Infectious Disease doctor, Andrew Pugliese, M.D., is a pioneer in the non-surgical treatment of acute and chronic sinusitis. He has been practicing medicine for more than 20 years and is triple board certified in infectious disease, sleep, and internal medicine. In recent years he has been able to explore the new technology available through MicroGen DX where in DNA is used to identify the pathogens causing an infection. Dr. Pugliese shared with us his experience in utilizing next generation DNA sequencing for the care of his patients and explained how this tool is offering better, clearer data than previous culture based technologies were able to offer.
“I’ve always depended on routine culture technique,” he told us. “Unfortunately, I’ve been involved in a lot of cases where I treated based on culture and sensitivity and yet the patient continuously came back with the same recurrent infectious. Obviously, I was missing something.
“With DNA sequencing, I’m able to find those organisms that may be involved in that chronic infection that are being completely missed.
This revolutionized the way I practice the management of chronic infections, not only in chronic wounds, but in chronic sinusitis.
“Sensitivities are important,” he said, “can’t deny that. However, if your culturing technique sees polymicrobial involvement and doesn’t understand what’s going on, they may throw it away and say it’s a contaminant when in fact, it’s a chronic wound that is prone to have polymicrobial involvement.
“What’s the sense of having sensitivities if it’s not giving you sensitivities on several of the organisms that are contributing to the infection?
“You may be missing a big portion of the picture. If you have anaerobes in there, if you have fungus in there, all of that is going to be missing if you use a routine culture. What is the benefit of having a sensitivity to that one organism when they’re maybe 15 organisms in there creating the pathology? You’re not getting ahead of that infection. Why? Because probably you’re treating for one or two organisms that may actually just be a minority of a complex infection.
“Once you create that biofilm and you start sharing genetic material, the more number of species that are involved in that chronic infection, the more re-concentrated it’s going to be to therapy. It is important to know what you’re dealing with from the get go as far as number of organisms. That is where you want to use DNA sequencing because obviously, you’re missing something important.”
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