CROSS-REFERENCE TO RELATED APPLICATION

[OOOIJ This application claims the benefit of U.S. Provisional Application No.

62/286.884 filed on January 25, 2016. winch is hereby incorporated by reference in its entirety.

TECHNICAL FIELD

[00021 The present disclosure relates generally to in vitro detection of infectious agents and, more specifically, to devices, systems, and methods for detecting viable infectious agents in a fluid sample using an electrolyte- insulator-semiconductor (LIS) sensor.

BACKGROUND

[0003] Infections caused by anti-infective resistant infectious agents or microbes are a significant problem for healthcare professionals in hospitals, nursing homes, and other healthcare environments. For example, such infections can lead to a potentially life- threatening complication known as sepsis where chemicals released into the bloodstream by an infectious agent can trigger a dangerous whole-body inflammatory response as well as a vasoactive response causing fever, low blood pressure, and possibly death. When faced with such an infection, a preferred course of action is for a clinician to use anti-infective compounds judiciously, preferably only those necessary to alleviate the infection.

However, what occurs most frequently today is that until the organism is identified and tested for drug sensitivity, broad spectrum anti -infectives, often multiple drugs, are given to the patient to insure adequacy of treatment. This tends to result in multiple drug resistant infectious agents. Ideally, the sensitivity of the infectious agent would be detected soon after its presence is identified. The present disclosure presents devices, systems, and methods for accomplishing this goal.

[0004] Existing methods and instraments used to detect anti-infective resistance in infectious agents include costly and labor intensive microbial culturing techniques to isolate the infectious agent and include tests such as agar disk diffusion or broth

iMcrodihition where anti-infectives are introduced as liquid suspensions, paper disks, or dried gradients on agar media. However, those methods require manual interpretation by skilled personnel and are prone to technical or clinician error.

[00051 ^' While automated inspection of such panels or media can reduce the likelihood of clinician error , current, mstminents used to conduct these inspections are often costly and require constant maintenance. In addition, current instruments often rely on an optical readout of the investigated samples requiring bulky detection equipment and access to power supplies. Most irnportaiitly, these methods require days to obtain a result as the infectious agents must reproduce several times in different media prior to being exposed to the anti- intective to determine then susceptibility.

[0006] In addition, such methods and instruments often cannot conduct such tests directly on a patient's bodily fluids and require lengthy sample preparation times.

[00071 As a result of the above limitations and restrictions, there is a need for improved devices, systems, and methods to quickly and effectively detect anti-infective resistant infectious agents in a patient sample.

SUMMARY

[0008] Various devices, systems and methods for detecting the susceptibility of an infectious agent in a patient sample to one or more anti-infectives are described herein.

[0009] In one embodiment, a method for detecting the susceptibility of an infectious agent to one or more anti-infectives can mclude introducing a fluid sample to a firs surface and a second surface, exposing the first surface to a first solution, and exposing the second surface to a second solution. The second surface can comprise an anti- infective.

[0010] In some instances, the fluid sample can comprise the infectious agent and the infectious agent can be introduced to the first surface or the second surface through the fluid sample. The method can also include determining the presence of the infectious agent hi the fluid sample.

[0011] The method can include sampling the first solution after exposing the first solution to the first surface. The method can also mclude sampling the second solution after exposing the second solution to the second surface. The method can include monitoring a first electrical characteristic of a first electrolyte-insiilator-semicondiictor (EIS) sensor exposed to the first solution sampled. The method can include monitoring a second electrical characteristic of a second EIS sensor exposed to the second solution sampled. The first electrical characteristic and/or the second electrical characteristic can be an electrical impedance, a voltage shift, a capacitance change, or a characteristic that is affected by a change in capacitance such as a change in resonant frequency (e.g., sound).

[0012J The method can further include comparing the first electrical characteristic and the second electrical characteristic to a ssess the susceptibility of the infectious agent to the anti -infective. Cornparing the first electrical characteristic and the second electrical characteristic can include detemiining a difference between the first electrical characteristic and the second electrical characteristic. The difference between the first electrical characteristic and the second electrical characteristic can be a result of a difference in a solution characteristic of the first solution and the second solution. The difference hi the solution charac teristic of the first solution and the second solution can result from a difference in molecular count, a concentration of an ion, and/or a solution temperature.

[00131 The first surface can be a filter surface or a well surface. The second surface can be separate from the first surface and can be another instance of the filter surface or the well surface. At least one of the first surface and the second surface can be a non-clogging filter. In addition, at least one of the first surface and the second surface can comprise pores of sequentially smaller pore size.

[00141 The infectious agent can be, but is not limited to, a bacteria, a fungus, a virus, or a prion. The first EIS sensor and the second EIS sensor can be housed by a protective chamber and the protective chamber can be an electrically isolated a

temperature controlled chamber, and/or a light controlled chamber. The first solution can be directed to the first surface by a pump. The second solution can also be directed to the second surface by a pump.

[0015J In another embodiment, a method for detecting a susceptibility of an infectious agent to an anti-infective can include introducing a fluid sample to a first surface and a second surface, exposing the first surface to a first solution, and exposing the second surface to a second solution. The second surface can comprise an anti-infective.

[0016] In some instances, the fluid sample can comprise the infectious agent and the infectious agent can be introduced to the first surface or the second surface through the fluid sample. The method can also include determining the presence of the infectious agent in the fluid sample.

[0017] The method can include sampling the first solution after exposing the first solution to the first surface. The method can also include sampling die second solution after exposing the second solution to the second surface. T!ie method can include monitoring a first electrical characteristic of an EIS sensor exposed to the first solution sampled. The method can also include monitoring a ^' second electrical characteristic of the EIS sensor exposed to the second solutio sampled.

[0018] ^' The method can further include comparing the first electrical characteristic and the second electrical characteristic to assess the susceptibility of the infectious agent to theanti-infective. Comparing the first electrical characteristic and the second electrical characteristic can include detemiining a difference between the first electrical characteristic and the second electrical characteristic. The difference between the first electrical characteristic and the second electrical characteristic can be a result of a difference in a solution characteristic of the first solution and the second solution. The difference in the solution charac teristic of the first solution and the second solution can result from a difference in a molecular count, a concentration of an ion, and/or a solution temperature.

