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The COVID-19 shutdown forced many institutions of higher education to shift in-person teaching to emergency remote teaching. This was particularly challenging for laboratory courses, where students are expected to learn hands-on skills needed for their career goals. Here, we describe the transformation of an upper-division microbiology laboratory to a course that seamlessly integrates online simulations with safe, hands-on experiences that can be done from home. This blended lab course helped students attain learning outcomes similar to those achieved in the in-person class. We illustrate the implementation of Unknown Portfolios to help students gain the data analysis and critical thinking skills needed to identify an unknown microorganism. Our data show that students who took these online courses mastered material as well as students who took the lab in person, demonstrating proficiency in laboratory safety skills, hands-on techniques, and theoretical class content. Last, we explore online adaptations to enhance in-person lab classes, aiming at reducing the accessibility and equity gaps inherited in many courses, as well as discussing challenges that instructors might experience in this process.

The COVID pandemic has put a spotlight on laboratory medicine, showcasing how vital diagnostic testing is for society and the health care system. It has also brought to light and accelerated the critical shortage of trained and experienced laboratory personnel that has been felt for decades. The need for laboratory professionals is expected to grow by 11% between 2020 and 2030, a higher rate of growth than the overall average for all other health care occupations. Here, the background to this workforce shortage is reviewed. Some proposed actions to help address the issue are put forth, including increasing awareness of the medical laboratory science profession along with bolstering training opportunities and awareness of alternate routes to obtaining certification as a medical laboratory scientist. In addition, recent survey data specifically related to the employee shortages in microbiology are presented which demonstrate that 80% of microbiology laboratories have vacant positions and that filling these positions is challenging for a number of reasons, including a lack of qualified applicants.

Cryptosporidium spp., Giardia duodenalis and Entamoeba histolytica are species of protozoa- causing diarrhoea that are common worldwide, while Entamoeba dispar, Dientamoeba fragilis and Blastocystis sp. appear to be commensal parasites whose role in pathogenicity remains controversial. We conducted the clinical evaluation of five singleplex and one duplex CerTest VIASURE Real-Time PCR Assays against a large panel of positive DNA samples (n = 358), and specifically to Cryptosporidium spp. (n = 96), G. duodenalis (n = 115), E. histolytica (n = 25) E. dispar (n = 11), Blastocystis sp. (n = 42), D. fragilis (n = 37), and related parasitic phylum species such as Apicomplexa, Euglenozoa, Microsporidia and Nematoda. DNA samples were obtained from clinical stool specimens or cultured isolates in a national reference centre. Estimated diagnostic sensitivity and specificity values were 0.94–1 for Cryptosporidium spp., 0.96–0.99 for G. duodenalis, 0.96–1 for E. histolytica, 1–1 for E. dispar, and 1–0.99 for D. fragilis in the evaluated singleplex assays. In the duplex assay for the simultaneous detection of Blastocystis sp. and D. fragilis these values were 1–0.98 and 1–0.99, respectively. Measures of diagnostic precision for repeatability and reproducibility were found to be under acceptable ranges. The assays identified six Cryptosporidium species (C. hominis, C. parvum, C. canis, C. felis, C. scrofarum, and C. ryanae), four G. duodenalis assemblages (A, B, C, and F), and six Blastocystis subtypes (ST1-ST5, and ST8). The evaluated singleplex and duplex VIASURE Real-Time PCR assays provide sensitive, practical, and cost-effective choices to the molecular diagnosis of the main diarrhoea-causing intestinal protists in clinical microbiology and research laboratories. [ABSTRACT FROM AUTHOR]

Healthcare services and institutions are focused on providing the most appropriate medical service in terms of patient safety and satisfaction outcomes. According to Lean methodologies, effectiveness and efficiency can be improved by assuring value-added processes. This article presents a joint approach for the development and implementation of Lean techniques combined with Total Laboratory Automation (TLA) for serology diagnosis in a microbiology laboratory in a tertiary-level hospital. The results obtained show an improvement in the process efficiency and its key performance indicators. In particular, for the HIV and COVID tests, the process Turnaround Times (TAT) were decreased by up to 87.3% and 19.3%, having a direct effect in the diagnostic response time. The process added-value for HIV tests increased by 81%. This meant a cost reduction per test, a higher number of diagnostic tests and clinical samples processed and laboratory resource optimisation. The implementation of TLA also enabled the reallocation of skilled labour towards value-added tasks, increased the process quality and reduced sample waiting times. This work opens up new opportunities for their deployment in other laboratory areas and sample types, directly influencing the overall quality of patient diagnosis in the context of tertiary healthcare facilities. [ABSTRACT FROM AUTHOR]

