A rapid, inexpensive, culture-free, universal bacterial identification system using internal transcribed spacer targeting primers: a proof-of-principle study

ABSTRACT Techniques for bacterial detection and identification can be characterized as either untargeted and taxonomically broad or targeted and taxonomically narrow. Untargeted techniques ( e.g. , culture and sequencing) are time-consuming and/or expensive while targeted techniques (polymerase chain reaction; PCR) can be faster and less expensive but require a strong pre-test suspicion of the potential organism to choose the correct test. We have developed a universal bacterial identification system that is as taxonomically broad as culture and amplicon sequencing but as fast, easy, and affordable as PCR. The platform utilizes a unique universal polymerase chain reaction (PCR) primer set that targets the internal transcribed spacer (ITS) regions between conserved bacterial genes, creating a distinguishable electrophoretic pattern for each bacterial species. Bioinformatic simulation demonstrates that at least 45 commonly isolated pathogenic species can be uniquely identified from a single set of PCR primers using this approach. We experimentally confirmed these predictions on seven representative human pathogens, including gram-negatives and gram-positives, aerobes and anaerobes, and spore formers. Without a priori knowledge of the organism, this system can rapidly identify the unique pattern generated by multiple species in a single reaction. Using quantitative PCR, the system can also determine the corresponding concentration of the organism in question. We also show that the primers are resilient to human DNA contamination at physiologic concentrations, eliminating the need for complex and time intensive extraction methods. Proof-of-principle testing on actual clinical specimens demonstrate that this assay can identify more than twice the species as current multiplex PCR assays ( e.g. , BioFire) using only one universal primer pair in a single PCR reaction, providing results in <3 hours for <$20 without bioinformatic turnaround time. SIGNIFICANCE STATEMENT This paper describes a novel bacterial identification system that is as taxonomically broad as culture and amplicon sequencing but as fast, easy, and affordable as PCR. The assay covers more than twice the species as the leading multiplex PCR assays but uses only one universal primer pair in a single PCR reaction. It is resilient to human genomic contamination precluding the need for timely or costly methods to clear human DNA. This approach represents a major advancement in the decades-long struggle to rapidly and accurately identify bacteria.