[0019] T!ie first surface can be a filter surface or a well surface. The second surface can be separate from the first surface and can be another instance of the filter surface or the well surface. At least one of the first surface and the second surface can be a non-clogging filter. In addition, at least one of the first surface and the second surface can comprise pores of sequentially smaller pore size.

[0020] T!ie infectious agent can be, but is not limited to, a bacteria, a fungus, a virus, or a prion. The first sensor and the second sensor can be housed by a protective chamber and the protective chamber can be an electrically isolated environment, a temperature controlled chamber, and or a light controlled chamber. The first solution can be direcied to the first surface by a pump. The second solution can also be directed to the second surface by a pump.

BRIEF DESCRIPTION OF THE DRAWINGS

[0021] Fig. 1 illustrates one embodiment of a system for detecting a susceptibility of an infectious agent to one or more anti-mfeetives.

[0022] Fig. 2 A illustrates a side view of an embodiment of an EIS sensor structure having an external reference electrode.

[0023] Fig. 2B illustrates a side view of an embodiment of an EIS sensor having an external reference electrode and a fimctionalization layer.

[0024] Fig. 3 A illustrates a side view of another embodiment of an EIS sensor.

[0025] Fig. 3B illustrates a side view of yet another embodiment of an EIS sensor. [0026] Fig. 4 illustrates example readouts from, an analyzer or reader of the system.

[0027] Fig..5 illustrates an embodiment of a method for detecting a susceptibility of an infectious agent to one or more aiiti-infeciives,

[0028} Fig. 6 illustrates another embodiment of the method for detecting a

susceptibility of an infectious agent to one or more anti-infectives.

DETAILED DESCRIPTION

[00291 Variations of the devices, systems, and methods described herein are best imderstood from the detailed description when read in conjunction with the accompanying drawings. It is emphasized that, according to common practice, the variou features of the drawings may not be to scale. On the contrary, the dimensions of the various features may be arbitrarily expanded or reduced for clarity and not all features may be visible or labeled in every drawing. The drawings are taken for illustrative purposes only and are not intended to define or limit the scope of the claims to that which is shown.

[0030] Figure 1 illustrates an embodiment of a system 100 for detecting or assessing a susceptibility of an infectious agent 102 to an anti-infective 104. The infectious agent 102 can be a bacteria, a fungus, a virus, or a prion.

[0031J In one embodiment the system 100 can comprise a fluid delivery device 106, a first filter housing 108A containing a first filter Γ10Α, a second filter housing 108B containing a second filter 110B, a first elecholyte-msulator-sen conductor (EIS) sensor 1 16A, a second EIS sensor 116B, and a parameter analyzer 114. The EIS sensors will be discussed in more detail in the sections that follow.

[0032] The first EIS sensor 1 16A, the second EIS sensor 116B, or a combination thereof can be located on a substrate 210 (see Figure 2A or Figure 2B). The substrate 112 can be comprised of a polymer or polymeric material, a metal, a ceramic, a semiconductor layer, an oxide layer, an insulator, or a combination thereof. Although not shown in Figure 1, the parameter analyzer 114 can be integrated into one device with the first EIS sensor 116A, the second EIS sensor 116B, or a combination thereof In other embodiments, the parameter analyzer 114 can be a standalone unit or device coupled to the substrate 202 and/or a reference electrode.

[0033J In another embodiment, the system 100 can comprise the fluid delivery device 106, the first filter housing 10SA containing the first filter I I OA, the second filter housing 1Q8B containing' the second filter HOB, one EIS sensor 16A (shown in step ID and step lE(b) of Figure I), and a parameter analyzer 114.

[00341 The system 100 can detect or assess the level of susceptibility of the infectious agent 102 to an anti-infective 104. In some instances, the fluid sample 124 can comprise the infectious agent 102. The. fluid sample 124 ca include a bodily fluid such as blood, serum, plasma, urine, saliva, joint fluid, semen, wound material, spinal fluid, mucus, or a combination thereof. In other embodiments, the fluid sample 124 can also include an environmental fluid such as liquids sampled from a stream, river, lake, ocean,

contamination site, quarantine zone, or emergency area. The fluid sample 124 can also be a food sample.

[0035 j The system 100 can also initially be used to determine the presence of the infectious agent 102 in the fluid sample 124 before detecting or assessing the level of susceptibility of the infectious agent 102 to the anti-infective 104.

[0036] The infectious agent 102 can be any metabolizing single or multi-cellular organism including a bacteria or fungus. The infectious agent 102 can also be a virus or a prion.

[0037} In certain embodiments, the infectious agent 102 can be a bacteria selec ted from the genera consisting of Acinetobacter, Aeromonas, Bacillus, Bacteroides, Citrobacter. Enterobacter, Escherichia, Klebsiella, Morganella, Pandoraea, Proteus, Providencia, Pseudomona s, Ralstonia, Raoultella, Salmonella, Serratia, Shewanella, Shigella,

Stenotrophornonas, Streptomyces, Staphylococcus, Enterococcus, Clostridium or any combination thereof. In other embodiments, the infectious agent 102 can be a fungus selected from the genera consisting of Candida, Cryptoeoccus, or any combination thereof. In another embodiment, the infectious agent 102 can include amoeba, hi further embodiments, the infectious agent 1 2 can be cancer cells and the anti -infectives 104 can be chemotherapeutics or other cancer treatments.

[0038] As illustrated in Figure 1, the fluid delivery device 106 can deliver or inject the fluid sample 124 into the first filter housing 108 A and the second filter housing 108B in step 1 A. The fluid deiiveiy device 106 can be a pump. For example, the fluid delivery device 106 can be a hydraulic pump, a pneumatic pump, a syringe pump, or a combination thereof. In other embodiments, the fluid delivery device 106 can be an injection cartridge, a microfluidic channel, a pipette, a reaction tube, a capillary, a test tube, a combination thereof, or a portion therein. [0039] The first filter housing 108 A or the second filter housing 108B can be a container or vessel configured to secure or enclose the first filter 11 OA or the second filter HOB, respectively. For example, the first filter housing 108 A or the second filter housing Ϊ08Β can be a protective chamber. The protective chamber can be an electrically isolated environment. The protective chamber can also be a temperature controlled chamber, a light controlled chamber, or a combination thereof.