ABSTRACT The online education market share is rapidly increasing, raising the demand to teach sciences outside the laboratory environment. Here, we present Microbiology at Home (M@H), a new approach that integrates hands-on microbiology experimentation with online interactive simulations using authentic scenarios in microbiology in the home environment. The M@H program includes 8 practical activities aligned to the ASM curriculum for practical skills. M@H kits are mailed to students, and each practical activity is prepacked individually with the required consumables, including microbial culture media to prepare at home using a microwave. These practicals are self-paced, and each activity is facilitated using a two-dimensional simulation package with prerecorded videos, protocols, and interactive activities. The students receive both synchronous and asynchronous support and guidance through online learning management systems fora and virtual gatherings. The M@H program was applied to an Introductory Microbiology cohort at the University of New England in 2020 and 2021. Based on student feedback, the experience not only provided real hands-on practice in microbiology but also acted to cement the engagement with the content by contextualizing it to the surrounding home environment. We anticipate that these activities will provide a way to successfully engage students with hands-on microbiology without the need for actual laboratory attendance, thus increasing accessibility to microbial protocols and applications.

The interpretation of microbiological results depends, to a large extent, on the quality of the samples received for investigations. Even with the advancements in laboratory automation and integration of molecular diagnosis in microbiology, interpretation of results still depends on the quality of specimens received. Therefore, an appropriate management of the samples is necessary to achieve an optimal diagnosis in microbiology laboratory. Recently, clinical microbiologists have begun to promote specimen management as a process critical to diagnostic success. Microbiology laboratory results that are accurate, significant and clinically relevant depend almost entirely on specimen management process. This article review the specimen management process, special skills and precise concepts required to collect the specimens for effective methods in diagnosis. [ABSTRACT FROM AUTHOR]

ObjectiveTo investigate the current situation of food safety knowledge， attitude and behavior （KAP） among professional technicians in food microbiology laboratory in China and explore the influencing factors， so as to provide the reference for improving their comprehensive ability.MethodsA questionnaire survey of food safety KAP covering 15 provinces in China was conducted among professional technicians in food microbiology laboratories subordinate to provincial， municipal and district （county） government departments and food microbiology laboratories of non-governmental organizations such as third-party institutions and enterprises， and the results were analyzed using statistical methods.ResultsA total of 1 505 questionnaires were collected and 1 386 were valid with an average score of 0.63 ± 0.14. Except for gender and the time of recent training， there were significant differences in the food safety KAP scores at different ages， academic qualifications， years of employment， professional background， department subordinated， administration levels， region where the lab was located and usual training form. A positive correlation had been found among knowledge， attitude and behavior scores.ConclusionAlthough some professionals got full marks， the average score was only slightly higher than the qualified level. The results of statistical analysis suggested that some professionals such as new recruits and professional technicians with lower academic qualification should pay attention to the improvement of food safety knowledge and accumulation of work experience， so as to constantly improving their professional skills. The comprehensive knowledge on food safety of technicians from laboratory at municipal and district （county） levels should also be strengthened. The technical trainings in the form of on-site training were suggested.

Healthcare services and institutions are focused on providing the most appropriate medical service in terms of patient safety and satisfaction outcomes. According to Lean methodologies, effectiveness and efficiency can be improved by assuring value-added processes. This article presents a joint approach for the development and implementation of Lean techniques combined with Total Laboratory Automation (TLA) for serology diagnosis in a microbiology laboratory in a tertiary-level hospital. The results obtained show an improvement in the process efficiency and its key performance indicators. In particular, for the HIV and COVID tests, the process Turnaround Times (TAT) were decreased by up to 87.3% and 19.3%, having a direct effect in the diagnostic response time. The process added-value for HIV tests increased by 81%. This meant a cost reduction per test, a higher number of diagnostic tests and clinical samples processed and laboratory resource optimisation. The implementation of TLA also enabled the reallocation of skilled labour towards value-added tasks, increased the process quality and reduced sample waiting times. This work opens up new opportunities for their deployment in other laboratory areas and sample types, directly influencing the overall quality of patient diagnosis in the context of tertiary healthcare facilities.

ABSTRACT Microbiology laboratory classes allow students to make connections between theoretical concepts and clinical practice through experiential learning. In the past, most laboratory sessions were taught in-person, on-site. However, advances in multimedia and the ability of learning management systems to provide online course delivery allow laboratory assignments to be taught through online simulations. An online unknown identification activity promotes active learning while allowing instructors to assess student knowledge. This article describes the creation of online clinical microbiology unknown assignments which are suitable for complementing a variety of microbiology courses in an online, hybrid, or in-person format.

