Clinical Microbiology
Summary
Clinical microbiology underpins the diagnosis, treatment and prevention of infectious diseases by identifying pathogenic organisms and their resistance traits, elucidating host–microbe interactions and guiding antimicrobial therapy. Laboratories encompass bacteriology, mycobacteriology, virology, mycology and parasitology, applying methods that range from direct microscopy and culture to immunoassays and nucleic‐acid amplification. Specimen quality and timely transport are crucial for reliable results. Culture remains indispensable for isolating organisms and performing susceptibility testing, while rapid antigen and molecular assays accelerate detection of fastidious or slow‐growing pathogens. Emerging tools—mass spectrometry for protein profiling, genomic sequencing for epidemiology and resistance surveillance, point‐of‐care diagnostics for decentralised testing—are reshaping the field. Interdisciplinary collaboration between clinicians and microbiologists ensures optimal specimen selection, accurate interpretation and tailored antimicrobial stewardship. As microbial resistance escalates and novel pathogens emerge, clinical microbiology continues to evolve, integrating technological advances with fundamental laboratory practices to safeguard patient outcomes and public health.
Research from Nature Portfolio
A multicentre genomic study of carbapenem‐ and colistin‐resistant Klebsiella pneumoniae collected in Thailand over five years revealed exceedingly high rates of tigecycline resistance in a predominant ST16 clone. Whole‐genome analyses uncovered a constellation of ramR, marR and acrR mutations driving overexpression of the AcrAB‐TolC efflux system, while plasmid‐borne tet(A) variants further reduced drug susceptibility. These findings highlight the convergence of chromosomal and mobile resistance determinants in high‐risk lineages and underscore the need for ongoing regional surveillance of last‐resort antibiotics.
Investigations of RND‐type multidrug efflux pumps in K. pneumoniae laboratory mutants demonstrated that overexpression of intrinsic transporters—AcrAB, OqxAB and newly characterised systems such as KexEF—can produce broad resistance to multiple antimicrobials. Functional cloning and expression analyses confirmed that deletion of upstream regulatory regions or exposure to subinhibitory antibiotics drives pump overactivity and multidrug resistance, emphasising the potential of efflux inhibitors as adjunctive therapies.
Clinical Microbiology publication trend
The graph below shows the total number of articles in clinical microbiology across all publications each year (not limited to Nature Index journals).
Technical terms
Beta‐lactamase inhibitor: A molecule that binds and inactivates beta‐lactamase enzymes, protecting beta‐lactam antibiotics from enzymatic degradation.
Efflux pump: A transmembrane protein complex that actively exports antimicrobial agents from the bacterial cell, reducing intracellular drug concentrations.
Minimum inhibitory concentration (MIC): The lowest concentration of an antimicrobial that visibly inhibits microbial growth in vitro.
Monte Carlo simulation: A computational method using repeated random sampling to estimate the probability of achieving pharmacodynamic targets against specified MIC distributions.
Pharmacokinetics/Pharmacodynamics (PK/PD): The relationship between drug concentration–time profiles (PK) and antimicrobial activity (PD), used to optimise dosing regimens.
Therapeutic drug monitoring (TDM): The measurement of drug levels in biological fluids to guide individualised dose adjustments and ensure therapeutic efficacy.
References
- Occurrence and mechanisms of tigecycline resistance in carbapenem- and colistin-resistant Klebsiella pneumoniae in Thailand. Scientific Reports (2024).
- The role of RND-type efflux pumps in multidrug-resistant mutants of Klebsiella pneumoniae. Scientific Reports (2020).
- Plasma and intraperitoneal pharmacokinetics of ceftazidime/avibactam in peritoneal dialysis patients. Clinical Microbiology and Infection (2023).
- Optimal treatment of ceftazidime-avibactam and aztreonam-avibactam against bloodstream infections or lower respiratory tract infections caused by extensively drug-resistant or pan drug-resistant (XDR/PDR) Pseudomonas aeruginosa. Frontiers in Cellular and Infection Microbiology (2023).
- Therapeutic Drug Monitoring of Ceftazidime-Avibactam Concentrations in Carbapenem-Resistant K. pneumoniae-Infected Patients With Different Kidney Statuses. Frontiers in Pharmacology (2022).
About these summaries
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