Culture-independent diagnostic testing: have we opened Pandora's box for good?

• We look at the transition of culture-independent diagnostic testing (CIDT) in the molecular era.
• We examined the potential impact of CIDT on routine culture in the microbiology laboratory.
• We explored the epidemiologic consequences of CIDT for acute gastroenteritis in the laboratory.
• We look at the future of microbiology testing in the wake of CIDT with potential options.

The ability to accurately and quickly identify microbial agents associated with infectious diseases has been a longstanding and continuous goal of diagnostic microbiology laboratories. Over the course of several decades, technology and testing methodologies in this field have gradually evolved from traditional- or classic-based culture and identification approaches to antigen capture systems and more molecular-oriented applications. Recently, these molecular-based applications have signaled a new era in clinical diagnostic microbiology with the commercial introduction of culture-independent diagnostic testing (CIDT) systems. The first major commercial venture into the CIDT arena involves the detection of acute bacterial gastroenteritis. Several commercial products are now on the market globally with at least 4 Food and Drug Administration approved since January of 2013. These new systems offer the direct detection of a variety of enteropathogens quickly without the need for traditional culture. In Greek mythology, Pandora opened a “jar” or “box” out of curiosity thereby releasing all of humanity's evils most notably diseases and plagues according to Hesiod's Theogony. While not ill-intentioned the only thing left in the box was Hope.