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Molecular Infectious Disease
Seven PCR panels, run under our own roof.
Real-time multiplex PCR performed by Prime Path staff in Denver. Organism identity and antimicrobial resistance markers arrive on the same report, 24–48 hours from specimen receipt at our facility.
Molecular Urinalysis
Urinary Tract Infection (UTI) Panel
A negative culture at 48 hours is not a clean bill. It is a limitation.
Standard urine culture reports the single organism that grows fastest on agar. It is blind to the rest. Published series put polymicrobial infection in as many as 30% of recurrent UTIs, and fastidious or low-burden organisms routinely fail to grow at all. Our multiplex PCR panel interrogates a single clean-catch specimen for Gram-positive and Gram-negative uropathogens, Candida species, and the resistance genes that decide whether the first prescription works. Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa, Enterococcus, and Group B Streptococcus are reported alongside beta-lactamase, carbapenemase, vancomycin, and methicillin resistance markers. The panel is at its most valuable exactly where culture is at its weakest: the elderly patient, the catheterized patient, the pregnant patient with frank dysuria and no growth, and the woman on her fourth empiric course this year. Molecular detection identifies nucleic acid, not viability. It does not distinguish active infection from asymptomatic colonization, and results must be read against the clinical picture.
Upper & Lower Respiratory
Respiratory Pathogen Panel (RPP)
Cough, fever, fatigue. The differential has not changed in fifty years. The pathogens have.
Acute respiratory infection drives more than 100 million ambulatory visits a year in the United States, and the CDC estimates that 30–50% of the antibiotics prescribed for them are unnecessary. The reason is not carelessness. Viral and bacterial presentations are clinically indistinguishable at the bedside, and the clinician has to decide before the answer exists. Our real-time multiplex panel resolves the question from a single nasopharyngeal swab, screening influenza A and B, respiratory syncytial virus, SARS-CoV-2, and rhinovirus/enterovirus alongside the bacterial and atypical causes that culture handles poorly: Mycoplasma pneumoniae, Bordetella pertussis, Chlamydia pneumoniae, and Legionella. Co-infection is detected rather than assumed. The panel earns its place in four situations: illness persisting beyond five to seven days without improvement, a cough past three weeks, worsening symptoms in a patient with COPD, asthma, CHF, or diabetes, and any respiratory complaint in an immunocompromised host. The result arrives inside the same care episode, which is the only window in which it can change the prescription.
Chronic & Acute Wounds
Wound Pathogen Panel
A wound that will not heal is infected. Biofilm is why the culture disagrees.
Chronic wounds affect more than 10.5 million Americans and consume an estimated $25 billion a year. They are overwhelmingly polymicrobial, and biofilm-associated bacteria can be up to a thousandfold more tolerant of antibiotics than the same organisms free-floating in a culture tube. Conventional culture takes three to five days and still returns a partial picture. Our PCR wound panel reads the microbial community and its resistance genes from a single swab of the cleansed wound bed, or from deep tissue or aspirate. Staphylococcus aureus and MRSA, Streptococcus pyogenes, Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Enterococcus faecalis, and rapid-growing mycobacteria are reported with mecA, ermB, mefA, AmpC, CTX-M, carbapenemase, and vancomycin-resistance markers. Order it for the diabetic foot ulcer with cellulitis, the pressure injury in long-term care, the surgical site that turned at day five, and any wound that has gone four to six weeks without measurable progress. Sample the wound bed. Superficial slough and eschar report the contaminants, not the infection.
Onychomycosis
Nail Fungal (Onychomycosis) Panel
Half the nails referred as fungal are not. The other half hide a mold that shrugs off terbinafine.
Onychomycosis affects roughly 14% of American adults, and prevalence climbs steeply with diabetes, peripheral vascular disease, and age. The diagnostic problem is that nail dystrophy has many causes and looks the same from across the room. KOH microscopy and fungal culture take weeks and miss up to 40% of true infections. Our real-time PCR panel identifies dermatophytes and non-dermatophyte molds directly from a nail clipping, detecting fungal DNA below the threshold of culture, including non-viable hyphae left behind by prior therapy. Trichophyton rubrum, T. mentagrophytes/interdigitale, and Epidermophyton floccosum are reported alongside Fusarium, Aspergillus, Scopulariopsis, Neoscytalidium, and Candida species. Mixed infections are named rather than averaged. The clinical case is straightforward: confirm fungal etiology before committing a patient to six to twelve weeks of oral terbinafine or itraconazole with the liver-function monitoring that comes with it. Also indicated after a negative or equivocal KOH, after first-line treatment failure, and in immunocompromised patients where an opportunistic mold is on the table.
