Readers respond

Feb. 1, 2010

Change in CF test names

I just wanted to touch base on the “Respiratory
Roundup” article by Christine Tubb that appeared in the December 2009
issue of MLO [pages 10-13]. Luminex would like to submit a
correction to the article. The article uses the old name for the Luminex
test: Tag-It Cystic Fibrosis Kit. The correct name is xTAG Cystic
Fibrosis 39 Kit v2. The full set of Luminex tests that are available on
this platform are as follows: xTAG Cystic Fibrosis Kit (Canada); xTAG
Cystic Fibrosis 39 Kit v2 (USA/Europe); and xTAG Cystic Fibrosis 71 Kit
v2 (Europe). Luminex changed the name to include “xTAG” when it acquired
Tm Bioscience in 2007. Thanks for making this correction.

—Lydia King, Account Executive

Seigenthaler Public Relations

for Luminex

Editor's note: Thank you to Ms. King for sending in this correction. We are having the
changes made on the archival material, and have also notified our
readers via our electronic newsletter, LABline.

Micro needs more “automating”

I seriously began to specialize in microbiology in 1982. While at very large academic medical centers, I have seen the steady but slow march to development of rapid methods and automation of infectious-disease diagnosis. But now, I manage microbiology in a 260-bed community hospital. We are on the “edge” of attempting to use more rapid methods. There are many used daily and on demand (newer EIA testing). But we cannot make the leap to molecular-based technology due to labor and equipment costs. In the coming two years, I will be investigating how we can offer molecular-based technology for the most frequently encountered pathogens, but my plans will require creativity. So, I read MLO and other publications to get in touch with what is happening in the small to medium-size community medical centers.

Thus, I enthusiastically opened to the “automating
micro” piece by Anne Beall [November 2009, “Lab basics 202,
Microbiology,” page 10]. However, I found her article to be a very
well-written piece about quality in microbiology, not automation.
Regarding the Rapid Test Technology section, Ms. Beall jumped too
quickly to the questions to ask surrounding molecular testing. There are
methods and instruments which, while not “automating” the diagnosis or
ID of organism, do save time, and improve accuracy and consistency for
microbiology labs. The following is a quick list of those with which I
am familiar. I am sure other time saving methods and products could have
been listed. There was no mention of:

  • Anoxomat, an automated system for filling jars
    used for anaerobic, enhanced CO2 cultures; eliminates
    consumables and tasks;
  • Giles Scientific “BIOMIC V3” which automates
    reading of Kirby-Bauer and Etest antimicrobial testing as well as
    manually inoculated biochemical panels (e.g., API, Remel panels, and
    the QC for all these methods);
  • AdvanDx PNA FISH for multiple pathogens in
    positive blood cultures within hours after positive Gram-stain
  • Chromogenic media that can reduce time and tasks
    in detection of MRSA, multiple Candida species, most common UTI
    (E coli, Enterococcus, Klebsiella), genital-tract screening
    for Group B Strep, and others.  These organisms can now be reported
    24 hours after culture plating by inoculation of initial specimen or
    positive blood-culture bottles directly onto these media; and
  • penicillin binding protein testing, which
    indicates MRSA 24 hours sooner than antimicrobial-susceptibility

While Ms. Beall posed good questions to be considered
in implementing “molecular” testing, she might have mentioned the basics
of methods and instrumentation which are now available.  There is a
list, albeit a short one, of vendors with same-day molecular methods for
bacterial pathogens in highest demand (e.g.,
C difficile, MRSA, Group B strep).  While established commercial
PCR vendors with “easy-to-use” or “next-day” PCR methods for viral
pathogens still take 18 to 24 hours, molecular testing is much faster
than even shortened cell-culture techniques.

Not to include references of what is now available
and what is “coming down the pike” shortchanges laboratories that need
to begin plan their futures.  “Newer” clinicians in even the
smallest of hospitals are now more informed about molecular pathogen
detection than we more experienced clinical microbiology technologists
and managers may be. For example, the Automating Micro section contained
the same information I have read for many years about Gram strainers,
and plate streakers and their flaws. These instruments are rarely used,
even in the largest hospital labs.

Again, a well-written article on the importance of
quality in microbiology is always a needed reminder: specimen
collection, transport, processing, interpretation, reporting. We must
remain challenged to go “back to basics” to continue to find ways to
save time, money, and other resources while improving patient
care. Technologists not only forget the value of a Gram stain in
demonstrating potential pathogens on “Day 1” but the cellular content
can be helpful in decisions about whether the organisms should be fully
identified and tested for antimicrobial susceptibility.

Clinical microbiology is always the slowest to
progress in diagnostic development. Yet, the infectious diseases
continue to challenge healthcare professionals to “keep up.” This will
not change. With all due respect, we need current examples of what other
progressive labs are doing.  Educate us about  research methods
being fast tracked to clinical labs. Give us timely information about
vendors, products, and methods which are being successfully used to
provide excellent patient care while we are being fiscally responsible.
Once we know the full spectrum of what is and what will be available,
 we can better judge of what is useful and possible in our particular
patient communities.

—Jill Midgett, MT(ASCP) SM

Manager, Microbiology Laboratory

Lawrence and Memorial Hospital

New London, CT

Editor's note:
Thanks to Ms. Midgett for voicing her concerns about the article on “Lab
basics 201.” We consulted with Anne Beall, the author of that section
whose comments follow.

Anne Beall's response: The title “Automating
micro,” could be misconstrued by some as an oxymoron; it was meant to be
a follow-up article to “Lab Basics 101.” The movement to a leaner and
more efficient micro lab, however, is well underway, all across the U.S.

Automation itself is a very broad topic and can range
from rapid results reporting through integrated IS systems to complete
tracked systems with advanced optical recognition technology with huge
knowledge bases for interpretation. Obviously, given the length of the
article and the sequence in the series, I kept it at a lower level, but
a level badly needed for micro labs today. To address a few specifics,
it has been my experience that Anoxomat and BioMIC can improve
productivity but are infrequently found in today's laboratory. I also
realize that Gram stainers and plate streakers are not new to the
laboratory they have not been heavily utilized in the U.S. Many
microbiologists are taking a closer look at these instruments for their
laboratories as they strive to automate some of the more manual
processes as a way to minimize expenses, provide quicker results, and
address the skilled-labor issue in their labs. There are many approaches
one can take advantage of today in advancing automation in the
microbiology laboratory. We also have to remember that this will be on
ongoing iterative process, not a quick fix. The biggest challenge to
automation and change in the micro lab, ironically, is not the
technology but the mind-set. We have entered a new paradigm in clinical
microbiology. It is our responsibility to build the next-generation
microbiology labs for our successors, but, first, we must be open to