Abstract Background Prompt and accurate identification of carbapenemase production is essential for appropriate treatment and infection control. NG-Test Carba 5 (termed herein “Carba 5”; NG Biotech, Guipry, France) is a multiplex immunochromatographic assay for the rapid phenotypic identification of five major carbapenemases (KPC, NDM, VIM, IMP, and OXA-48-like) from bacterial isolates. This study aimed to evaluate the diagnostic performance of Carba 5 and its impact on the turn-around-time in a clinical microbiology laboratory. Results Carba 5 was retrospectively evaluated using 78 carbapenemase producers and 23 non-carbapenemase producers confirmed by PCR and sequencing. The performance and time required for carbapenemase identification were prospectively evaluated using 47 carbapenem resistant Enterobacteriaceae isolates, and the results were compared to those obtained using Xpert Carba-R (Cepheid, Sunnyvale, CA, USA). For the bacterial isolates included in retrospective and prospective evaluation, the Carba 5 assay correctly identified 147 isolates except one isolate with a sensitivity of 99.13% (95% CI 95.25–99.98%) and specificity of 100% (95% CI 89.42–100%). The Carba 5 assay missed one VIM-1 among 13 VIM producers. The assay showed a sensitivity of 92.31% (95% CI 63.97–99.81%) for detecting VIM and 100% for detecting KPC, NDM, OXA-48-like, and IMP. Compared to the Xpert Carba-R assay, Carba 5 exhibited 100% agreement and was more time-efficient (median time 24 min vs. 1 h 11 min). Conclusions The Carba 5 assay has potential as an alternative to molecular methods for detecting major carbapenemases from bacterial isolates in a clinical microbiology laboratory. Compared to the Xpert Carba-R, Carba 5 turns out to be more affordable and time-efficient while showing a comparable performance, and may accelerate therapeutic and infection control decisions.

ABSTRACT The COVID-19 shutdown forced many institutions of higher education to shift in-person teaching to emergency remote teaching. This was particularly challenging for laboratory courses, where students are expected to learn hands-on skills needed for their career goals. Here, we describe the transformation of an upper-division microbiology laboratory to a course that seamlessly integrates online simulations with safe, hands-on experiences that can be done from home. This blended lab course helped students attain learning outcomes similar to those achieved in the in-person class. We illustrate the implementation of Unknown Portfolios to help students gain the data analysis and critical thinking skills needed to identify an unknown microorganism. Our data show that students who took these online courses mastered material as well as students who took the lab in person, demonstrating proficiency in laboratory safety skills, hands-on techniques, and theoretical class content. Last, we explore online adaptations to enhance in-person lab classes, aiming at reducing the accessibility and equity gaps inherited in many courses, as well as discussing challenges that instructors might experience in this process.

Antimicrobial resistance (AMR) is a major global health challenge, especially in low- and middle-income countries (LMIC). Programs that appropriate antibiotic use such as antimicrobial stewardship, is a global health strategy adopted by the World Health Organization to contain threats posed by AMR. Unfortunately, many LMICs are at best left behind in the process of developing antimicrobial stewardship programs (ASP). We highlighted the roles of the clinical microbiology laboratory in antimicrobial stewardship and challenges associated with the program in LMICs. We further suggested ways forward in the adoption and implementation of existing programs in resource-limited settings. There is generally nonexistent or at best, fewer ASP in the LMICs. More efforts need to be channeled toward fighting the AMR scourge, primarily by adopting ASP while utilizing the little resources available.

Antimicrobial resistance (AMR) is considered a global threat, and novel drug discovery needs to be complemented with systematic and standardized epidemiological surveillance. Surveillance data are currently generated using phenotypic characterization. However, due to poor scalability, this approach does little for true epidemiological investigations. There is a strong case for whole-genome sequencing (WGS) to enhance the phenotypic data. To establish global AMR surveillance using WGS, we developed a laboratory implementation approach that we applied within the NIHR Global Health Research Unit (GHRU) on Genomic Surveillance of Antimicrobial Resistance. In this paper, we outline the laboratory implementation at 4 units: Colombia, India, Nigeria, and the Philippines. The journey to embedding WGS capacity was split into 4 phases: Assessment, Assembly, Optimization, and Reassessment. We show that on-boarding WGS capabilities can greatly enhance the real-time processing power within regional and national AMR surveillance initiatives, despite the high initial investment in laboratory infrastructure and maintenance. Countries looking to introduce WGS as a surveillance tool could begin by sequencing select Global Antimicrobial Resistance Surveillance System (GLASS) priority pathogens that can demonstrate the standardization and impact genome sequencing has in tackling AMR. [ABSTRACT FROM AUTHOR]

