Rapid antibiotic susceptibility testing and species identification for mixed infections

Abstract

Antimicrobial resistance is an increasing problem globally. Rapid antibiotic susceptibility testing (AST) is urgently needed in the clinic to enable personalized prescription in high-resistance environments and limit the use of broad-spectrum drugs. Previously we have described a 30 min AST method based on imaging of individual bacterial cells. However, current phenotypic AST methods do not include species identification (ID), leaving time-consuming plating or culturing as the only available option when ID is needed to make the sensitivity call. Here we describe a method to perform phenotypic AST at the single-cell level in a microfluidic chip that allows subsequent genotyping by in situ FISH. By stratifying the phenotypic AST response on the species of individual cells, it is possible to determine the susceptibility profile for each species in a mixed infection sample in 1.5 h. In this proof-of-principle study, we demonstrate the operation with four antibiotics and a mixed sample with four species.