HOW SCIENTIFIC ARE OUR MICROBIOLOGY REPORTS IN CLINICAL CARE?
Dr.T.V.Rao MD There is a growing concern all over the world about the growing costs in laboratory investigations performed on many economically poor patients, However many use the laboratories at random without rationalism, the clinicians should not forget every test done unnecessarily is counterproductive, in reality lies with reporting clinical microbiology findings should in theory be the easy part—the final step before an effective treatment plan is formed. But as any seasoned clinical microbiologist knows, that couldn’t be further from the truth. I always tell my friends in the department if a test is done without a clinical assumption and successive negative or positive results will have a bearing effect on the increasing costs to the patient and improper clinical care. There has always been an age-old challenge in what results the microbiology laboratory should report Unlike other departments in the clinical laboratory—hematology and clinical chemistry, for example—we produce a lot of positive results that shouldn’t be acted on. Not forgetting we have ten times more commensal BACTERIA than our own cells, how test results are reported—and whether microbiology reports include commensal organisms or other information that may or may not be clinically significant—can have dramatic consequences for patient care. A test report can muddle the conversation about appropriate treatments, or it can save a patient’s life. Take a case of a Gynecologists sending many specimens of vaginal swabs with a white discharge, as it happens many laborites reporting E.coli with many antibiogram patterns, it is just E.coli entering the Vaginal area from fecal contamination, and misuse of Antibiotics starts and certainly lead to drug resistance when the normal flora treated with new generation antibiotics if you look to our fundamental a vaginal swab is not suitable for parasitic or fungal detection it is the secretions they have to observe for Clue cells, Trachoma’s or Candida infections, CAN HIGHER TECHNOLOGY SOLVE THE PROBLEMS -? “In years, past, microbiology tests simply detected how many and which bacteria were present. We have progressed from counting colonies with colony counting lenses, Now many of us do that and more We now have new methods coming along that produce a lot more information, and not just more information but different types of information, Take the case of Bactec or Vitek 2 System ( AUTOMATION) results too do not benefit in clinical cure if the matters are not understood form clinical request, to the separation of pathogen from commensals,. “We have new technologies like MALDI TOF, which give us chemical libraries, and sequencing, which gives us sequencing databases, and all of that comes with information requests, and again, questions about clinical significance.
THE BEST PRACTICE IN DIAGNOSTIC MICROBIOLOGY – DO NOT DEVAITE FROM YOU BASIC LEARNING AS A POST GRADAUTE STUDENT - There are well-described and defined protocols for the historical problem: dealing with growing commensal organisms that perhaps aren’t of clinical significance,” It is unfortunate many Clinicians are happy if they get a positive result of the culture not knowing treating commensals with antibiotics is counterproductive however in most developed countries due to shortage of qualified Microbiology practitioners many commensals nonpathogens and contamination are believed as true pathogens Adding to the problem is that each lab seems to favor a different style of reporting,. “
WHY SIMPLE INFORMATION IS BETTER FOR CLINICIANS -The lab must communicate the test results as clearly as possible, and it could be as simple as how the test report is formatted, it’s important to involve your primary users in developing the reports. We might show an example of a report to our clinician users, to make sure that what we’re trying to communicate is clearly presented and has all the information they need.” It is utmost even in teaching hospitals there are lot gaps in understanding, THE UTILITY OF MICROBIOLOGY LABORATORY But the challenge is to make sure that meaning translates to our physician colleagues. And with the advent of new, high-throughput technologies, results that were difficult to report in the past have become even more challenging, Most of the newly qualified and Microbiologists report many commensal as pathogen with over consciousness to the matter they deal. Improper use of diagnostic Microbiology is one the leading causes of Misuse of Antibiotics,
In conclusion practicing Clinical Microbiology is much more difficult with progress of time and technology as it matters in clinical care
References – Changing role of Clinical Microbiology s ASM resources
Dr.T.V.Rao MD Freelance Clinical Microbiologist and Reporter on Infectious diseases