ABSTRACT We previously developed and assessed “The Art of Microbiology,” a course-based undergraduate research experience (CURE) which uses agar art to spur student experimentation, where we found student outcomes related to science persistence. However, these outcomes were not correlated with specific activities and gains were not reported from more than one class. In this study, we explored which of the three major activities in this CURE—agar art, experimental design, or poster presentations—affected student engagement and outcomes associated with improved understanding of the nature of science (NOS). The Art of Microbiology was studied in three microbiology teaching laboratories: at a research university with either the CURE developer (18 students) or a CURE implementer (39 students) and at a community college with a CURE implementer (25 students). Our quasi-experimental mixed methods study used pre/post-NOS surveys and semi-structured class-wide interviews. Community college students had lower baseline NOS responses but had gains in NOS similar to research university students post-CURE. We surveyed research university students following each major activity using the Assessing Student Perspective of Engagement in Class Tool (ASPECT) survey but did not find a correlation between NOS and activity engagement. Of the three activities, we found the highest engagement with agar art, especially in the CURE developer class. Interviewed students in all classes described agar art as a fun, relevant, and low-stakes assignment. This work contributes to the evidence supporting agar art as a curricular tool, especially in ways that can add research to classrooms in and beyond the research university.

Background: Prompt and accurate identification of carbapenemase production is essential for appropriate treatment and infection control. NG-Test Carba 5 (termed herein "Carba 5"; NG Biotech, Guipry, France) is a multiplex immunochromatographic assay for the rapid phenotypic identification of five major carbapenemases (KPC, NDM, VIM, IMP, and OXA-48-like) from bacterial isolates. This study aimed to evaluate the diagnostic performance of Carba 5 and its impact on the turn-around-time in a clinical microbiology laboratory. Results: Carba 5 was retrospectively evaluated using 78 carbapenemase producers and 23 non-carbapenemase producers confirmed by PCR and sequencing. The performance and time required for carbapenemase identification were prospectively evaluated using 47 carbapenem resistant Enterobacteriaceae isolates, and the results were compared to those obtained using Xpert Carba-R (Cepheid, Sunnyvale, CA, USA). For the bacterial isolates included in retrospective and prospective evaluation, the Carba 5 assay correctly identified 147 isolates except one isolate with a sensitivity of 99.13% (95% CI 95.25–99.98%) and specificity of 100% (95% CI 89.42–100%). The Carba 5 assay missed one VIM-1 among 13 VIM producers. The assay showed a sensitivity of 92.31% (95% CI 63.97–99.81%) for detecting VIM and 100% for detecting KPC, NDM, OXA-48-like, and IMP. Compared to the Xpert Carba-R assay, Carba 5 exhibited 100% agreement and was more time-efficient (median time 24 min vs. 1 h 11 min). Conclusions: The Carba 5 assay has potential as an alternative to molecular methods for detecting major carbapenemases from bacterial isolates in a clinical microbiology laboratory. Compared to the Xpert Carba-R, Carba 5 turns out to be more affordable and time-efficient while showing a comparable performance, and may accelerate therapeutic and infection control decisions. [ABSTRACT FROM AUTHOR]

Aim: Errors in the preanalytical process are errors in the process from the beginning of the test order to the acceptance of the samples to the laboratory. The undesirable effect of the prenatal process in the Microbiology Laboratory is contamination. In our study, the effects of contamination rates in blood and urine cultures on the laboratory were evaluated in terms of cost and time; our sample rejection rates were calculated. Material and Methods: The total number of samples sent to Düzce University Faculty of Medicine Medical Microbiology Laboratory between January 2019 and January 2022 were obtained retrospectively from the data system of our hospital. Results: A total of 821236 samples were sent to the Medical Microbiology Laboratory, and 11905 of them (%1,45) were rejected without being evaluated. A total of 43606 urine culture samples were sent, and 11223 (%25,7) samples resulted in contamination. It was found that the contamination rate in urine culture was higher in women than in men, while in the pediatric emergency department (%38,1) it was higher than in other departments. A total of 13397 blood. samples were sent in a menstrual blood culture bottle. Of these patient samples, 916 (%6,8) samples resulted in contamination. It was found that the contamination rate was higher in emergency departments (%9,1) than in other departments. The cost of blood and urine culture samples resulting in contamination has been calculated as a total of 51700 TL. Laboratory employees had to spend 506 hours for contaminated samples. Conclusion: In order to prevent contaminations and sample rejection, it is thought that the "correct sample collection and transfer" trainings, which are carried out with appropriate frequency in our hospital, should be increased in sections with high contamination and rejection rates. [ABSTRACT FROM AUTHOR]

