Abstract
ABSTRACTTechnological advances have changed the practice of clinical microbiology. We implemented Bruker matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) and BD Kiestra total laboratory automation (TLA) 4 and 3 years ago, respectively. To assess the impact of these new technologies, we compared turnaround times (TATs) for positive and negative urine cultures before and after implementation. In comparison I, TATs for 61,157 urine cultures were extracted for two periods corresponding to pre-TLA and post-TLA, both using MALDI-TOF MS for organism identification. In comparison II, time to organism identification (ID) and antimicrobial susceptibility (AST) reports were calculated for 5,402 positive culture reports representing four different periods: (i) manual plating and conventional biochemical identification (CONV), (ii) manual plating and MALDI-TOF MS identification (MALDI), (iii) MALDI-TOF MS identification and early phase implementation of TLA (TLA1), and (iv) MALDI-TOF MS identification and late phase implementation of TLA (TLA2). By the comparison I results, median pre- and post-TLA TATs to organism IDs (18.5 to 16.9 h), AST results (41.8 to 40.8 h), and preliminary results for negative cultures (17.7 to 13.6 h), including interquartile ranges for all comparisons, were significantly decreased post-TLA (P < 0.001). By the comparison II results, MALDI significantly improved TAT to organism ID compared to CONV (21.3 to 18 h). TLA further improved overall TAT to ID (18 to 16.5 h) and AST (42.3 to 40.7 h) results compared to MALDI (P < 0.001). In summary, TLA significantly improved TAT to organism ID, AST report, and preliminary negative results. MALDI-TOF MS significantly improved TAT for organism ID. Use of MALDI-TOF MS and TLA individually and together results in significant decreases in microbiology report TATs.
Highlights
Technological advances have changed the practice of clinical microbiology
Mutters et al [11] demonstrated a reduction in turnaround times with implementation of both total laboratory automation and MALDI-TOF MS for organisms recovered from blood samples, while Graham et al [12] demonstrated improved standardization and shortened the time to first plate reading in a prospective study comparing conventional processing to TLA
Comparison I of two 6-month time periods that included over 61,000 total specimens before and after implementation of TLA showed significantly improved turnaround times (TATs) and TAT variability for positive reports, including identifications and results of antimicrobial testing (Table 2 and Fig. 1)
Summary
We implemented Bruker matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) and BD Kiestra total laboratory automation (TLA) 4 and 3 years ago, respectively. To assess the impact of these new technologies, we compared turnaround times (TATs) for positive and negative urine cultures before and after implementation. Total laboratory automation generally refers to an integrated model of automation joined by a conveyor system [4] In microbiology, this includes automated processing of specimens, incubation, imaging of plates, reading of high-resolution plate images, discarding of plates when results are final, and delivery of plates to workbenches. Mutters et al [11] demonstrated a reduction in turnaround times with implementation of both total laboratory automation and MALDI-TOF MS for organisms recovered from blood samples, while Graham et al [12] demonstrated improved standardization and shortened the time to first plate reading in a prospective study comparing conventional processing to TLA. Total laboratory automation in clinical chemistry has been shown to decrease turnaround times and affect length of hospital stay [13, 14]
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