Misdiagnosis of Bacterial Pathogens by the Diagnostic Centers: A Prospective Route for Antibiotic Resistance

Successful treatment against infectious agents depends on rapid and accurate detection of the causative organisms. Misdiagnosis can hamper such success while leading to improper advising of antibiotics. In Bangladesh, diagnostic centers detect and identify pathogens through culture and biochemical test-based methods and suggest antibiotics based solely on disk-diffusion methods. In this pilot study, we tried to validate the identity of the isolates characterized by diagnostic facilities near Dhaka. One hundred and twenty pre-characterized clinical isolates were collected and analyzed biochemically and genotypically. Random Amplification of Polymorphic DNA-PCR, rcsA, and phoA genes-based PCR and Loop-Mediated Isothermal Amplification (LAMP)-based identification of Klebsiella pneumoniae and Escherichia coli, respectively, followed by 16S rRNA sequencing confirmed misidentification of some clinical pathogens of other genera as Klebsiella spp. and E. coli. The Clinical and Laboratory Standards Institute (CLSI) provides different guidelines for each group of pathogens, where antibiotic choice, sensitivity pattern, and breakpoint measurement are other. The lack of adherence to proper standards resulting in misdiagnosis may facilitate antibiotic-resistant development. Henceforth, we have observed misidentification of clinical pathogens by the diagnostic centers and suggest that using rapid molecular techniques like LAMP may avoid misdiagnosis and subsequently circumvent antibiotic resistance development.