Ultra-rapid, Quantitative, Label-free Antibiotic Susceptibility Testing via Optically Detected Purine Metabolites

There is an urgent need for the development of novel and truly rapid (equal or less than 1 hour) antibiotic susceptibility testing (AST) platforms in order to provide best antimicrobial prescribing practices and to help reduce the increasing global threat of antibiotic resistance. A 785 nm surface enhanced Raman spectroscopy (SERS) based phenotypic methodology is described that results in accurate minimum inhibitory concentration (MIC) determinations for all tested strain-antibiotic pairs. The SERS-AST procedure results in accurate MICs, the key quantitative measure of in vitro drug susceptibility, in 1 hour, including a 30-minute incubation period. The method is effective for both Gram positive and negative species, and for antibiotics with different initial primary targets of antibiotic activity, and for both bactericidal and bacteriostatic antibiotics. The molecular level mechanism of this methodology is described. Bacterial SERS spectra are due to secreted purine nucleotide degradation products (principally adenine, guanine, xanthine and hypoxanthine) resulting from water washing induced bacterial stringent response and the resulting (p)ppGpp alarmone mediates nucleobase formation from unneeded tRNA and rRNA. The rewiring of metabolic responses resulting from the secondary metabolic effects of antibiotic exposure during the 30-minute incubation period accounts for the dose dependence of the SERS spectral intensities which are used to accurately yield the MIC. This is the fastest demonstrated AST method yielding MICs.