Selective reporting of antibiotic susceptibility test results may help guide appropriate antibiotic prescribing, particularly for urinary tract infections. Our objective was to describe laboratory urine culture susceptibility reporting practices and to estimate their impact on antibiotic prescribing in outpatients. We examined all positive urine cultures with Escherichia coli , Klebsiella pneumoniae , or Proteus mirabilis associated with an antibiotic prescription among outpatients over 65 years of age in Ontario, Canada from 2014 through 2017. We evaluated antibiotic prescribing in the empirical window (1–3 days before culture result) and in the directed window (0–5 days after culture result). Unadjusted and adjusted odds ratios were reported to estimate the association between reporting and prescribing. In total 113 780 eligible urine cultures from 48 laboratories were included in the study cohort. Susceptibility reporting practices were highly variable between laboratories, with a range across antibiotics from norfloxacin (n = 5/48, 10.4% reporting) to nitrofurantoin (n = 40/48, 83.3% reporting). Reporting antibiotic susceptibility was associated with increased odds of prescribing that antibiotic in the directed window (aOR 2.98, 95%CI 2.07–4.28). At the laboratory level, the proportion of urine cultures reporting specific antibiotic susceptibility results was also associated with an increase in prescribing of that antibiotic in the empirical window (adjusted OR 1.23, 95%CI 1.13–1.33, per 25% increase in reporting). Laboratory reporting of antibiotic susceptibility results for urine cultures is associated with empirical and directed prescribing of the reported antibiotics. Laboratories can play an important role in guiding appropriate antibiotic selection for urinary indications. [ABSTRACT FROM AUTHOR]

Objective: This study presents trends in organism isolation and antimicrobial resistance in routine microbiology test results from acute-care hospital microbiology laboratories in Vermont.Methods: Organism identifications and antimicrobial susceptibility test results were captured from acute-care hospital laboratories to monitor geographic and temporal trends in resistance and emerging microbial threats with the free WHONET software.Results: Data were provided from 12 acute care hospital laboratories from 2011 through 2018 for 318,833 isolates from 148,994 patients (70% female, 74% outpatient, and 63% urine). Significant differences (p < 0.05) in age, gender, and antimicrobial susceptibility results (e.g. Escherichia coli and levofloxacin) between outpatient and inpatient isolates were identified with temporal increases in certain species (e.g. Aerococcus urinae) and resistance (e.g. Streptococcus pneumoniae and erythromycin). The use of multi-resistance phenotypes demonstrated significant heterogeneity (p < 0.05) in MRSA strains between facilities, for example Staphylococcus aureus resistant to six priority antimicrobials were found in no critical access hospitals (fewer than 25 inpatient beds) but in all non-critical access hospitals.Conclusions: Comprehensive electronic surveillance of antimicrobial resistance utilizing routine clinical microbiology data with free software tools offers early recognition and tracking of emerging community and healthcare resistance threats at the local and state level. [ABSTRACT FROM AUTHOR]

Background: Clinical laboratories are critical to correct diagnosis of medical conditions to ensure appropriate management. Point prevalence survey (PPS) of antimicrobial use and resistance performed in Nigeria in 2015 and 2017 showed high rates of antibiotic use, but poor laboratory utilization for definitive diagnosis of the infections for which the antimicrobials were prescribed. This study investigated the reasons for clinicians? poor utilization of the clinical laboratory for definitive diagnosis and treatment of infections. Methods: A cross sectional survey of clinicians attending the 2018 annual scientific conference and general meeting of the National Postgraduate Medical College of Nigeria (NPMCN) in Owerri, Southeastern Nigeria, was conducted using self-administered structured questionnaire to obtain information on the sub-optimal utilization of the clinical microbiology laboratory. Results: Of 283 respondents, 14.8% were general practitioners and 85.2% were specialists who have been in practice for a median period of 20 years (range 3 - 48 years). The specialists included surgeons (26%), family physicians (19.8%), internists (14.3%), pathologists (13.9%), paediatricians (8.8%), obstetricians and gynecologists (8.1%), community medicine physicians (6.2%), and dental surgeons (2.6%). Majority of the respondents (90.8%) work in public, 88.3% work in tertiary and 9.9% in secondary care hospitals. For diagnosis of infections, 16% and 49.8% reported using laboratory "always" and "very often" respectively. Among these, the most commonly utilized investigations were microscopy, culture and sensitivity (62.4%), DNA detection (18.3%), GeneXpert for tuberculosis (17.2%), and antigen detection (16.7%). Among clinicians that "hardly make use" of the laboratory, their reasons for non-use were; clinical diagnosis being sufficient (39.7%), delayed results (17.2%), having knowledge of „potent? antibiotics (15.5%), lack of access to microbiology laboratory (13.8%), absence of pathologists to assure quality of tests (12.1%), and no need of the laboratory to manage patients with infections (8.6%). Conclusion: These findings indicate that poor use of the microbiology laboratory seems mainly associated with perception and attitude of the physicians to the relevance of the laboratory, and perceived inadequacy of microbiology practice in some others. There is need to raise physicians? awareness on the relevance and what constitutes optimal use of the clinical microbiology laboratory for accurate diagnosis of infections and appropriate antimicrobial use. [ABSTRACT FROM AUTHOR]

