Automated versus Manual Sample Inoculations in Routine Clinical Microbiology: a Performance Evaluation of the Fully Automated InoqulA Instrument

Froment, P.; Marchandin, H.; Perre, P Vande; Lamy, Brigitte

doi:10.1128/jcm.02341-13

Cited by 42 publications

(43 citation statements)

References 6 publications

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“…WASP processing of clinical specimens yielded significantly more morphologies and recovered species than yielded by manual processing, independent from the number of CFU counts present in the sample. This finding parallels those of a previous study that analyzed urine specimens processed with the BD Kiestra system versus manual handling (4,12). Indeed, next to a higher number of morphologies and isolated species, automated processing by WASP led to detection of more potential pathogens.…”

Section: Discussionsupporting

confidence: 78%

“…For many years, the general perception was that clinical microbiology would be far too complex to allow for automated processing and that robots would not be able to replace human operators. However, it has been demonstrated that automated inoculation of samples can be superior to manual processing and that automated reading of disk diffusion agar plates significantly increases the precision of results (3)(4)(5)(6). Thus, automated sample processing promises an improved standardization of sample processing, incubation times, and plate reading protocols.…”

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confidence: 99%

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Performance of Copan WASP for Routine Urine Microbiology

et al. 2016

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This study compared a manual workup of urine clinical samples with fully automated WASPLab processing. As a first step, two different inocula (1 and 10 l) and different streaking patterns were compared using WASP and InoqulA BT instrumentation. Significantly more single colonies were produced with the10-l inoculum than with the 1-l inoculum, and automated streaking yielded significantly more single colonies than manual streaking on whole plates (P < 0.001). In a second step, 379 clinical urine samples were evaluated using WASP and the manual workup. Average numbers of detected morphologies, recovered species, and CFUs per milliliter of all 379 urine samples showed excellent agreement between WASPLab and the manual workup. The percentage of urine samples clinically categorized as positive or negative did not differ between the automated and manual workflow, but within the positive samples, automated processing by WASPLab resulted in the detection of more potential pathogens. In summary, the present study demonstrates that (i) the streaking pattern, i.e., primarily the number of zigzags/length of streaking lines, is critical for optimizing the number of single colonies yielded from primary cultures of urine samples; (ii) automated streaking by the WASP instrument is superior to manual streaking regarding the number of single colonies yielded (for 32.2% of the samples); and (iii) automated streaking leads to higher numbers of detected morphologies (for 47.5% of the samples), species (for 17.4% of the samples), and pathogens (for 3.4% of the samples). The results of this study point to an improved quality of microbiological analyses and laboratory reports when using automated sample processing by WASP and WASPLab.

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Section: Discussionsupporting

confidence: 78%

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confidence: 99%

Performance of Copan WASP for Routine Urine Microbiology

et al. 2016

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“…Thus, laboratories should carefully select and validate automated qualitative and quantitative patterns yielding the best performance for each sample type. Similar to previous studies (2)(3)(4)(5)14), a higher number of discrete colonies was reproducibly obtained with the automated inoculation systems InoqulA and WASP than that with manual inoculation. Moreover, the difference in the recovery of microorganisms obtained between manual and automated inoculations increased with increasing bacterial concentrations in the sample.…”

Section: Discussionsupporting

confidence: 76%

“…However, the true effectiveness of automated inoculation systems needs to be validated by independent routine clinical microbiology laboratories. Compared to manual streaking, a few studies have demonstrated that the InoqulA and Previ Isola automated systems produce more isolated colonies, show better reproducibility, have no cross-contamination, and exhibit a significant decrease in hands-on plating time (2)(3)(4)(5). These studies concluded that such automated systems should improve laboratory workflow and shorten the time to results, but direct laboratory impact assessments remain to be performed to confirm these expectations.…”

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confidence: 92%

Comparison of Inoculation with the InoqulA and WASP Automated Systems with Manual Inoculation

et al. 2015

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bThe quality of sample inoculation is critical for achieving an optimal yield of discrete colonies in both monomicrobial and polymicrobial samples to perform identification and antibiotic susceptibility testing. Consequently, we compared the performance between the InoqulA (BD Kiestra), the WASP (Copan), and manual inoculation methods. Defined mono-and polymicrobial samples of 4 bacterial species and cloudy urine specimens were inoculated on chromogenic agar by the InoqulA, the WASP, and manual methods. Images taken with ImagA (BD Kiestra) were analyzed with the VisionLab version 3.43 image analysis software to assess the quality of growth and to prevent subjective interpretation of the data. A 3-to 10-fold higher yield of discrete colonies was observed following automated inoculation with both the InoqulA and WASP systems than that with manual inoculation. The difference in performance between automated and manual inoculation was mainly observed at concentrations of >10 6 bacteria/ml. Inoculation with the InoqulA system allowed us to obtain significantly more discrete colonies than the WASP system at concentrations of >10 7 bacteria/ml. However, the level of difference observed was bacterial species dependent. Discrete colonies of bacteria present in 100-to 1,000-fold lower concentrations than the most concentrated populations in defined polymicrobial samples were not reproducibly recovered, even with the automated systems. The analysis of cloudy urine specimens showed that InoqulA inoculation provided a statistically significantly higher number of discrete colonies than that with WASP and manual inoculation. Consequently, the automated InoqulA inoculation greatly decreased the requirement for bacterial subculture and thus resulted in a significant reduction in the time to results, laboratory workload, and laboratory costs.T he emergence of automation in bacteriology has opened a new era in clinical diagnostic laboratories. Automation is impacting laboratory management and workflow but also offers new perspectives for research and development in bacteriology by developing intelligent algorithms and driving innovation. Sample inoculation is a fastidious and repetitive process representing about 25% of a laboratory's workload (1). Thus, automated inoculation systems represent a need in diagnostic laboratories given the reductions in human, material, and financial resources and the increase in sample volumes (1). Moreover, the quality of inoculation is critical for achieving an optimal yield of discrete colonies in both monomicrobial and polymicrobial samples to facilitate rapid identification (ID) and antibiotic susceptibility testing (AST). Several inoculation and streaking instruments are currently available for routine diagnostic laboratories, including the Autoplak (NTE-SENER), the InoqulA (BD Kiestra), the Innova (BD), the PreLUD (i2a), the Previ Isola (bioMérieux), and the WASP (Copan). However, the true effectiveness of automated inoculation systems needs to be validated by independent routine clinical mic...

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“…The standardization and quality of specimen plating using automated systems appear to be superior to those achieved by manual inoculation (9). However, it remains unclear if improved reproducibility of sample streaking impacts turnaround time or the accuracy of specimen workup, with some studies demonstrating results comparable to those achieved using manual approaches (10) and others showing reductions in turnaround time (11,12).…”

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confidence: 92%