Dr.T.V.Rao MD There is a growing concern all over the world about the growing costs in laboratory investigations performed on many economically poor patients, However many use the laboratories at random without rationalism, the clinicians should not forget every test done unnecessarily is counterproductive, in reality lies with reporting clinical microbiology findings should in theory be the easy part—the final step before an effective treatment plan is formed. But as any seasoned clinical microbiologist knows, that couldn’t be further from the truth. I always tell my friends in the department if a test is done without a clinical assumption and successive negative or positive results will have a bearing effect on the increasing costs to the patient and improper clinical care. There has always been an age-old challenge in what results the microbiology laboratory should report Unlike other departments in the clinical laboratory—hematology and clinical chemistry, for example—we produce a lot of positive results that shouldn’t be acted on. Not forgetting we have ten times more commensal BACTERIA than our own cells, how test results are reported—and whether microbiology reports include commensal organisms or other information that may or may not be clinically significant—can have dramatic consequences for patient care. A test report can muddle the conversation about appropriate treatments, or it can save a patient’s life. Take a case of a Gynecologists sending many specimens of vaginal swabs with a white discharge, as it happens many laborites reporting E.coli with many antibiogram patterns, it is just E.coli entering the Vaginal area from fecal contamination, and misuse of Antibiotics starts and certainly lead to drug resistance when the normal flora treated with new generation antibiotics if you look to our fundamental a vaginal swab is not suitable for parasitic or fungal detection it is the secretions they have to observe for Clue cells, Trachoma’s or Candida infections, CAN HIGHER TECHNOLOGY SOLVE THE PROBLEMS -? “In years, past, microbiology tests simply detected how many and which bacteria were present. We have progressed from counting colonies with colony counting lenses, Now many of us do that and more We now have new methods coming along that produce a lot more information, and not just more information but different types of information, Take the case of Bactec or Vitek 2 System ( AUTOMATION) results too do not benefit in clinical cure if the matters are not understood form clinical request, to the separation of pathogen from commensals,. “We have new technologies like MALDI TOF, which give us chemical libraries, and sequencing, which gives us sequencing databases, and all of that comes with information requests, and again, questions about clinical significance.
THE BEST PRACTICE IN DIAGNOSTIC MICROBIOLOGY – DO NOT DEVAITE FROM YOU BASIC LEARNING AS A POST GRADAUTE STUDENT - There are well-described and defined protocols for the historical problem: dealing with growing commensal organisms that perhaps aren’t of clinical significance,” It is unfortunate many Clinicians are happy if they get a positive result of the culture not knowing treating commensals with antibiotics is counterproductive however in most developed countries due to shortage of qualified Microbiology practitioners many commensals nonpathogens and contamination are believed as true pathogens Adding to the problem is that each lab seems to favor a different style of reporting,. “
WHY SIMPLE INFORMATION IS BETTER FOR CLINICIANS -The lab must communicate the test results as clearly as possible, and it could be as simple as how the test report is formatted, it’s important to involve your primary users in developing the reports. We might show an example of a report to our clinician users, to make sure that what we’re trying to communicate is clearly presented and has all the information they need.” It is utmost even in teaching hospitals there are lot gaps in understanding, THE UTILITY OF MICROBIOLOGY LABORATORY But the challenge is to make sure that meaning translates to our physician colleagues. And with the advent of new, high-throughput technologies, results that were difficult to report in the past have become even more challenging, Most of the newly qualified and Microbiologists report many commensal as pathogen with over consciousness to the matter they deal. Improper use of diagnostic Microbiology is one the leading causes of Misuse of Antibiotics,
In conclusion practicing Clinical Microbiology is much more difficult with progress of time and technology as it matters in clinical care
References – Changing role of Clinical Microbiology s ASM resources
Dr.T.V.Rao MD Freelance Clinical Microbiologist and Reporter on Infectious diseases
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