[0040 j The first filter 110A, the second filter 110B, or a combination thereof can be a non-clogging filter. T!ie first filter surface 126A can be a non-clogging filter surface. The second filter surface 126B can also be a non-clogging filter surface. The first filter 11 OA, the second filter H OB, or a combination thereof can also have filter pores of sequentially smaller pore size. For example, the first filter 110A, the second filter 11 OB, or a

combination thereof can have larger filter pores at the top of the filter and progressively smaller filters pores toward the bottom of the filter. Although not shown in Figure 1, it is contemplated by this disclosure that the first filter 110A or the second filter 1 10B can refer to a plurality of filters in a stacked arrangement.

[0041 j The first filter 110A can comprise the infectious agent 102 when the fluid sample 124 introduced to the first filter 11 OA comprises or carries the infectious agent 102. The second filter 1 lOB can also comprise the infectious agent 102 when the fluid sample 124 introduced to the second filter 1 Ϊ0Β comprises or carries the infectious agent 102.

[0042 j The first filter 110A can be a mesh or matrix structure for isolating or separating the infectious agent 102 or othe molecules or cells from the supernatant of the fluid sample 124. The second filter 110B can also be a mesh or matrix structure for isolating or separating the infectious agent 102 or other molecules or cells from the supernatant of the fluid sample 124. In certain embodiments, the first filter 110A or the second filter 110B can be selected from the group consisting of cellulose acetate, regenerated cellulose, nylon, polystyrene, polyvinyhdene fluoride (PVDF), polyethersulfone (PES),

polytetrafluorethylene (PTFE), glass microfiber, or a combination thereof.

[0043] The first filter 110A can comprise a first filter surface 126A. The first filter surface 126A can be the portion of the first filter 110A used to isolate or trap the infectious agent 102. The first filter surface 126 A can include an external surface, an internal surface extending into the first filter 110A, or a combination thereof.

[0044] The second filter 110B can comprise a second filter surface 126B. The second filter surface 126B can be the portion of the second filter 1 Ϊ0Β used to isolate or trap the infectious agent 102. Hie second filter surface 126B can include an external surface, an interna! surface extending into the second filter 1 Ϊ0Β, or a combination thereof.

[0045] The second filter 1 !OB or the second filter surface 126B can comprise the anti- infective 104. The anti.-inieeti.ve 104 can be added or introduced to the second filter surface 126B before or -after exposing the second filter surface 126B to the fluid sample 124.

[0046] fii another embodiment, the anti-infective Ϊ04 can be incorporated or embedded into or coated onto the second filter 10SB or the second filter surface 126B before exposing the second filter 110B or the second filter surface I26B to the fluid sample 124.

[0047] In yet another embodiment, the anti-infective 104 can be introduced through a solution exposed to the first filter Ϊ lOA, the second filter 1 IQB, or a combination thereof. For example, the anti-infective 104 can be introduced through the nutrient solution 130.

[00481 The and -infective 104 can comprise a bacteriostatic anti-infective, a bactericidal anti-infective, an anti-fungal anti-infective, an antiviral anti-infective, a prion inhibitor, or a combination thereof.

[0049] In another embodiment, the anti-infective Ϊ04 can be a bacterial growth inhibitor or stimulator. The bacterial growth inhibitor or stimulator can selectively inhibit or promote the growth of gram positive or grain negative bacteria. The bacterial growth inhibitor or stimulator can comprise a dye or a chemical compound. In some embodiments, the dye can include, but is not limited to. Methylene blue, Bromothymol blue, Eosiii B, Safranin O. Crystal violet, or a combination thereof. The chemical compound can include, but is not limited to, sodium azide, bile acids, high sodium chloride, or a combination thereof. The anti-infective 104 can also comprise a carbon source other than glucose, such as lactose or mannose, to select for certain bacterial species. The bacterial growth inhibitor, the carbon source, or a combination thereof can a lso be added to the nutrient solution 130.

[0050] The first filter housing 108 A or the second filter housing 108B can have at least one opening which allows fluid or supernatant from the fluid sample 124 to evacuate the first filter housing 108 A or the second filter housing 108B. For example, step 1 A can include the additional step of discarding the fluid or supernatant from the fluid sample 124 through the opening after isolating the infectious agent 102 on the first filter surface 126 A or the second filter surface Ϊ26Β.

[0051] In an alternative embodiment not shown in Figure 1 , a stimulus solution can be added to the fluid sample 124 before introducing the fluid sample 124 to the first filter 110A or the second filter 110B. The stimulus solution can be a nutrient or growth solution. Th stiiiiuhis solution can have a different composition than nutrient solution 130. The stimulus solution can be a super nutrient solution.

[00521 ^' Tlie fluid sample 124 can also be pre- filtered in a step before step 1 A. This pre- fiJtering ste can involve filtering the fluid sample 124 using a filter, a mieroiluidic filter, or a combination thereof to fiiter out oilier larger cellular components including b lood cells or epithelial cells fro the fluid sample 124 when the fluid sample 124 is composed of bodily fluid.

[00531 The same fluid delivery device 06 or another fluid delivery device 106 can also be used to deliver or inject nutrient solution 130 to the fir st filter housing 108 A, the second filter housing 108B ₅ or a combination thereof in step IB. The fluid delivery device 106 can continuously or periodically expose the first filter surface 12 A. the second filter surface 126B, or a combination thereof to the imtrient solution 130.

