Molecular testing for infectious diseases should be done in the clinical microbiology laboratory

Points of agreement: • Molecular testing improves turnaround time and diagnostic accuracy for a variety of infectious agents. • Regardless of the laboratory setting where molecular testing is performed, expertise in clinical microbiology in the individual overseeing test selection, development, and offering consultative services is essential. • Random access testing which allows analysis of individual or small-batch specimen testing in real time can improve clinical outcomes. • Testing in a centralized multidisciplinary laboratory is more efficient than testing in multiple laboratory settings. Points requiring further consideration: • Although molecular testing menus are constantly expanding, the number of individuals with the necessary molecular skill set is not keeping pace. This shortage of skilled personnel may damper rapid test menu expansion at many institutions. • Molecular testing has a high per-test cost compared to most laboratory tests. The highest-volume molecular tests are those that detect infectious disease agents. Molecular pathology laboratories may look to add these tests to their test menu to help subsidize more expensive and esoteric human genetic and molecular oncology tests. • Molecular testing is undergoing a rapid evolution with many potential test platforms and testing strategies. Testing platforms for the rapid detection of infectious agents may not be as useful for pharmacogenomic or molecular oncology analyses. It will be incumbent upon members of the clinical microbiology community involved in molecular testing to provide clinical outcome data to justify the use of specialized testing platforms best adapted for infectious disease diagnosis.