Infectious disease physicians rate microbiology services and practices

Quality of the aetiological diagnosis of ventilator-associated pneumonia in Spain in the opinion of intensive care specialists and microbiologists

INTRODUCTION

Current guidelines for the microbiological diagnosis of ventilator-associated pneumonia (VAP) are imprecise. Based on data provided by intensive care specialists (ICS) and microbiologists, this study defines the clinical practices and microbiological techniques currently used for an aetiological diagnosis of VAP and pinpoints deficiencies.

METHODS

Eighty hospitals in the national health network with intensive care and microbiology departments were sent two questionnaires, one for each department, in order to collect data on VAP diagnosis for the previous year.

RESULTS

Out of the 80 hospitals, 35 (43.8%) hospitals participated. These included 673 ICU beds, 32,020 ICU admissions, 173,820 ICU days stay, and generated 27,048 lower respiratory tract specimens in the year. A third of the hospitals (35%) had a microbiology department available 24/7. Most samples (83%) were tracheal aspirates. Gram stain results were immediately reported in around half (47%) of the hospitals. Quantification was made in 75% of hospitals. Molecular techniques and direct susceptibility testing were performed in 12% and one institution, respectively. Mean turnaround time for a microbiological report was 1.7 (SD; 0.7), and 2.2 (SD; 0.6) days for a negative and positive result, respectively. Telephone/in-person information was offered by 65% of the hospitals. Most (89%) ICS considered microbiological information as very useful. No written procedures were available in half the ICUs.

CONCLUSIONS

Both ICS and microbiologists agreed that present guidelines for the diagnosis of VAP could be much improved, and that a new set of consensus guidelines is urgently required. A need for guidelines to be more effectively implemented was also identified in order to improve outcomes in patients with VAP.

The role of the laboratory in choosing antibiotics

OBJECTIVE

Antimicrobial resistance is one of the biggest problem in medicine at the beginning of the third millennium. Antibiotic resistance is frequently associated with significant morbidity, longer hospitalization, excess costs and mortality.

METHODS

In this work we discussed the role of clinical microbiology laboratory as an essential part for an effective infection control program, especially in management and treatment of "difficult infections".

RESULTS

At present time, laboratory personnel have a broad range of new technologies that they can use to support and enhance the efforts of the infection control staff. In addition a network of established experts in the determination of antimicrobial breakpoints and in antimicrobial susceptibility testing has been constituted in Europe under the auspices of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the European Centre for Disease Prevention and Control (ECDC).

CONCLUSION

Qualified personnel and new strategies to overcome drug resistance can contribute to solve the microbial infections problems.

Speculations on the microbiology laboratory of the future

Changes in the availability of skilled laboratory personnel, new technologies, and the financial environment will all influence the practice of diagnostic microbiology in the near and more distant future. Because of the special expertise needed for the accurate identification of anaerobic bacteria, the ability to diagnose anaerobic infections may decline as a consequence of these changes. Physicians should anticipate a difficult time in the years between the loss of expertise in traditional methods and development of reliable and accurate molecular assays.

Role of clinical microbiology laboratories in the management and control of infectious diseases and the delivery of health care

Modern medicine has led to dramatic changes in infectious diseases practice. Vaccination and antibiotic therapy have benefited millions of persons. However, constrained resources now threaten our ability to adequately manage threats of infectious diseases by placing clinical microbiology services and expertise distant from the patient and their infectious diseases physician. Continuing in such a direction threatens quality of laboratory results, timeliness of diagnosis, appropriateness of treatment, effective communication, reduction of health care-associated infections, advances in infectious diseases practice, and training of future practitioners. Microbiology laboratories are the first lines of defense for detection of new antibiotic resistance, outbreaks of foodborne infection, and a possible bioterrorism event. Maintaining high-quality clinical microbiology laboratories on the site of the institution that they serve is the current best approach for managing today's problems of emerging infectious diseases and antimicrobial agent resistance by providing good patient care outcomes that actually save money.