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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Schlattmann, Peter / Tate, Jillian R. / Tsongalis, Gregory J.

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Validation criteria for nucleic acid amplification techniques for bacterial infections

Gerd Döring1 / Klaus Unertl2 / Alexandra Heininger3

1Institut für Medizinische Mikrobiologie und Hygiene, Universitätsklinikum Tübingen, Eberhard-Karls-Universität Tübingen, Tübingen, Germany

2Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Tübingen, Eberhard-Karls-Universität Tübingen, Tübingen, Germany

3Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Tübingen, Eberhard-Karls-Universität Tübingen, Tübingen, Germany

Corresponding author: Prof. Dr. Gerd Döring, Institut für Medizinische Mikrobiologie und Hygiene, Wilhelmstraße 31, 72074 Tübingen, Germany Phone: +49-7071-2982069, Fax: +49-7071-293011,

Citation Information: Clinical Chemistry and Laboratory Medicine. Volume 46, Issue 7, Pages 909–918, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: 10.1515/CCLM.2008.152, April 2008

Publication History

Published Online:
2008-04-21

Abstract

Nucleic acid techniques (NATs), such as species-specific and universal polymerase chain reactions (PCRs), are finding ever wider use in the diagnosis of bacterial infection. However, although universal PCR assays, in particular, approach a type of modern Petri dish, they have a number of limitations which restrict their applicability. The sensitivity of universal PCR is lower than that of many species-specific PCRs, and the contamination of samples and PCR reagents with irrelevant DNA from various sources remains a problem. Thus, NATs in general and universal PCR assays in particular require careful validation to be of value for the diagnosis of infection. Validation includes sampling, DNA extraction/isolation, template amplification and visualisation of the results. Furthermore, it implies the establishment of measures of asepsis, the inclusion of positive and negative controls, techniques to optimise the release of DNA from bacterial cells, adequate repetition of the amplification reaction, and routine testing of reagent negative and inhibition controls. Finally, it entails the comparison of results obtained by NATs with those obtained by conventional microbiological methods and matching with clinical evidence of infection. Validation of NATs in clinical diagnosis remains an ongoing challenge. Because of these limitations, NATs can only serve as adjunct tools for the diagnosis of infection in selected cases; they cannot replace conventional culturing techniques.

Clin Chem Lab Med 2008;46:909–18.

Keywords: bacteraemia; bacterial infections; nucleic acid testing; polymerase chain reaction (PCR); validation

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