[0054] After exposing the first iilter 110A or the second iilter 1 10B to the nutrient solution 130, the first filter 110A or the second filter HOB can be heated to a temperature of between 30 °C and 40 °C and a llowed to incubate for an incubation period 132 in step IC. In one embodiment, the first filter 11 OA or the second filter HOB can be incubated while in the first fiiter housing 108 A or the second filter housing iOSB, respectively. In another embodiment, the first filter 11 OA or the second filter HOB can be removed from the first filter housing 108 A o the second fiiter housing 108B, respectively, prior to incubation. In some embodiments, the first filter 110A. the second filter 110B, or a combination thereof can be incubated with the nutrient solution 130. The incubation period 132 can range from 15 minutes to over one hour. In other embodiments, the incubation period 132 can be less than 15 minutes. The incubation period 132 can be adjusted based on the type of infectious agent 102, such as the type of bacteria, fungus, vims, or prion.

[0055 j The incubation period 132 can also be adjusted based on the amount of the infectious agent 102 present in tlie fluid sample 124. For example, the incubation period 132 can be increased when the amount of the infectious agent 102 is below a threshold amount. The first filter Π0Α or tlie second filter HOB can be allowed to incubate with the nutrient solution 130 in order to promote the proliferation of the infectious agent 102 on the first filter surface 126A or the second filter surface 126B, respectively. One advantage of incubating the first iilter 110A and the second filter HOB is to increase the sensitivity of the system 100 to small amounts of the infectious agent 102. For example, incubating the first filter 110A and the second filter 1 iOB can allow the system 100 to reduce its level of detection. [O056J After incubating the first filter i 10A or the second filter 110B, the effluent or outflow of the nutrient sohition 130 exposed to the first filter 110A or the second filter HOB ca be sampled. The effluent or outflow of the nutrient solution 130 exposed to the first filter 11 OA can be referred to as the first sample effluent 13 A.

[0057] The first sampie effluent 134A can be analyzed by a first EIS sensor 116A in step ID. The first sample effluent 134 A can be analyzed by applying or introducing an aliquot of the first sample effluent 134A to the first EIS sensor 116A. In another embodiment the first sample effluent 134 A can be analyzed by inserting a portion of the first EIS sensor 116A directly into the first sample effluent 134A.

[0058] The effluent or outflow of the nutrient solution 130 exposed to the seco d filter 110B can be referred to as the second sample effluent Ϊ34Β. In one embodiment, the second sample effluent Ϊ34Β can be analyzed by a seco d EIS sensor 116B in step lE(a). The second sample effluent 134B can be analyzed by applying or introducing an aliquot of the second sample effluent 134B to the second EIS sensor 116B. In another embodiment, the second sample effluent 134B can be analyzed by mserting a portion of the second EIS sensor 116B directly into the second sample effluent 134B.

[0059} T!ie first sample effluent 134A and the second sample effluent 134B can each comprise a solution characteristic 136. The solution characteristic 136 can refer to one or more attributes of the solution making up the first sample effluent Ί34Α, the second sample effluent 134B, or a combinatio thereof. For example, the solution characteristic 136 can include a concentration of a solute, an absolute number or molecular count of solutes in solution, a solution temperature, or a combination thereof. For example, the solution characteristic 136 can refer to the amount or concentration of ions, organic molecules such as amino acids, vitamins or glucose, minerals, or other inorganic compounds in the sample effluent 134.

[0060] T!ie solution characteristic 136 can vary as a result of natural changes due to the energy use, growth, and metabolism of the infectious agent 102. For example, the solution characteristic 136 can be a direct or indirect byproduct of a cellular activity undertaken by the infectious agent 102 such as cell metabolism or cell growth. The solution characteristic 136 can vary as a result of io s, organic molecules, or minerals produced by, consumed by, or otherwise attributed to the infectious agent 102 on the first filter surface 126 A, the second filter surface I26B, or a combination thereof. For example, the solution

characteristic 136 can change as a result of an amount or concentration of nutrients such as glucose, ions, or vitamins consumed or depleted by an infectious agent 02 such as a bacteria, fungus, or virus.

[0061| In one embodiment, the first sample effluent 134A, the second sample effluent 1 MB, or a combination thereof can comprise hydrogen ions (it) as a byproduct of bacterial cell metabolism or growth. Ixi other embodiments, the first sample effluent 134A, the second sample effluent 134B, or a combination thereof can comprise adenosine triphosphate (ATP), carbon dioxide (C(¾), lactic acid, carbonic acid, nitrates (N(¾ ^~ ), or a combination thereof produced by or attributed to the infectious agent 102.

[0062] In an alternative embodiment shown in Figure 1, the same EIS sensor 116 A can be used to analyze the first sample effluent Ϊ34Α and the second sample effluent 134B. In this embodiment, the EIS sensor 1I6A can be cleaned or recalibrated after each analysis or use.

[0063] In yet another embodiment, the fust EIS sensor II ©A, the second EIS sensor 1 16 , or a combination thereof can be integrated into the first filter 110 A, the second filter 110B, or a combination thereof. For example, the first EIS sensor 116A can be integrated into the fust filter 110A and the second EIS sensor 116B can be integrated into the second filter I iOB.

[0064] A parameter analyzer 114 can monitor an electrical characteristic (see Figure 4) of me first EIS sensor 116 A exposed to the first sample effluent Ί34Α in step IF. The parameter analyzer 114 can also monitor the electrical characteristic of the second EIS sensor 11 SB exposed to the second sample effluent 134B in step IF. In one example embodiment, the parameter analyzer 114 can be an impedance analyzer. In another example embodiment, the parameter analyzer 114 can be a capacitance analyzer. In this embodmieiit, the electrical characteristic of the fhst EIS sensor 116 A can be referred to as a first electrical characteristic and the electrical chaiacteristic of the second EIS sensor 116B can be referred to as the second electrical characteristic.

[0065] When only one EIS sensor 116A is used to sample the sample effluents, the parameter analyzer 114 can monitor the electrical characteristic of the one EIS sensor 116A exposed to the first sample effluent 134A and the parameter analyzer 114 can also monitor the elec trical characteristic of the one EIS sensor Ί16Α exposed to the second sample effluent 134B. In this embodiment, the electrical characteristic of the one EIS sensor 116A while sampling the first sample effluent 134A can be referred to as the first electrical characteristic and the electrical characteristic of the one EIS sensor 116 A while sampling the second sample effluent Γ34Β can be referred to as the second electrical characteristic. [0066] The electrical characteristic can include an electrical impedance or impedance change, a voltage or voltage change, a current or change in current, a capacitance or a capacitance change, a characteristic change that is affected by a change in capacitance such as a change in a. resonant, frequency, a resistance or resistance change, a noise level or noise level .change, a subthreshold swing, a level of induction or induction change, or a combination thereof measured at or nea ^' the first EIS sensor 116A, the second EIS sensor 1 Ϊ6Β, o a combination thereof.

