprehensive review.JSLS. 2018; 22 (00018)e2018Crossref PubMed Scopus (102) Google Scholar]. The third review in this CMI issue [[6]Poljak M. Šterbenc A. Use of drones in clinical microbiology and infectious diseases: current status, challenges and barriers.Clin Microbiol Infect. 2020; 26: 425-430Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar] reviews the literature evaluating various pilot programmes of real-life drone implementation in several settings, such as transporting samples, blood, vaccines, medicines, organs, life-saving medical supplies and equipment. A promising proof-of-concept ‘lab-on-a-drone’ [[7]Priye A. Wong S. Bi Y. Carpio M. Chang J. Coen M. et al.Lab-on-a-drone: toward pinpoint deployment of smartphone-enabled nucleic acid–based diagnostics for mobile health care.Anal Chem. 2016; 88: 4651-4660Crossref PubMed Scopus (116) Google Scholar] is briefly described, as well as several pilot studies showing the benefits of drone use in surveillance and epidemiology of infectious diseases. Drones have a vast potential in clinical microbiology, infectious diseases and epidemiology, and will soon significantly reshape various areas of diagnostic microbiology as well as medicine in general. However, national airspace legislation, legal medical issues, topography and climate differences, cost-effectiveness, community attitudes and cultural acceptance currently impede widespread drone use. The last and probably most controversial approach in the mobile microbiology laboratory landscape, summarized in the fourth review in this CMI issue [[8]Cambau E. Poljak M. Sniffing animals as a diagnostic tool in infectious diseases.Clin Microbiol Infect. 2020; 26: 431-435Abstract Full Text Full Text PDF Scopus (16) Google Scholar], is the use of sniffing animals as a diagnostic tool in infectious diseases. Dogs reliably detect stool associated with toxigenic Clostridioides difficile. Additionally, dogs showed high sensitivity and moderate specificity to detect urinary tract infections in comparison with culture-based methods, especially for Escherichia coli. In several studies, African giant pouched rats showed superiority in the diagnosis of tuberculosis to microscopy, but inferiority to culture/molecular methods. In three African countries, trained rats screened, in addition to standard methods, from 2007 to 2018, more than 550 000 sputum samples, detecting over 14 000 individuals with tuberculosis. Several malaria detection approaches have been successfully explored, analysing host skin odour or exhaled breath. Although the results of some sniffing animal studies and real-life experience are fascinating, lack of reproducibility as well as cost of animal training and housing are the major drawbacks for a wider implementation in the field of infectious diseases. The ultimate goal is to understand the biological background of this animal ability and to characterize the specific volatile organic compounds that animals are recognizing. Subsequently, spectrometry, metabolomics or other analytical approaches could analyse these compounds. Volatile organic compound identification, improvement of odour sampling methods and POC instrument development could allow scent-based test implementations for major human pathogens in the near future. In conclusion, current clinical microbiology practice desperately needs creative solutions. A collection of four narrative reviews discussing several aspects of mobile microbiology concepts in the light of today's evidence, proposing solutions and providing future perspectives is available to CMI readers. Further progress will foster the widespread implementation of mobile microbiological laboratories in remote areas, and in both resource-limited and resource-rich settings in the near future despite remaining challenges. Clinical microbiologists, as experts to bridge laboratory and clinical practice in infectious diseases, should be endorsed to take a leading role in validation, consideration, implementation and quality control, and mobile microbiological laboratory use. The authors have no conflict of interest to disclose." @default.
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