Automation in Clinical Microbiology

Abstract

b Historically, the trend toward automation in clinical pathology laboratories has largely bypassed the clinical microbiology laboratory. In this article, we review the historical impediments to automation in the microbiology laboratory and offer insight into the reasons why we believe that we are on the cusp of a dramatic change that will sweep a wave of automation into clinical microbiology laboratories. We review the currently available specimen-processing instruments as well as the total laboratory automation solutions. Lastly, we outline the types of studies that will need to be performed to fully assess the benefits of automation in microbiology laboratories.Editor's Note: In this issue of the Journal of Clinical Microbiology, Paul Bourbeau and Nate Ledeboer provide an informed review of an exciting new concept in clinical microbiology, the use of instrumentation to automate the front-end processing and workup of specimens submitted to a laboratory for analysis. The potential value of such instrumentation includes the possibility of substantial cost savings, standardization of initial specimen processing, more rapid and consistent provision of both identification and antimicrobial susceptibility test results, and a diminished risk for laboratory-acquired infections. However, as with any new diagnostic modality in clinical microbiology, there now exists a pressing need for investigations aimed at elucidating the performance characteristics of this new technology. Going forward, it will be imperative that laboratorians assess this new technology in objective, comparative, and preferably prospective clinical studies. Such studies will be necessary to define the true, rather than perceived or hoped-for, value of front-end and total laboratory automation in clinical microbiology. The Journal of Clinical Microbiology enthusiastically awaits submission of manuscripts that report the results of such investigations. Gary V. Doern, Editor in Chief, Journal of Clinical MicrobiologyI n recent years, while automation has steadily spread throughout the clinical chemistry and clinical hematology areas of diagnostic laboratories, clinical microbiology laboratories have largely been excluded from this trend. Although continuous-monitoring blood culture systems, automated microbial identification, and automated antimicrobial susceptibility testing systems are widely utilized in microbiology laboratories, microbiology specimen processing and culture workup, in particular, remain largely manual tasks, and indeed, few changes to the methods used to perform these tasks have occurred for many years. While we acknowledge that some larger microbiology laboratories utilize urine-plating instrumentation, most microbiology laboratories have littleto-no automation in their specimen-processing areas, with the exception of some laboratories in Western Europe, Australia, and the Middle Eastern nations. Still fewer laboratories have implemented some version of total laboratory automation (TLA).Driven by a variety of factors, we believe th...