ROLE OF MOLECULAR EPIDEMIOLOGY IN INFECTION CONTROL

Stefan Weber; Michael A Pfaller; Loreen A Herwaldt

doi:10.1016/S0891-5520(05)70355-X

An avalanche of new molecular typing tests has recently overwhelmed infectious disease clinicians and hospital epidemiologists. The plethora of new acronyms confuse even experts in the field who seem to have given up following every development unless it is related to their own research. In a letter published by the Journal of Clinical Microbiology, Achtman coined several acronyms to describe the current state of the art: YATM (Yet Another Typing Method), TBCA (Totally Boring Clonal Analysis), and TATBSTM (Tried And True But Stodgy Typing Method). 1 The extremely rapid pace of development is illustrated also by the fact that a review of molecular typing methods, which was published by this journal in December 1989, referred to the polymerase chain reaction (PCR) and ribotyping as “newer methods” and did not mention pulsed field gel electrophoresis (PFGE). 18 Furthermore, the number of published manuscripts that describe using molecular typing methods has grown exponentially. Molecular typing methods, when used properly in conjunction with classical epidemiologic methods, facilitate the hospital epidemiologist's job. When used inappropriately, molecular typing methods, at best, add substantial cost to the investigation and, at worst, could lead the epidemiologist to incorrect conclusions. The purpose of this article is to review molecular typing methods that have been used successfully in the practice of hospital epidemiology. The basic principles of these methods are explained and their strengths and weaknesses described. In addition, published studies and the authors' own experiences are cited to demonstrate how hospital epidemiologists can use these methods to solve problems. It is hoped that this approach will allow hospital epidemiologists to use these methods wisely so that they do not stray into a morass of YATMs and TBCAs. Before describing the methods, two scenarios are presented to illustrate the power of molecular typing methods in some situations and the limitations of these same methods in other situations.

ROLE OF MOLECULAR EPIDEMIOLOGY IN INFECTION CONTROL

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