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Revolutionizing clinical microbiology laboratory organization in hospitals with in situ point-of-care.

Cohen-Bacrie S, Ninove L, Nougairède A, Charrel R, Richet H, Minodier P, Badiaga S, Noël G, La Scola B, de Lamballerie X, Drancourt M, Raoult D - PLoS ONE (2011)

Bottom Line: Twenty-three molecular and immuno-detection tests, which were technically undemanding, were progressively implemented, with results obtained in less than four hours.Altogether, patients who received POC tests were immediately discharged nearly thrice as often as patients who underwent a conventional diagnostic procedure.The on-site POC-lab met physicians' needs and influenced the management of 8% of the patients that presented to emergency wards.

View Article: PubMed Central - PubMed

Affiliation: Fédération de Microbiologie Clinique, Assistance Publique des Hôpitaux de Marseille-Pôle des Maladies Infectieuses, Hôpital la Timone, Marseille, France.

ABSTRACT

Background: Clinical 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 findings: One 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.

Conclusions: The 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.

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Related in: MedlinePlus

Kinetics of the diagnoses resulting from POC testing from 2008 to 2010.Left vertical axis: the number of positive results provided for meningitis, gastrointestinal infections, obstetric infections and tropical fever. Right vertical axis: the number of positive results provided for respiratory infections. Under the graph, the implementation of tests is indicated by arrows in chronological order. BP: B. pertussis; EV: enterovirus; HP: H. pylori; IMN: infectious mononucleosis; MP: M. pneumoniae; NM: N. meningitidis; PCT: procalcitonin, Rota/adeno: rotavirus/adenovirus; RSV: respiratory syncytial virus; SP: S. pneumoniae.
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pone-0022403-g002: Kinetics of the diagnoses resulting from POC testing from 2008 to 2010.Left vertical axis: the number of positive results provided for meningitis, gastrointestinal infections, obstetric infections and tropical fever. Right vertical axis: the number of positive results provided for respiratory infections. Under the graph, the implementation of tests is indicated by arrows in chronological order. BP: B. pertussis; EV: enterovirus; HP: H. pylori; IMN: infectious mononucleosis; MP: M. pneumoniae; NM: N. meningitidis; PCT: procalcitonin, Rota/adeno: rotavirus/adenovirus; RSV: respiratory syncytial virus; SP: S. pneumoniae.

Mentions: Testing related to respiratory tract infections (as listed in table S1) represented 78% of the overall demand. A burst of influenza demands related to the A/H1N1 outbreak occurred in 2009 with an early peak of diagnoses observed as early as August of 2009 (figure 2). From June 2009 through April of 2010, 1,075 tests out of 10,609 demands were positive for the influenza A virus, compared with 520 positive tests out of 3,491 demands from November of 2008 through April of 2009 (86% of A influenza virus). The diagnostic yields peaked at 15% in November 2009 in comparison to the previous influenza epidemic, which peaked at 25% in January of 2009. Alternatively, the number of respiratory syncytial virus diagnoses was stationary from 2008 to 2009 and from 2009 to 2010, regarding the period spreading from November through April (522 and 506 diagnoses, respectively).


Revolutionizing clinical microbiology laboratory organization in hospitals with in situ point-of-care.

Cohen-Bacrie S, Ninove L, Nougairède A, Charrel R, Richet H, Minodier P, Badiaga S, Noël G, La Scola B, de Lamballerie X, Drancourt M, Raoult D - PLoS ONE (2011)

Kinetics of the diagnoses resulting from POC testing from 2008 to 2010.Left vertical axis: the number of positive results provided for meningitis, gastrointestinal infections, obstetric infections and tropical fever. Right vertical axis: the number of positive results provided for respiratory infections. Under the graph, the implementation of tests is indicated by arrows in chronological order. BP: B. pertussis; EV: enterovirus; HP: H. pylori; IMN: infectious mononucleosis; MP: M. pneumoniae; NM: N. meningitidis; PCT: procalcitonin, Rota/adeno: rotavirus/adenovirus; RSV: respiratory syncytial virus; SP: S. pneumoniae.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3139639&req=5

pone-0022403-g002: Kinetics of the diagnoses resulting from POC testing from 2008 to 2010.Left vertical axis: the number of positive results provided for meningitis, gastrointestinal infections, obstetric infections and tropical fever. Right vertical axis: the number of positive results provided for respiratory infections. Under the graph, the implementation of tests is indicated by arrows in chronological order. BP: B. pertussis; EV: enterovirus; HP: H. pylori; IMN: infectious mononucleosis; MP: M. pneumoniae; NM: N. meningitidis; PCT: procalcitonin, Rota/adeno: rotavirus/adenovirus; RSV: respiratory syncytial virus; SP: S. pneumoniae.
Mentions: Testing related to respiratory tract infections (as listed in table S1) represented 78% of the overall demand. A burst of influenza demands related to the A/H1N1 outbreak occurred in 2009 with an early peak of diagnoses observed as early as August of 2009 (figure 2). From June 2009 through April of 2010, 1,075 tests out of 10,609 demands were positive for the influenza A virus, compared with 520 positive tests out of 3,491 demands from November of 2008 through April of 2009 (86% of A influenza virus). The diagnostic yields peaked at 15% in November 2009 in comparison to the previous influenza epidemic, which peaked at 25% in January of 2009. Alternatively, the number of respiratory syncytial virus diagnoses was stationary from 2008 to 2009 and from 2009 to 2010, regarding the period spreading from November through April (522 and 506 diagnoses, respectively).

Bottom Line: Twenty-three molecular and immuno-detection tests, which were technically undemanding, were progressively implemented, with results obtained in less than four hours.Altogether, patients who received POC tests were immediately discharged nearly thrice as often as patients who underwent a conventional diagnostic procedure.The on-site POC-lab met physicians' needs and influenced the management of 8% of the patients that presented to emergency wards.

View Article: PubMed Central - PubMed

Affiliation: Fédération de Microbiologie Clinique, Assistance Publique des Hôpitaux de Marseille-Pôle des Maladies Infectieuses, Hôpital la Timone, Marseille, France.

ABSTRACT

Background: Clinical 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 findings: One 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.

Conclusions: The 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.

Show MeSH
Related in: MedlinePlus