(1→3)-β-D-glucan causes respiratory airway irritation as a biomarker for biological agents in indoor environments. We evaluated (1→3)-β-D-glucan levels in three microbiology laboratories every month for one year by applying a health risk assessment methodology and determined the associated environmental factors. In total, 192 samples were retrieved using a new, two-stage bioaerosol cyclone (BC 221) sampler. Analysis of (1→3)-β-D-glucan was performed using the kinetic Limulus amebocyte lysate assay. This study revealed that illumination was negatively correlated with (1→3)-β-D-glucan (r = −0.206, p = 0.04) and that relative humidity and season were positively associated with (1→3)-β-D-glucan (p < 0.05). Among the environmental factors, season (particularly spring) was most significantly associated with (1→3)-β-D-glucan levels. Future studies regarding the relationship between (1→3)-β-D-glucan levels and other biological agents, including fungi, bacteria, endotoxin, and other environmental factors, should be assessed. The hazard quotient in summer is higher than the acceptable level of 1 for children if they stay in laboratories for 12 hours. Inhalation exposure to (1→3)-β-D-glucan by children in microbiology laboratories is thus not safe in summer. [ABSTRACT FROM AUTHOR]

Microbial physiology is a basic course taught throughout biomedical science disciplines. Students study the structure, growth, and metabolism of microorganisms and often find it difficult to learn the information, usually because they fail to see the wider applications. The current microbiology laboratory series describes how to transform a “cookbook” undergraduate laboratory to an inquiry-based one by incorporating problem-based learning. The students use a food poisoning case study that develops over a series of seven experiments and take on the role of the microbiology technician who is responsible for coming up with the answer and submitting a report to a clinician. The case provides coherence to the sessions, and the students are given the opportunity to learn about, and practice, common techniques they would encounter in a clinical microbiology laboratory. Those include the aseptic method, cultivation of bacteria, quantification of bacteria in culture, isolation of pure culture, morphological observation by light microscopy, Gram staining, the use of selective and differential media, and the effectiveness of a variety of antimicrobials and antibiotics. This laboratory series has been designed so that it can be implemented in any setting, using simple materials and inexpensive, nonspecialized equipment. The experiments are carried out in small groups, and a facilitator may tutor up to two groups of 10 students at a time. The current method has been successfully implemented for the past 2 yr, and the students demonstrated greater motivation in learning and understanding. [ABSTRACT FROM AUTHOR]

Background: To validate the performance, reproducibility, and reliability of BD automated instruments in order to establish a fully automated clinical microbiology laboratory. Methods: We used control strains and clinical samples to assess the accuracy, reproducibility, and reliability of the BD Kiestra WCA, the BD Phoenix, and BD Bruker MALDI-Biotyper instruments and compared them to previously established conventional methods. The following processes were evaluated: sample inoculation and spreading, colony counts, sorting of cultures, antibiotic susceptibility test, and microbial identification. Results: The BD Kiestra recovered single colonies in less time than conventional methods (e.g. E. coli, 7h vs 10h, respectively) and agreement between both methodologies was excellent for colony counts (κ=0.824) and sorting cultures (κ=0.821). Antibiotic susceptibility tests performed with BD Phoenix and disk diffusion demonstrated 96.3% agreement with both methods. Finally, we compared microbial identification in BD Phoenix and Bruker MALDI-Biotyper and observed perfect agreement (κ=1) and identification at a species level for control strains. Together these instruments allow us to process clinical urine samples in 36h (effective time). Conclusion: The BD automated technologies have improved performance compared with conventional methods, and are suitable for its implementation in very busy microbiology laboratories. [ABSTRACT FROM AUTHOR]

Objective. Determine airborne bacteria in a teaching laboratory of microbiology at the Distrital University and establish the bacteriological quality of air which users are exposed. Methods. Air samples were taken by sedimentation technique. The recovered colonies were counted, macroscopic and microscopic characterized and culture in selective media. The isolates were identifies by BD BBL Crystal. Results. It was found greater counts of gram-positive bacteria compared with Gram negative. It was identified bacteria of genus Micrococcus, Staphylococcus, Leuconostoc, Bacillus, Corynebacterium, Pseudomonas, Yersinia, Serratia, Shigella, Klebsiella, Citrobacter and Acinetobacter. The results showed that the bacteria identified do not present high risk to healthy of users, but it is necessary to implement measures to reduce the bacterial presence. Additionally, in this way decrease possible impact in general health of its occupants. [ABSTRACT FROM AUTHOR]