Ophthalmic Infection
Ocular Pathogen Panel
The cornea does not forgive empiric guessing.
Ocular infection reaches more than 1.5 million Americans each year, from routine conjunctivitis to sight-threatening keratitis and endophthalmitis. Culture and microscopy miss an estimated 30% of cases, defeated by slow-growing and atypical organisms, and every day of delay carries visual cost. Our multiplex PCR panel screens a conjunctival or corneal swab for bacterial, viral, and fungal pathogens with resistance markers reported when present: Pseudomonas aeruginosa and Staphylococcus aureus, the two leading causes of contact-lens-associated corneal infection; Chlamydia trachomatis and Neisseria gonorrhoeae; adenovirus, HSV-1, varicella-zoster, and cytomegalovirus; and Fusarium species. Send it for the acute red eye before topical antibiotics commit you, for the contact-lens wearer with unilateral pain, for suspected herpes keratitis with dendritic ulceration or recurrent unilateral inflammation, and for any new redness, pain, or vision change after cataract surgery, LASIK, intravitreal injection, or corneal transplant. Culture and microscopy can take days the retina does not have. Our panel returns the answer inside the narrow window in which targeted therapy still preserves sight.
Ear, Nose & Throat
ENT Pathogen Panel
Three patients, identical exams, three different prescriptions. Only one of them is right.
ENT complaints drive more than 30 million U.S. clinic visits a year, and viral, bacterial, and fungal causes are indistinguishable on examination. The result is empiric prescribing at scale — by CDC estimate, 30–50% of antibiotic courses for outpatient respiratory and ENT illness are unnecessary, and as many as 60% of patients treated for ENT complaints turn out to have viral disease. Our real-time multiplex panel applies to throat swabs, nasal swabs, and middle-ear aspirate, reporting Streptococcus pyogenes, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Fusobacterium necrophorum, Pseudomonas aeruginosa, Bordetella pertussis, and Mycoplasma pneumoniae, with beta-lactamase, ermB, mefA, and metallo-beta-lactamase resistance markers. It is built for the sore throat with an equivocal rapid strep, the third episode of otitis media in six months, sinusitis running past twelve weeks or four acute episodes a year, and the ENT infection that did not improve on a full course of guideline-directed therapy. Note the site of collection on the requisition; interpretation depends on it.
Sexual Health
Sexually Transmitted Infection (STI) Panel
The patient who just wants to be sure is often the index case.
Roughly 80% of early chlamydia and gonorrhea infections are asymptomatic, which means the examination room offers no signal and screening carries the entire diagnostic burden. Untreated, these infections propagate into pelvic inflammatory disease, infertility, ectopic pregnancy, and adverse neonatal outcomes. Our multiplex real-time PCR panel detects bacterial, viral, and protozoal targets from a single first-void urine specimen or vaginal swab, with patient-collected swabs accepted where clinically appropriate: Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Trichomonas vaginalis, and HSV-1 and HSV-2. Antimicrobial resistance markers are included, which matters more each year as gonococcal and Mycoplasma resistance expands. Indicated for annual screening of sexually active women under 25 per USPSTF and CDC guidance, at the first prenatal visit and again in the third trimester for higher-risk pregnancies, for symptomatic patients, after a partner diagnosis, and during infertility or recurrent-pregnancy-loss workup. Kits ship in discreet packaging and results return through the encrypted provider portal. This panel does not test for syphilis; order serology separately.
Reported With Every Bacterial Panel
Antimicrobial Resistance (AMR) Gene Detection
Organism identity answers half the question. The other half is whether your first choice will work.
AMR gene detection is not a separate order at Prime Path. It is built into every bacterial PCR panel we run, and the markers are reported on the same page as the organism. Depending on the panel and the organisms detected, that report may include methicillin resistance (mecA), extended-spectrum and other beta-lactamases (blaTEM, blaCTX-M, AmpC), carbapenemases (blaKPC, blaNDM, blaOXA-48, blaVIM, blaIMP), vancomycin resistance (vanA, vanB), macrolide resistance (ermB, mefA), and fluoroquinolone-associated markers (gyrA, parC). Antibiotic-resistant infection causes more than 35,000 deaths a year in the United States, and resistance among uropathogenic E. coli has climbed more than 30% in the past decade. Genotypic resistance detection identifies the presence of a resistance gene. It is not a phenotypic susceptibility test, it does not report an MIC, and gene presence does not guarantee expression. Read it as a stewardship signal that narrows empiric therapy days earlier than culture allows — not as a substitute for susceptibility testing where an MIC is clinically required.