[00671 The parameter analyzer 114 can be electrically or communicatively coupled to the first EIS sensor 116 A, the second EIS sensor 116B, or a combination thereof to monitor the electrical characteristic of the first EIS sensor 116 A, the second EIS sensor 116B, or a combination thereof over time. The parameter analyzer 1 14 can also be connected to a display or display component configured to provide a read-out of the electrical

characteristic of the first EIS sensor 116 A, the second EIS sensor 116B, or a combination thereof. When only one EIS sensor 1 16A is used to sample the sample effluents, the parameter analyzer 114 can be electrically or communicatively coupled to the one EIS sensor 116A.

[00681 l* ¹ certain embodiments, the parameter analyzer 114 can be a mobile device, a handheld device, a tablet device, or a computing device such as a laptop or desktop computer. The parameter analyzer 114 can compare the first electrical characteristic with the second electrica l characteristic to assess the susceptibility of the infectious agent 102 to the anti-infective 104.

[0069] The first electrical characteristic can differ from the second electrical characteristic when the solution characteristic 136 of the first sample effluent 134A differs from the solution characteristic 136 of the second sample effluent 134B as a result of differences in the solution temperature, the concentration of solutes present in the sample effluents, or the amount of solutes present in the sample effluents. For example, the first electrical characteristic and the second electrical characteristic can differ when the solution characteristic 136 of the first sample effluent Ϊ34Α and the solution characteristic of the second sample effluent 134B differ in their pH , temperature, the concentration of another ion, or a combination thereof.

[0070] The parameter analyzer 114 or a reader communicatively coupled to the parameter analyzer 114 can assess the susceptibiliiy of the infectious agent 102 to the anti- infective 104 as a binary assessment or a gradated or tiered assessment. In one

embodiment, the parameter analyzer 114 or a reader communicatively coupled to the parameter analyzer 114 can assess the susceptibility of the infectious agent 02 as either resistant or non-resistant to the anti-iniective 104. In this embodiment, the second filter HOB or the second filter surface 126B can comprise a set amount of the anti-infective 104. The parameter analyzer 114 or a reader cominunicativeiy coupled to the parameter analyzer 114 can then assess the susceptibility of the infectious agent 102 as either resistant or non- resistant based on any detected differences in first electrical characteristic and the second electrical characteristic.

[00711 The parameter analyzer 114 or a reader communicatively coupled to the parameter analyzer 114 can assess the susceptibility of the infectious agent 102 as not resistant to the anti-infective 104 when the parameter analyzer 114 or a reader

communicatively coupled to the parameter analyzer 114 tails to detect a difference or a statistically significant difference between the first electrical characteristic and the second electrical characteristic. More specifically, a statistically significant difference hi the electrical characteristic can be a difference exceeding a threshold value.

[0072} In other embodiments, the parameter analyzer 114 or a reader communicatively coupled to the parameter analyzer 114 can assess the level of susceptibility of the infectious agent 102 on a gradated or tiered scale. For example, the parameter analyzer 114 or a reader communicatively coupled to the parameter analyzer 114 can assess the susceptibility of the infectious agent 102 as being resistant , mildly susceptible, or susceptible to the anti- infective 104. In these embodiments, additional filter surfaces, including the second filter surface 126B and a third filter surface, can be used which comprise anti-mfeetives 104 of different concentrations. While three categories of susceptibility ar e discussed, it should be imderstood by one of ordinary skill in the art that four or greater categories of susceptibility or four or grea ter filters c an be used to assess the level of susceptibility of the infectious agent 102 to differing concentrations of the anti-infective 104.

[0073} The steps depicted in Figure 1 do not require the particular order shown to achieve the desired result and certain steps or processes may occur in parallel.

[0074} Figure 2 A illustrates a side cross-sectional view of an example EIS sensor 200. The EIS sensor 200 can be any of the first EIS sensor 116A or the second EIS sensor 116B. The EIS sensor 200 can have an external reference electrode 202 extending into a fluid sample 204. The fluid sample 204 can be any of the first sample effluent 134 A or the second sample effluent 134B. The fluid sample 204 can also contain one or more electrolytes o analytes. [00751 An EIS sensor 200 can comprise an electrolyte or electrically conducting solution, such as the fluid sample 204, an insulator layer 216, and a semiconductor layer 206 which can foe connected or coupled to one or more metal contacts 208 or contact layers. As depicted in Figure 2A, the EIS sensor 200 can comprise the fluid sample 204acting as the electrolyte, the insulator layer 216, the semiconductor layer 206. the contact layer 208, a. substrate layer 210. or a combination thereof. The substrate layer 210 can be composed of, but is not limited to, any non-conducting material such as a polymer, an oxide, a ceramic, or a composite thereof.

[0076] The semiconductor layer 206 can be composed of, but is not limited to, silicon or any other semiconducting material which allows a voltage to be applied through the metal contact layer 208, the semiconductor layer 206, the insulator layer 216, and/or the fluid sample 204 or electrolyte to an external reference electrode 202. The semiconductor layer 206 can also be made of an organic semiconductor, a carbon nanotube, graphene, an organic conductor such as those derived from polyacetylene, polyaniline, Quinacridone, Poiy(3,4-ethyleiiedioxytliiophene) or PEDOT, PEDOT: polystyrene sulfonate (PSS), or a combination thereof.

[0077} The insulator layer 216 (which can also be referred to as an isolator layer) can be a higli-k dielectric layer or a material layer having a high dielectric constant (k). For example, the insulator layer 216 can comprise aluminum oxide, hafnium oxide, titanium oxide, zirconium oxide, yttrium oxide, tantalum oxide, hafnium silicate, zirconium silicate, silicon nitride, aluminum nitride, hafnium nitride, zirconium nitride, or combination thereof. As a more specific example, the insulator layer 216 can comprise aluminum dioxide, hafnium dioxide, zirconium dioxide, or a combination thereof. In other embodiments, the insulator layer 2Ϊ6 can comprise a silicon dioxide layer.

