• Document: Novel Technologies in Microbiology
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Novel Technologies in Microbiology BENEFITS BEYOND THE LAB Susan M. Poutanen, MD, MPH, FRCPC Microbiologist/ID Consultant, UHN/MSH Associate Professor, U. of Toronto AMMI Canada ─ CACMID May 4, 2017 Disclosures • Advisory Board/Consultant – Accelerate Diagnostics – Merck – Paladin Labs • Research Support – Accelerate Diagnostics – Bio-Rad • Honorarium – Merck Objectives By the end of this session, you should be able to: 1. Describe advances in microbiology diagnostics and the paradigm shift associated with them 2. Discuss the clinical impact of novel technologies in microbiology beyond the laboratory 3. Outline future microbiology technologies that have the potential to improve patient care TECHNOLOGIES Œ Specimen Processing  Incubation Ž Microbial Identification  Nucleic Acid Amplification Tests  Novel Technologies ‘ Point of Care Testing PARADIGM SH in Microbiology BEFORE: 8-4pm LAB NOW: 24/7 LAB FUTURE: 24/7 LAB & POC PARADIGM SH in Microbiology Clinical Impact of These New Technologies: 1. Lab function 2. Antimicrobial stewardship 3. Infection control 4. Patient outcomes Novak et al. Clin Lab Med 2013;33:567-588 1. Lab Function Productivity (workload/staff full time equivalent) Turn-around-times Quality 2. Antimicrobial Stewardship Faster time to appropriate antimicrobial Earlier discontinuation of antimicrobials & reduction of associated adverse events and costs 3. Infection Control Earlier initiation/discontinuation of precautions Reduction in nosocomial transmission/outbreaks 4. Patient Outcome Improved patient flow/bed management Shorter duration of admission Reduced morbidity/mortality Which are is your Primary Affiliation? 100% 1. Laboratory 90% 80% 2. Antimicrobial 70% stewardship 60% 50% 3. Infection control 40% 30% 4. Patient care 20% 10% 0% 0% 0% 0% 0% 5. Other 0% 10 Œ Specimen Processing Traditional Specimen Processing and Streaking 2006 InoqulA (BD) 2008 WASP (Walk-away Specimen Processor), Copan Slide 15 Incubation Traditional Specimen Incubation, Sorting, and Reading Smart Incubators • Space efficient O2 and CO2 incubators • Digital microbiology capabilities with artificial intelligence enabling: – Detection of growth and no growth and sorting of plates accordingly at set incubation times – Detection of specific colours, colony counts, zones of inhibition • Remote reading of digital images TLA (BD Kiestra) TLA = total laboratory automation WASPLab (Copan) Threshold for Growth Detection Low: 105-7 cfu/L High: 109-11 cfu/L Mutters et al. Ann Lab Med 2014;34:111-117 Virtuo (bioMérieux) • Robotic automatic receiving and sorting positives from negative blood cultures • Automated blood volume detection • Simulated BC study: â time to detection by: Ø3 hours for bacteria Ø5 hours for Candida spp. Altun et al. JCM 2016;54(4):1148-1151 Outcomes Related to Delays in Appropriate Therapy • Delay to effective antimicrobial therapy is the single strongest predictor of survival in septic shock – Effective antimicrobial therapy within the first hour: Ø associated with 80% survival – For every additional hour delay in the first 6 h: Ø survival dropped an average of 7.6% A. Kumar. Crit Care Med 2006; 34:1589–1596 ŽMicrobial Identification Traditional Specimen Incubation, Sorting, and Reading MALDI-TOF • Matrix-assisted laser desorption ionization- time of flight • Accurate • Fast turn-around-time (~5 min) • Low hands-on time • Inexpensive Vitek MS (bioMérieux) Bruker MALDI Biotyper (BD) BC: MALDI-TOF from Short Incubation Cultures or Positive Filtrate/Sediment *Matic et al. AMMI • â time to ID by 25-31* hrs CACMID 2017, P23 Verroken et al. PLOS One 2016;11(5) Bio- Lock

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