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The article discusses research that highlights the differences in urine sample standard operating procedures (SOP) among different clinical microbiology departments in Denmark. Topics covered include the potential for introducing bias in statistics in local laboratory information systems and national databases, bacterial or fungal findings in urine cultures, and the effect of new SOP on urine culture positive rate and number of registered hospital-acquired symptomatic urinary tract infection.

• The DxU 850m Iris Urine Microscopy analyzer has low sensitivity in UTI-screening. • Increasing the cutoffs for significant growth has minor effect on sensitivity. • Low sensitivity is limiting particle analysis as screening tool for urine samples. We evaluated the DxU 850m Iris Urine Microscopy analyzer as a screening tool for excluding negative urine samples (n = 1337). At a cutoff of 103 colony counts·mL−1, sensitivity was 55.1 %, specificity 68.6 %. The DxU 850m Iris does not offer acceptable prediction of culture-negative urine samples at the tested cutoff. [ABSTRACT FROM AUTHOR]

The EFLM Task and Finish Group Urinalysis has updated the ECLM European Urinalysis Guidelines (2000) on urinalysis and urine bacterial culture, to improve accuracy of these examinations in European clinical laboratories, and to support diagnostic industry to develop new technologies. Graded recommendations were built in the following areas: Strategies of urine testing are described to patients with complicated or uncomplicated urinary tract infection (UTI), and high or low-risk to kidney disease. Patient preparation, and urine collection are supported with two quality indicators: contamination rate (cultures), and density of urine (chemistry, particles). Measurements of both urine albumin and α1-microglobulin are recommended for sensitive detection of kidney disease in high-risk patients. Performance specifications are given for urine protein measurements and quality control of multiproperty strip tests. Procedures for microscopy are reviewed for diagnostic urine particles, including urine bacteria. Technologies in automated particle counting and visual microscopy are updated with advice how to verify new instruments with the reference microscopy. Chromogenic agar is recommended as primary medium in urine cultures. Limits of significant growth are reviewed, with an optimised workflow for routine specimens, using leukocyturia to reduce less important antimicrobial susceptibility testing. Automation in bacteriology is encouraged to shorten turn-around times. Matrix assisted laser desorption ionization time-of-flight mass spectrometry is applicable for rapid identification of uropathogens. Aerococcus urinae, A. sanguinicola and Actinotignum schaalii are taken into the list of uropathogens. A reference examination procedure was developed for urine bacterial cultures. [ABSTRACT FROM AUTHOR]

Background: Azole resistance complicates treatment of patients with invasive aspergillosis with an increased mortality. Azole resistance in Aspergillus fumigatus is a growing problem and associated with human and environmental azole use. Denmark has a considerable and highly efficient agricultural sector. Following reports on environmental azole resistance in A. fumigatus from Danish patients, the ministry of health requested a prospective national surveillance of azole‐resistant A. fumigatus and particularly that of environmental origin. Objectives: To present the data from the first 2 years of the surveillance programme. Methods: Unique isolates regarded as clinically relevant and any A. fumigatus isolated on a preferred weekday (background samples) were included. EUCAST susceptibility testing was performed and azole‐resistant isolates underwent cyp51A gene sequencing. Results: The azole resistance prevalence was 6.1% (66/1083) at patient level. The TR34/L98H prevalence was 3.6% (39/1083) and included the variants TR34/L98H, TR343/L98H and TR34/L98H/S297T/F495I. Resistance caused by other Cyp51A variants accounted for 1.3% (14/1083) and included G54R, P216S, F219L, G54W, M220I, M220K, M220R, G432S, G448S and Y121F alterations. Non‐Cyp51A‐mediated resistance accounted for 1.2% (13/1083). Proportionally, TR34/L98H, other Cyp51A variants and non‐Cyp51A‐mediated resistance accounted for 59.1% (39/66), 21.2% (14/66) and 19.7% (13/66), respectively, of all resistance. Azole resistance was detected in all five regions in Denmark, and TR34/L98H specifically, in four of five regions during the surveillance period. Conclusion: The azole resistance prevalence does not lead to a change in the initial treatment of aspergillosis at this point, but causes concern and leads to therapeutic challenges in the affected patients. [ABSTRACT FROM AUTHOR]

Die EFLM Task and Finish Group Urinalysis hat die ECLM European Urinalysis Guideline aus dem Jahr 2000 zur Urinanalyse und Urinbakterienkultur für Patient:innen mit Harnwegsinfektionen und mit unterschiedlichem Risiko für Nierenerkrankungen aktualisiert. Die Leitlinie unterstützt medizinisch begründete und wirtschaftlich ausgewogene Laborprozesse unter Berücksichtigung der Anforderungen der DIN EN ISO 15189:2022 sowie die Diagnostikindustrie bei Qualitätsspezifikationen für neue Technologien. [ABSTRACT FROM AUTHOR]

The article discusses application of Copan eSwab™ media as diagnostic tool in bacterial keratitis. It mentions that Copan is a liquid-based transport system that maintains viability of bacteria for up to 48 hours. It examines the sensitivity and specificity of Copan media compared to direct sampling on agar plates in patients with bacterial keratitis. It notes that agar plates are more sensitive and with higher specificity than Copan for the diagnosis of bacterial keratitis.

Mucormycosis is a life threatening infection in patients with haematological disease. We introduced a Mucorales-PCR and an aggressive, multidisciplinary management approach for mucormycosis during 2016-2017 and evaluated patient outcomes in 13 patients diagnosed and treated in 2012-2019. Management principle: repeated surgical debridement until biopsies from the resection margins were clean as defined by negative Blankophor microscopy, Mucorales-PCR (both reported within 24 h), and cultures. Cultured isolates underwent EUCAST E.Def 9.3.1 susceptibility testing. Antifungal therapy (AFT) (mono/combination) combined with topical AFT (when possible) was given according to the minimal inhibitory concentration (MIC), severity of the infection, and for azoles, specifically, it was guided by therapeutic drug monitoring. The outcome was evaluated by case record review. All patients underwent surgery guided by diagnostic biopsies from tissue and resection margins (195 samples in total). Comparing 2012-2015 and 2016-2019, the median number of patients of surgical debridements was 3 and 2.5 and of diagnostic samples: microscopy/culture/PCR was 3/3/6 and 10.5/10/10.5, respectively. The sensitivity of microscopy (76%) and Mucorales-PCR (70%) were similar and microscopy was superior to that of culture (53%; p = 0.039). Initial systemic AFT was liposomal amphotericin B (n = 12) or posaconazole (n = 1) given as monotherapy (n = 4) or in combination with isavuconazole/posaconazole (n = 3/6) and terbinafine (n = 3). Nine patients received topical amphotericin B. All received isavuconazole or posaconazole consolidation therapy (n = 13). Mucormycosis related six month mortality was 3/5 in 2012-2015 and 0/7 patients in 2016-2019 (one patient was lost for follow-up). Implementation of combination therapy (systemic+topical AFT/combination systemic AFT) and aggressive surgical debridement guided by optimised diagnostic tests may improve the outcome of mucormycosis in haematologic patients. [ABSTRACT FROM AUTHOR]