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Clinical Microbiology in the Year 2025

This article offers a mini-preview of what's to come in the field of clinical microbiology, and it's the first such undertaking that any of the authors has ever attempted without tongue firmly planted in cheek. Obviously, the scenario portrayed herein is an exercise in pure fantasy, based loosely on the evolutionary pace of clinical microbiology witnessed over the past 25 years. Unlike readers of Sports Illustrated's yearly predictions of champions and losers, however, the reader will have to wait longer than a single season to prove us right or wrong (23 years to be exact). Had the task been the opposite—i.e., to reminisce about the state of clinical microbiology a quarter century ago—we would have discussed the introduction of the Analytab Products bacterial identification system or the first-generation AutoMicrobic system (AMS, Vitek Systems, Inc.) originally designed for use in the U.S. space program. We could generate a smirk by recollecting that the role of the clinical microbiologist in the mid-1970s was to identify all microbial life forms recovered from clinical specimens and then to provide susceptibility test results for each by disk diffusion testing. It was the clinician who would then sort through the myriad of results and decide which organism(s) deserved a therapeutic response. We could prompt a grimace or two by recalling that blood cultures were monitored visually for evidence of bacterial growth once or twice per day and that all anaerobes were identified to species level no matter how much time or how many biochemical reactions were required to do the trick. Interestingly, the two aspects of clinical microbiology that haven't changed much since the mid-1970s are the identification of fungal diseases and the identification of parasitic diseases. 
 
As a discipline and profession, clinical microbiology has “come a long way baby” (Virginia Slims, circa 1970), but we have just begun the molecular diagnostics learning curve, and it's hard to predict just how far we can take this new tool from a technical, practical, and economic standpoint. Because of the recent explosion of technology, many clinical microbiologists have openly speculated that ours is a dying profession—one that will ultimately be consumed by the growing molecular diagnostic beast. With that in mind, here's a mythical take on the future of the clinical microbiology laboratory. One additional note: this might represent the only publication in the history of the Journal of Clinical Microbiology that contains no references. Why is this? The references that would have been cited haven't been written yet!