Training laboratory technicians from the Ethiopian periphery in the MODS technique enables rapid and low-cost diagnosis of Mycobacterium tuberculosis infection

Tuberculosis (TB) is a leading cause of morbidity and mortality and is frequently complicated by emergence of drug-resistant strains. Diagnosis of TB in developing countries is often based on the relatively insensitive acid-fast staining that does not enable susceptibility profiling. Microscopic observation drug susceptibility assay (MODS) is an inexpensive, simple method that enables rapid TB culture coupled with susceptibility testing. A 3-week MODS training of three Ethiopian laboratory technicians was conducted at Hadassah-Hebrew University Medical Center, Israel. Results of the trainee readings were blindly assessed by an experienced instructor. Two hundred fifty-five (255) trainee culture readings were evaluated throughout the course. The sensitivity and specificity were 75-100% and 31.5-100%, respectively. Multivariate analysis revealed that sensitivity and duration of incubation were positively correlated, although specificity was positively correlated with the length of training. MODS can be reliably performed by laboratory technicians inexperienced in culture techniques in developing countries, with high sensitivity and specificity reached after a brief learning period.

Limitations of paperless on-line reporting of diagnostic bacteriology culture results

AIMS

To estimate the extent to which microbiology laboratory results made available on a computerised reporting system do not reach their intended destination.

METHODS

Prospective observational study of 180 urine cultures submitted from patients seen at the accident and emergency department of a 250 bed university affiliated general hospital. Observations were made of: telephone requests for results; whether results were noted in patients' charts; and antibiotic administration to patients sent home.

RESULTS

Results were requested/recorded for 73% of 37 patients admitted to hospital and for only 23% of 143 patients sent home (p < 1 x 10(-7)). Overall, results were more frequently recorded for patients with positive cultures (p = 0.04). When determined separately for admitted and discharged groups, this association was not shown. Three of 14 culture positive patients sent home and for whom results were not recorded received inappropriate therapy; 19 culture negative patients were given antibiotics.

CONCLUSIONS

In view of the results, measures were instituted to ensure delivery of printed reports to the health care providers of patients not admitted from the accident and emergency department. Organisations operating computerised reporting systems in evolving health care settings must ensure that system design guarantees delivery of reports to all end-users. This will minimise therapeutic problems, reduce wastage of laboratory resources, and limit risks of litigation.

Utility of clinical symptoms versus laboratory tests for evaluation of acute gastroenteritis

Our purpose was to find the utility of laboratory tests in emergency ward evaluation of patients with gastroenteritis. Medical records of 163 adult cases were retrospectively reviewed. Blood laboratory tests were drawn in 116 cases, 78 had at least one abnormality. Urine tested ketone-positive in 15 of 116 cases. One hundred fifteen were treated with intravenous fluids, 20 with antibiotics, and 4 were admitted. Fifty-eight stool cultures were sent, and 13 yielded enteric pathogens. Cultures from patients with fever or symptoms of long duration had higher yields (57% vs 11.3% and 38.1% vs 0%, P < 0.001, respectively), and when combined had sensitivity of 100% and specificity of 65%. There was no association between abnormal blood laboratory results, intravenous hydration, and antibiotic treatment with the stool culture being positive or with the patient being hospitalized. Laboratory tests are used often, but are very seldom contributory for evaluating domestically acquired gastroenteritis.