[O078J As depicted in Figure 2A, the semiconductor layer 206 can be disposed or placed on a contact layer 208. The contact layer 208 can be composed of, but is not limited to, a metal. For example, the contact layer 208 can be a gold layer, an aluminum layer, a platinum layer, or a composite thereof. The contact layer 208 can be disposed or placed on the substrate layer 210.

[007 J As depicted in Figure 2 A, the fluid sample 204, the insulator layer 216, the semiconductor layer 206, and the contact layer 208 can be surrounded by a container wall 214. The container wall 214 can be made of an inert or non-conductive material. The container wall 214 can hold or delivery the fluid sample 204 or electrolyte to the EIS sensor 200. [0080} As depicted in Figure 2 A, the EIS sensor 200 can also comprise an external reference electrode 202 in liquid communication wit the fluid sample 204. The external reference electrode 202 can be used to apply a known potential to the EIS sensor 200. The external reference electrode 202 can have a stable and well-known internal voltage and can act as a differential noise filter for .removing electrical noise from measurements taken by the sensor. The system can use the external reference electrode to detemmie or record a relative change in the electrical characteristic of the sensor rather than having to ascertain an absolute change. The system can also use the extemai reference electrode to determine or record a relative difference between the electrical characteristic of the sensors. Ei one embodiment, the external reference electrode 202 can be a standalone probe or electrode. In other embodiments, the external reference electrode 202 can be coupled to the parameter analyzer 114 or a reader connected to the parameter analyzer 114. The parameter analyzer 1 14 can also be used to apply a voltage to the external reference electrode 202.

[0081] In one embodiment, the external reference electrode 202 can be a silver/silver chloride (Ag AgCl) electrode. In other embodiments, the external reference electrode 202 can be a saturated calomel reference electrode (SCE) or a copper-copper (II) sulfate electrode (CSE). In another embodiment not shown hi Figure 2A, a quasi or pseudo reference electrode, such as a metal metal electrode, a salt/chloride electrode, or a combination thereof can be placed on the substrate layer 210. In yet another embodiment, this quasi or pseudo elecirode can be covered by an additional fimctionalization layer or passivation layer such as a KCL electrolyte gel

[0082] In one or more embodiments, the operation of the EIS sensor 200 can involve the parameter analyzer 114 (or other voltage source) applying a DC polarization voltage (usually in the range of +/- 5V) to the metal contact layer 208 and the external reference electrode 202 via the semiconductor layer 206, the insulator layer 216, a fiinctionalization layer (if any), and the fluid sample 204 or electrolyte to set a working point. Next, the parameter analyzer 114 can apply a small superimposed AC voltage (usually in the 10-50 mV range or the Hz-kHz range) to the EIS sensor 200 in order to measure the capacitance or another electrica l characteristic, such as a resonant frequency, or response of the EIS sensor 200 using the parameter analyzer 114. The capacitance is a function of the applied DC voltage applied to the EIS sensor 200 and an interfacial potential at the

elechOlyte/insulator interface or the eleofrol^e ranctionalization layer interface. An example capacitance/voltage (C V) measurement curve is provided in Figure 4. Depending on the concentration or amount of an analyte, ion, or cellular byproduct present in the fluid sample 204 or electrolyte, a horizontal shift (ΔΥ) of the C/V measurement curve will occur when such voltages are applied to the same fluid sample 204 or electrolyte solution over time or different fluid samples or different. electrolyte solutions. This potential horizontal shift (ΔΥ) of the C/V measurement curve can he evaluated at a fixed capacitance value within the linear region of the C/V measurement curve. The capacitance can be fixed by using- a feedback circuit which can allow an analyzer or reader to directly measure or calculate the potential horizontal shift (ΔΥ) of the C/V measurement curve.

[00831 Tlie capacitance is a function of the applied DC voltage applied to the EIS structure and interfacial potential at the electral>te/msitlator or electrolyte/

functionalization layer. A typical C/V measurement curve is provided hi Figure 4. Due to the electrochemical interaction (AV), a horizontal shift of the C/V curve is visible, depending on the analyte concentration in the solution. As a resulting measuring signal the potential shift can be evaluated at a fixed capacitance value within the linear region of the C V curve. Tlie measiued capacitance can be fixed by using a feedback circuit, allowing to directly measuring potential shifts.

[ΘΘ84] Figure 2B illustrates a side cross-sectional view of another embodiment of the EIS sensor 200. hi this embodiment, the EIS sensor 200 can include a functionalization layer 218 placed or disposed on the insulator layer 216. Tlie fiinctionalization layer 218 can comprise silanes, DNA, proteins, antibodies, self-assembled mono layers (SAMs), buffered hydrogeis, PVC, parylene, poly ACE, or any other biochemically active materials.

[0085 j Figure 3 A illustrates a side cross-sectional view of another embodiment of the EIS sensor 200. As depicted in Figure 3 A, the EIS sensor 200 can have a dual sensor assembly including a first sensor assembly 300 and a second sensor assembly 302. In this embodiment, the first sensor assembly 300 and the second sensor assembly 302 can be disposed or placed on the same substrate 210. In addition, the fluid sample 204 can flow over or be exposed to both the first sensor assembly 300 and the second sensor assembly 302 simultaneously. In this embodiment, the first sensor assembly 300 and the second sensor assembly 302 can be separated by a container wall 214 or container divide. The iirst sensor assembly 300 can comprise a functionalization layer 218 disposed on or covering the insulator layer 216. The second sensor assembly 302 can act as an on-chip reference electrode.

[0086] As shown in Figure 3 A, a passivation layer 304 can be disposed on or cover the insulator layer 216 of the second sensor assembly 302. The passivation layer 304 can be configured to prevent the second sensor assembly 302 from interacting with the analyte. ions, or other byproducts in the fluid sample 204 or electrolyte solution. For example, the passivaiioii layer 304 can be a pH-insensiiive layer. The passivation layer 304 can comprise silanes, self-assembled monolayers (SAMs), buffered hydrogels, parylene, polyACE, or an oilier biochemically inert material.