Efforts to optimize the use of antimicrobial agents, referred to as antimicrobial stewardship programs (ASPs), are increasingly becoming part of the clinical enterprise at big and small hospitals. Such programs aim to achieve the synergistic goals of improving patient outcomes, limiting the unintended consequences of drug resistance and superinfections, and reducing health care expenditures. This article will review the need for antimicrobial stewardship and the key components of setting up a program; then, it will describe the ASP at one medical center to underscore how attention to acceptance by the clinical staff is crucial to changing the culture of antimicrobial use. Although the details may differ for each institution, the foundation of a successful stewardship program is support from hospital leadership and the cooperative interaction among the pharmacy, infectious diseases specialists, and clinical microbiologists. [ABSTRACT FROM AUTHOR]

Clinical microbiologists and microbiology laboratories are experiencing changes due to evolving views on‘healthcare delivery’ as an economic activity, due to changes in the medical environment and the demographics of the workforce, and technical evolution. Cost-effectiveness of laboratory procedures has been achieved through consolidation and integration of laboratories. Consolidation offers economy of scale and reduction in numbers of on-site staff, but also leads to separation of microbiologists from their clinical colleagues. Integration puts different laboratory disciplines under a single management, and leads to reorganisation of laboratories along common work-lines. Cost-savings combined with on-site availability of laboratories are achieved at the expense of a reduction in the influence of microbiologists in the daily running of the laboratory. Medically, there is growing emphasis on evidence-based diagnostics. Because of time-delays inherent in culturing, microbiology has a limited impact on patient outcomes. Increased clinical relevance of microbiological testing through rapid testing is mandatory. There is an increasing shortage in Europe and the USA of trained microbiology laboratory technicians and microbiologists. This reinforces the trend towards more automation and integration. Technological advances, particularly in molecular diagnostics, offer the possibility of rapid reporting and improvement of the impact of clinical microbiology on patient management. Molecular tests, however, fit perfectly the concept of an integrated laboratory and may further loosen the link between microbiologist and microbiology tests. The challenge for clinical microbiology will be to use new techniques to improve its cost-effectiveness and impact on infectious disease management. The future organisation of microbiology laboratories must support this but is itself of secondary importance. The training of future microbiologists must prepare them for this changing environment. [ABSTRACT FROM AUTHOR]

We analysed by age and sex the inter-laboratory variation in submission rates and positivity rates of urine samples from primary care that were submitted to seven microbiology laboratories within the South West of England. There was an almost twofold difference between the lowest and highest submission and positivity rates across all sex and age groups. This could not be accounted for by differences in population, age mix or numbers of nursing home beds. Increased submission in children will increase diagnosis of urinary tract infection (UTI). In contrast, over-investigation in other age groups increases laboratory and primary care costs and, in the asymptomatic elderly, may lead to unnecessary antibiotic treatment. Continued education is needed in primary care to improve the management of urinary symptoms. Laboratory-based studies of UTI are likely to underestimate the true incidence of this infection substantially. Standardised protocols for urine specimen submission are essential for practices and laboratories participating in surveillance of UTI and antibiotic resistance. In our discussion we offer seven recommendations for improving UTI investigation in general practice. [ABSTRACT FROM AUTHOR]

Early diagnosis and treatment has an important impact on the morbidity and mortality of infections caused by multidrug-resistant bacteria. Multidrug-resistant gram-negative bacilli (MR-GNB) constitute the main current threat in hospitals and especially in intensive care units (ICU). The role of the microbiology laboratory is essential in providing a rapid and effective response. This review updates the microbiology laboratory procedures for the rapid detection of BGN-MR and its resistance determinants. The role of the laboratory in the surveillance and control of outbreaks caused by these bacteria, including typing techniques, is also studied. The importance of providing standardized resistance maps that allow knowing the epidemiological situation of the different units is emphasized. Finally, the importance of effective communication systems for the transmission of results and decision making in the management of patients infected by BGN-MR is reviewed., (Copyright © 2022 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.)

