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The role of labs in antimicrobial stewardship Microbiology labs are at the forefront of antimicrobial stewardship efforts, able to both optimise treatment options in individual cases and assist infection control efforts in the surveillance of resistant organisms. Lab Management & Science spoke to clinical microbiologist Dr Chetna Govind about the crucial role labs play in this vital field. “The best way to look at antimicrobial
reports that monitor the most common
point in the day are placed on culture plates,
stewardship is to view it as a bundle of
bacterial organisms in their practice
then placed in an incubator,” Dr Govind
interventions aimed at optimising patient
environments. This is also a great way to
said. “The next day you evaluate the samples
care while minimising resistance,” said
determine what the susceptibilities of your
by subjecting them to biochemical testing,
Dr Govind, a past chairperson of the South
environment or patient.
including a susceptibility test. This traditional
African Society for Clinical Microbiology
“What is the microbial aetiology? Is it
approach is a very manual process. However,
(SASCM). “The idea is to produce results
bacterial, is it pneumococcal? Is it viral?
we have learned that, despite our love for the
that lead to the best clinical outcome for the
If so, which virus are we looking for?”
manual process, it has to be moved towards
treatment or prevention of infection, with
Dr Govind said. “The most appropriate test
automation. The manual process takes a
minimal toxicity to the patient and minimal
to determine the nature of an infection can
lot of time, and unfortunately the modern
impact on subsequent resistance.”
only be determined in the lab.” It is also
medical diagnostic environment requires you
imperative that labs generate cumulative
to be fast. The move towards automation is
implemented antimicrobial stewardship
antimicrobial susceptibility reports (CASRs)
therefore of paramount importance.”
results in the best clinical outcome for
to inform local guidelines and assist their
the treatment or prevention of infection,
efforts to collaborate with infection control
were foiled not only by the variety of
with minimal toxicity to the patient and
professionals in outbreak investigations.
specimens and container types, from stool
According to Dr Govind, properly
minimal impact on subsequent resistance.
Early detection of resistant organisms is
Early attempts at microbiology automation
samples and bone biopsies to tubes of
While the frontline against the growing
essential and laboratories serve as an early
blood, but also by the variety of methods
threat of antimicrobial resistance is
warning system. “Let’s say a patient presents
required to identify organisms. Even as
the clinical healthcare setting, much of
with a chest infection of unknown origin,”
mass spectrometry has standardised
the real heavy lifting is performed by
Dr Govind says. “The laboratory can help
microbe identification, and blood culture
clinicians in microbiology laboratories.
diagnose the patient accurately and provide
and antimicrobial susceptibility testing have
“The role of the lab is absolutely essential,”
empiric antibiotic choices to doctors based on
been automated, laboratories still often
Dr Govind said. “Laboratories should guide
that diagnosis. We can also monitor for sepsis
conduct specimen processing and culture
healthcare workers in terms of the possible
markers in samples from the patient and
workup by hand. Now, however, that may
microbiological aetiologies of the diseases
monitor the patient for signs of nosocomial
finally be changing.
they are investigating.”
event formation.”
“Essentially, an automated microbiology lab is one in which a sample is fed onto a
Labs an essential support system
Lab automation
track system on one end and a culture plate
Because of the ubiquitous nature of
Today’s microbiology labs face many
and image is produced at the other end,”
pathogens that could potentially become
challenges – including increasing volumes,
Dr Govind said. The system includes a smart
resistant, Dr Govind recommends that
cost containment pressures, staff shortages
incubator, which allows researchers to
healthcare practitioners and infection
and the introduction of new testing
abandon the traditional method of leaving
control experts maintain surveillance
techniques. All of these factors are driving
the specimen overnight in favour of a system
the need to do more with less. When it
which lets them incubate each specimen for
comes to automation, clinical microbiology
an optimum period of time.
Despite our love for the manual process, the future of the microbiology lab is automated
has for many years lagged behind other laboratory disciplines. Robotics and computer
Automation equipment
processing revolutionised chemistry and
There are a number of cutting-edge and
haematology instruments decades ago.
expensive pieces of lab equipment to achieve
Meanwhile, clinical microbiologists continue
her optimisation objectives. They are the
to open specimen containers by hand and
IRIS urinalysis machine, the MALDI-Link,
grow bacteria using methods familiar to
the BD-MAX enteric bacterial panel and
microbiologists from the 19th century.
the GeneXpert MTB/RIF tuberculosis tester.
“Traditionally, samples that arrive at some w w w.lm s m a g a z i n e .c o. z a
The first of these, the MALDI-Link, is used
LMS Issue 1 | 2019
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