[0087] In one embodiment, the first sensor assembly 300 can include an insulator layer 216 disposed on or covering a semiconductor layer 206. In this embodiment, the semiconductor layer 206 of the first sensor assembly 300 can be disposed on or cover a contact layer 208. Moreover, the contact layer 208 of the first sensor assembly 300 can be disposed on or cover the substrate layer 210. Also, in this embodiment, the second sensor assembly 302 can include a passivation layer 304 disposed on or covering the insulator layer 216. In addition, the insulator layer 216 can be disposed on or cover the

semiconductor layer 206. Furthermore, in this embodiment, the semiconductor layer 206 of the second sensor assembly 302 can be disposed on or cover the contact layer 208.

Moreover, the contact layer 208 of the second sensor assembly 302 can be disposed on or cover the substrate layer 210 and can be separated from the contact layer 208 of the first sensor assembly 300 by the container wall 214 or a container divide.

[00881 hi this embodiment the parameter analyzer 114 can have a lead connection wire, such as a copper wire, connected to the contact layer 208 of the first sensor assembly 300 and another lead connection wire connected to the contact layer 20S of the second sensor assembly 302.

[0089} In this and other embodiments, the EIS sensor 200 shown in Figure 3A miniaturizes the sensor set-up shown in Figures 2A and 2B. The second sensor assembly 302 can act as an on-chip reference electiode and obviates the need of an external reference electiode, such as the external reference electrode 202. The passivation layer 304 of the second sensor assembly 302 prevents the interaction of the second sensor assembly 302 with the ions, analyte, or other byproducts in the fluid sample 204 or electrolyte solution in order to be able to differentiate the electrical signals obtained by the parameter analyzer 114 or another reader.

[0090J Figure 3B illustrates a side cross-sectional view of yet another embodiment of the EIS sensor 200. As depicted hi Figure 3B, the EIS sensor 200 can have the first sensor assembly 300 of Figure 3 A and an on-chip reference electrode 306 made of a conductor layer 308. hi one embodiment the conductor layer 308 can be a metal covered with a metal salt such as a metal chloride. For example, the conductor layer 308 can be a silver/silver chloride contact. Ei this embodiment, the conductor layer 308 can be covered by a passivation layer 304 such as a KCL electrolyte gel, to prevent interference with the analyte, ions, or byproducts in the fluid sample 204 or electrolyte solution. For example, the passivation layer 304 can be comprised of silanes, SAMs, buffered hydrogels. PVC, parylene, polyACE, or any other biochemically-inert or pH insensitive material.

[0091] Although example EIS sensor 200 are presented in Figures 2A, 2B, 3 A, and 3B, it is understood by one of ordinary ^' skill in the art that die EIS sensors disclosed in U.S. Patent No. 5,182.005 to Schwiegk et al.; the EIS sensors disclosed in Poghossian et al. Penicillin Detection by Means of Field-Effect Ba sed Sensors : EnFET, Capacitive EIS Sensor or LAPS? Sensors and Actuators B (2001) 78: 237; the EIS sensors disclosed in Schoning, Michael J., 'Playing Around ^* with Field-Effect Sensors on the Basis of EIS Structures, LAPS and ISFETs, Sensors (2005) 5: 126-138; and the EIS sensors disclosed in Kumar et al.. Sensitivity Enhancement Mechanisms in Textured Dielectric Based

Electrolyte-Iiisiilator-Seniiconductoi" (EIS) Sensors, ECS Journal of Solid State Science and Technology (2015) 4(3): N18-N23, the contents of which are all incorporated herein by reference in then entireties, can also be used to detect the susceptibility of an infectious agent in a fluid sample to one or more anti-infectives according to the methods or processes disclosed herein. In addition, the EIS sensor 200 can comprise filters, well plates, wells, readers, analyzers, electrodes, sensor contacts, sensor components, sensor layers, or substrates disclosed in any of U.S. Patent Application No. 14/297,603, filed on June 5, 2014; U.S. Patent Application No. 14/586,802, filed on December 30, 2014; U.S. Patent Application No. 14/878,936, filed on October 8, 2015; U.S. Patent Application No.

15/081,491, filed on March 25, 2016; U.S. Patent Application No. 15/159,625, filed on May 19, 2016; U.S. Patent Application No. 15/236,260, filed on August 12, 2016; and U.S. Pa tent No. 9,377,456, the contents of which are all hereby incorporated by reference in their entireties.

[0092} Figure 4 illustrates one example of capacitance/voltage (C/V) curves displayed by the system 100. As can be seen in the C V curves of Figure 4, the difference betwee the solution characteristics of two fluid samples or one fluid sample over time can be measured by the change in the voltage (ΔΥ) at a constant capacitance. In one example, the hydroxy! groups of insulator layer 216 can interact with the hydrogen ions (W) in the fluid sample 204 or electrolyte solution. This ca create a additional voltage or capacitance at the surface of the EIS sensor 200. This additional voltage capacitance will alter the C V curves. Also, for example, the analyte or ion can interact with the ftinctionalization layer 218 causing the same effect. To obtain a dynamic sensor response, the EIS sensor 200 can also be operated in a constant capacitance mode. In this constant capacitance mode, the capacitance can be set a fixed value (e.g., a flat-band capacitance) and the voltage shift (AV) that results fro the surface potential generated at the interface of the

layer can be directly recorded.

[0093] Figure 5 illustrates a method 500 for detecting a susceptibility of an infectious agent 102 to one or more anti-infectives- 104. The method 500 can include introducing a fluid sample 124 to a fust surface, such as the first filter surface 126A, and a second surface, such as the second filter surface 126B, in a step 502. The method 500 can also include exposing the first surface to a first solution, such as the nutrient solution 130, in a step 504. The first smface can comprise the infectious agent 102 when the infectious agent 102 is present in the fluid sample 124.