Background: It is expected that health information technology (HIT) will deliver a safer, more efficient and effective health care system. The aim of this study was to undertake a qualitative and video-ethnographic examination of the impact of information technologies on work processes in the reception area of a Microbiology Department, to ascertain what changed, how it changed and the impact of the change. Materials and Methods: The setting for this study was the microbiology laboratory of a large tertiary hospital in Sydney. The study consisted of qualitative (interview and focus group) data and observation sessions for the period August 2005 to October 2006 along with video footage shot in three sessions covering the original system and the two stages of the Cerner implementation. Data analysis was assisted by NVivo software and process maps were produced from the video footage. Results: There were two laboratory information systems observed in the video footage with computerized provider order entry introduced four months later. Process maps highlighted the large number of pre data entry steps with the original system whilst the newer system incorporated many of these steps in to the data entry stage. However, any time saved with the new system was offset by the requirement to complete some data entry of patient information not previously required. Other changes noted included the change of responsibilities for the reception staff and the physical changes required to accommodate the increased activity around the data entry area. Conclusions: Implementing a new HIT is always an exciting time for any environment but ensuring that the implementation goes smoothly and with minimal trouble requires the administrator and their team to plan well in advance for staff training, physical layout and possible staff resource reallocation.

Quality assurance is an important aspect of laboratory management. One of the activities involved is the participation in external quality assessment (EQA) schemes by the clinical laboratory. These EQA schemes should be organised according to well-defined guidelines, such as the ESO/IEC Guide 43. The present work provides an inventory of the EQA schemes organised in Europe. The schemes are related to the fields of bacteriology, parasitology and virology. For each field various surveys have been organised. Data such as the number of participants, frequency of survey and number of samples in a survey are presented. The nature and way of manufacturing the control material is specified. [ABSTRACT FROM AUTHOR]

Increased infections from injection drug use harm patients and are costly to the health care system. The impact on clinical microbiology laboratories is less recognized. Microbiology laboratories face increased test volume and test complexity from the spectrum and burden of pathogens associated with injection drug use, which lead to diagnostic challenges and overtaxed resources. We describe stressed workflows, pathogens that defy protocols, and limits of current technologies. Laboratories may benefit from protocol revisions, additional resources, workflow oversight, and improved communication with clinical providers to optimally meet challenges associated with this public health crisis., Competing Interests: Disclosure Dr S.D. Kimmel received support from the National Institute on Drug Abuse (NIDA) (R25DA013582, R25DA033211), and the National Institute of Allergy and Infectious Diseases (5T32AI052074). He consults for Abt Associates on a Massachusetts Department of Public Health project to expand access to medications for opioid use disorder in postacute medical care facilities. Dr N.S. Miller reports support from the Massachusetts Department of Public Health (HIV/HCV/STI/TB Prevention, Linkage, and Retention in Care and Treatment Program)., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objectives: Since physicians play an important role in antibiotic usage, it is vital to understand their antibiotic-prescribing behaviour and knowledge on antimicrobial resistance in order to develop and implement effective antibiotic stewardship interventions. The aim of this study was to evaluate Portuguese physicians' knowledge and to understand prescription behaviours, difficulties and barriers in their antibiotic prescription process in order to promote better and well-adapted antibiotic stewardship policies., Methods: This study was conducted in 2016 using a self-administered questionnaire to physicians in two tertiary public hospitals from two different regions in Portugal., Results: Participating physicians [response rate 47.6% (30/63)] identified antibiotic resistance as a global problem; however, one-third did not recognise antibiotic resistance as a major problem on their own hospital. Factors that most influenced antibiotic prescription were 'microbiology laboratory results', 'patient clinical situation' and patient 'co-morbidities'. On the other hand, 'colleagues' opinion' and 'costs control' were considered as less determining factors. Regarding difficulties and bottlenecks in the antibiotic prescription process, participant physicians reported 'lack of (or delayed) microbiological results' and 'no access to antibiotic susceptibility patterns' as major barriers. 'Education and training' was considered the most effective intervention to improve antibiotic prescription., Conclusion: These results suggest that the design and implementation of antibiotic stewardship interventions should provide better data management and sharing tools between physicians and the microbiology laboratory, especially through the creation of antimicrobial prescribing guidelines according to hospital epidemiology, and easy access to hospital antibiotic susceptibility patterns and epidemiological data., (Copyright © 2018 International Society for Chemotherapy of Infection and Cancer. Published by Elsevier Ltd. All rights reserved.)

We investigated blood cultures that revealed growth at night when no technologists were in the microbiology laboratory and at other times when the laboratory was staffed. On average, it took 7 h and 26 min and 2 h and 12 min for laboratory personnel to report positive blood culture Gram stain results to physicians when growth was detected by automated instruments during the former and latter time periods, respectively. When positive blood culture results led to a change in therapy, it took an average of 8 h and 21 min and 5 h and 26 min in the former and latter groups, respectively, from detection to when the order was written. [Copyright &y& Elsevier]