Revolutionizing Clinical Microbiology Laboratory Organization in Hospitals with In Situ Point-of-Care

Abstract

BackgroundClinical microbiology may direct decisions regarding hospitalization, isolation and anti-infective therapy, but it is not effective at the time of early care. Point-of-care (POC) tests have been developed for this purpose.Methods and FindingsOne pilot POC-lab was located close to the core laboratory and emergency ward to test the proof of concept. A second POC-lab was located inside the emergency ward of a distant hospital without a microbiology laboratory. Twenty-three molecular and immuno-detection tests, which were technically undemanding, were progressively implemented, with results obtained in less than four hours. From 2008 to 2010, 51,179 tests yielded 6,244 diagnoses. The second POC-lab detected contagious pathogens in 982 patients who benefited from targeted isolation measures, including those undertaken during the influenza outbreak. POC tests prevented unnecessary treatment of patients with non-streptococcal tonsillitis (n = 1,844) and pregnant women negative for Streptococcus agalactiae carriage (n = 763). The cerebrospinal fluid culture remained sterile in 50% of the 49 patients with bacterial meningitis, therefore antibiotic treatment was guided by the molecular tests performed in the POC-labs. With regard to enterovirus meningitis, the mean length-of-stay of infected patients over 15 years old significantly decreased from 2008 to 2010 compared with 2005 when the POC was not in place (1.43±1.09 versus 2.91±2.31 days; p = 0.0009). Altogether, patients who received POC tests were immediately discharged nearly thrice as often as patients who underwent a conventional diagnostic procedure.ConclusionsThe on-site POC-lab met physicians' needs and influenced the management of 8% of the patients that presented to emergency wards. This strategy might represent a major evolution of decision-making regarding the management of infectious diseases and patient care.

Clostridium difficile027 Emerging Outbreak in Marseille, France

“…We developed the point-of-care laboratory, which allows the use of both molecular and immunodetection tests to facilitate decision-making regarding the management of infectious diseases and patient care. 9 The Xpert C. difficile Epi polymerase chain reaction (PCR) assay was used from April 2012 in the 2 point-of-care laboratories located in the Timone hospital and the North hospital. 9 The Xpert C. difficile Epi PCR assay is a multiplex real-time PCR that detects the toxin B gene {tcdB), the binary toxin gene (cdt), and the tcdC gene deletion at ntl 17, identifying the 027 ribotype.…”

“…9 The Xpert C. difficile Epi polymerase chain reaction (PCR) assay was used from April 2012 in the 2 point-of-care laboratories located in the Timone hospital and the North hospital. 9 The Xpert C. difficile Epi PCR assay is a multiplex real-time PCR that detects the toxin B gene {tcdB), the binary toxin gene (cdt), and the tcdC gene deletion at ntl 17, identifying the 027 ribotype. 10 From March 18, 2012, to July 5,2013, we tested 2,205 stool samples for C. difficile toxin gene and detected 92 positive samples (4.2%) at the point-of-care laboratory.…”

Monoclonal Antibodies for the Diagnosis of Borrelia crocidurae

“…Indeed, both antibodies could be incorporated into a format well suited for the rapid point-of-care diagnosis of relapsing fever in both endemic countries 3 and in countries with travelers. 34 In Africa, relapsing fever is often confused with malaria, 1 therefore requires specific treatment and a specific prophylaxis.…”

Mass spectrometry: a revolution in clinical microbiology?

“…Indeed a growing range of rapid diagnostic tests that can be performed at the point-of-care has been implemented such as real-time PCR assays [32] . These tools considered to be expensive and time-consuming have clearly evolved and represented a suitable evolution for routine identification.…”