[00941 The method 500 can also include exposing the second smface to a second solution, such as additional instances of the nutrient solution 130 in a step 506. The second surface can comprise one or more anti-infectives 104 or anti-infectives of differing concentrations. The second surface can also comprise the infectious agent 102 when the infectious agent 102 is present in the fluid sampie 124.

[0095} Tlie method 500 can also include sampling the first solution after exposing the fust solution to the first surface in step 508. Sampling the first solution can include sampling the effluent or outflow of the first solution, such as the first sample effluent 134A. In one embodiment, sampling the fust solution can also involve separating the first solution from the first surface so the first solution is not in fluid conmmnication with the first surface, the infectious agent 102 on the first surface, or a combination thereof when sampled. The method 500 can also mclude sampling the second solution after exposing the second solution to the second smface in step 510. Sampling the second solution can include sampling the effluent or outflow of the second solution, such as the second sample effluent 134B. In one embodiment, sampling the second solution can also involve separating the second solution from the second surface so the second solution is not in fluid

conimunication with the second surface, the infectious agent 102 on the second surface, or a combination thereof when sampled.

[0096| Tlie method 500 can also include monitoiing a first electrical characteristic of a first EIS sensor ϊ 16A exposed to the first solution sampled in step 512. The method 500 can also include monitoring a second electrical characteristic of a second EIS sensor ϊ 16B exposed to the second solution sampled in step 514. The method 500 can further include comparing the first eiectiical characteristic and the second eiectiical characteristic to assess the susceptibility of the infectious agent 02 to the anti-infective 104 in step 516.

[00971 The flowcharts or process flows depicted in Figure 5 do not require the

particular order shown/to achieve the desired result and certain steps or processes may occur in parallel.

[0098] Figure 6 illustrates another method 600 for detecting a susceptibility of an infectious agent 102 to one of more anti-mfectives 104. The method 600 can include introducing a fluid sample 124 to a first surface, such as the first filter surface 126 A, and a second surface, such as the second filter surface 126B, in a step 602. The method 600 can also include exposing the first surface to a first solution, such as the nutrient solution 130, in a step 604. The first surface can comprise the infectious a ent 102 when the infectious agent 02 is present in the fluid sample 124.

[0099] The method 600 can also include exposing the second surface to a second solution, such as additional instances of the nutrient solution 130 in a step 606. The second surface can comprise one or more anti -infec tives 104 or anti -infec tives of differing concentrations. The second sm face can also comprise the infectious agent 102 when the infectious agent 102 is present in the fluid sample 124.

[0100] The method 600 can also include sampling the first solution after exposing the first solution to the first smface in ste 608. Sampling the first solution can include sampling the effluent or outflow of the first solution, such as the first sample effluent 134A. hi one embodiment, sampling the first solution can also involve separating the first solution from the first smface so the first solution is not in fluid communication with the first surface, the infectious agent 102 on the first surface, or a combination thereof. The method 600 can also include sampling the second solution after exposing the second solution to the second surface in step 610. Sampling the second solution can include sampling the effluent or outflo w of the second solution, such as the second sample effluent 134B. In one embodiment, sampling the second solution can also involve separating the second solution from the second surface so the second solution is not in fluid

communication with the second surface, the infectious agent 102 on the second sm face, or a combination thereof.

[OlOi] The method 600 can also include monitoring first electrical characteristic of an EIS sensor 116 exposed to the first solution sampled in step 612. Hie method 600 can also include monitoring a second electrical characteristic of the EIS sensor 116 exposed to the second solution sampled in ste 14. The method 600 can further include comparing the first electrical .characteristic, and .the second electrical characteristic to assess the susceptibility of the infectious agent 102 to the anti-infective 104 hi step 616.

[01021 ^' ¾e flowcharts or process flows depicted in Figure 6 do not require the particular order shown/to achieve the desired result and certain steps or processes may occur in parallel.

[0103] Each of the individual variations or embodiments described and illustrated herein lias discrete components and features which may be readily separated from or combined with the features of any of the other variations or embodiments. Modifications may be made to adapt a particular situation, material, composition of matter, process, process act(s) or step(s) to the objective(s), spirit or scope of the present invention.

[0104] Methods recited herein may be earned out hi any order of the recited events that is logically possible, as well as the recited order of events. For example, the flowcharts or process flows depicted in the figures do not require the particular order shown to achieve the desired result. Moreover, additional steps or operations may be provided or steps or operations may be eliminated to achieve the desired result.

[0105] It will be understood by one of ordinary skill in the art that a ll or a portion of the methods disclosed herein may be embodied in a non-transitory machine readable or accessible medium comprising instructions readable or executable by a processor or processing unit of a computing device or oilier type of machine.

[0106] Furthermore, where a range of values is provided, every intervening value between the upper and lower limit of that range and any other stated or intervening value in that stated range is encompassed within the invention. Also, any optional feature of the inventive variations described may be set forth and claimed independently, or in combination with any one or more of the fea tures described herein.

[0107J All existing subject matter mentioned herein {e.g. , publications, patents, patent applications and hardware) is incorporated by reference herein in its entirety except insofar as the subject matter may conflict with that of the present invention (in which case what is present herein shall prevail). Tire referenced items are provided solely for then disclosure prior to the tiling date of the present application. Nothing herein is to be construed as an admission that the present invention is not entitled to antedate such material by virtue of prior invention.

[0I08J Reference to a singular item, includes the possibility that there are plural of the same items present. More specifically, as used herein and in the appended claims, the singular forms " ," "an," "said" and 'the" include plural referents unless the context clearly dictates otherwise. It is further noted that the claims may be drafted to exclude any optional element. As such, this statement is intended to serve as antecedent basis for use of such exclusive terminology as "solely," "only" and the like in connection with the recitation of claim elements, or use of a "negative" Limitation. Unless defined otherwise, all technical and scientific terms used herein ^' have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs.

[0109] This disclosure is not intended to be limited to the scope of the particular forms set forth, but is intended to cover alternatives, modifications, and equivalents of the variations or embodiments described herein. Further, the scope of the disclosure fully encompasses other variations or embodiments that may become obvious to those skilled in the art hi view of tins disclosure. The scope of the present invention i limited only by the appended claims.