Hospital-based Laboratories Research Articles

Addressing HLA Laboratory Vacancy Challenges: Insights from a Survey-Based Analysis

Abstract Introduction/Objective Laboratory vacancies pose significant challenges to institutions across diverse sectors. Understanding the landscape of these vacancies is crucial for developing effective strategies on how best to address them. The American Society of Histocompatibility & Immunogenetics (ASHI) Laboratory Professionals Recruitment Initiative (LPRI) was created to help address these issues by promoting and raising awareness of Histocompatibility and Immunogenetics (HLA) labs. This poster presents findings from a comprehensive survey conducted among various types of institutions to explore the prevailing dynamics surrounding HLA laboratory job vacancies. The primary purpose of this study is to provide a comprehensive overview of the HLA laboratory job vacancy landscape, including current vacancy rates, time taken to fill vacancies, and the perceived underlying causes attributed to these vacancies. Methods/Case Report The ASHI LPRI developed structured survey was administered to HLA laboratories represented in different service sectors, including hospital based, reference, organ procurement and independent laboratories. The survey collected data on the type of institution, current laboratory job vacancy rates, average time taken to fill vacancies, and perceived primary causes for vacancies. Data analysis was conducted to identify patterns and insights into the HLA laboratory vacancy challenges. Results (if a Case Study enter NA) The majority of respondents were from hospital-based or independent HLA laboratories, with few identifying as reference or organ procurement laboratories. Licensure or required certification was not a restricting factor in filling the vacancies. Vacancy rates for the varying institutions range between 10%- 25% with few reporting greater than 25% vacancy rate. A majority (54%) report their vacancies remain open for > 6 months. Predominant vacancy perpetuation was most attributed to lack of applicants (58%) and insufficient pay offered (41%). Conclusion The findings of this study offer valuable insights into the complexities surrounding laboratory job vacancies in the clinical HLA space. Understanding the underlying causes and dynamics of these vacancies is essential for developing targeted strategies to mitigate the problem. By addressing these challenges, institutions can enhance workforce stability and ensure optimal laboratory operations. This poster serves as a foundation for further research and policy interventions aimed at addressing laboratory vacancy challenges.

Does LDL-C determination method affect statin prescribing for primary prevention? A register-based study in Southern Denmark.

Examine whether the low-density lipoprotein cholesterol (LDL -C) determination method influences the rate of statin initiation for primary prevention of cardiovascular disease. We conducted a register-based retrospective study in the Region of Southern Denmark. Two hospital-based laboratories in the region directly measure LDL -C whereas four laboratories calculate LDL -C using Friedewald's formula. Physicians do not choose which method is used. We included all statin-naïve patients ≥40 years with no history of cardiovascular disease, diabetes, or chronic kidney disease, who had their LDL -C determined during 2018-2019. There were 202807 people who had LDL -C determined during the study period (median age 59 years, 44% women) of which 37% had a direct LDL -C measurement. The median reported LDL -C was 3.40mmol/L [interquartile range (IQR) 2.90-4.00] for those with a direct measurement vs. 3.00mmol/L (IQR 2.40-3.50) for those with calculated LDL -C. For those with direct measurement, re-calculated LDL -C (using Friedewald's formula) was 0.35mmol/L lower than the reported direct LDL -C measurement. Among those with directly measured LDL -C, 3.6% initiated statins compared with 2.7% of those with a calculated LDL -C. Direct LDL -C measurement led to higher odds of having a statin initiated compared with calculated LDL -C (adjusted odds ratio 1.23, 95% CI 1.17-1.30); for those with triglycerides >1.7mmol/L the adjusted odds ratio was 1.41 (95% CI 1.30-1.52). Differences in the reporting of LDL -C from laboratories using different methods have a substantial influence on physician's decisions to prescribe statins.

Discrepancies between two D-dimer assays and impact on clinical decisions; a retrospective analysis of samples tested in community and hospital-based laboratories in Auckland.

In patients with suspected venous thromboembolism, an elevated D-dimer level provides an important branch-point in the management pathway. This study compared two D-dimer assays, INNOVANCE® DDimer (Innovance) and STA®-Liatest® D-Di Plus (Liatest), to assess potential impact on clinical management. Reflecting current practice in Waitematā, Auckland, we compared paired samples from 805 patients referred to hospital following a community D-dimer test. Samples were determined to be positive or negative using a 500μg/L fibrinogen equivalent units (FEU), and age-adjusted cut-offs. In the Innovance assay, 2% of samples had a result <500μg/L FEU. In contrast, by Liatest, 18% were below 500μg/L. This positive bias of Innovance was amplified with use of age-adjusted cut-offs; 23% of samples with an elevated Innovance result showed a normal result by Liatest. On average, the Innovance values were 22% higher than Liatest. Results suggestive of interference from heterophile antibodies were seen in 6% of sample-pairs. Innovance D-dimer test yielded higher values than Liatest and experienced interference from suspected heterophile antibodies. Discrepancies in nearly a quarter of patients may be leading to substantial under or over investigation, inefficient use of resources and clinical confusion.

Recording and Reporting of Antimicrobial Resistance (AMR) Priority Variables and Its Implication on Expanding Surveillance Sites in Nepal: A CAPTURA Experience.

Data on antimicrobial resistance (AMR) from sites not participating in the National AMR surveillance network, conducted by National Public Health Laboratory (NPHL), remain largely unknown in Nepal. The "Capturing Data on Antimicrobial Resistance Patterns and Trends in Use in Regions of Asia" (CAPTURA) assessed AMR data from previously untapped data sources in Nepal. A retrospective cross-sectional data review was carried out for the AMR data recorded between January 2017 and December 2019 to analyze AMR data from 26 hospital-based laboratories and 2 diagnostic laboratories in Nepal. Of the 56 health facilities initially contacted to participate in this project activity, 50.0% (28/56) signed a data-sharing agreement with CAPTURA. Eleven of the 28 hospitals were AMR surveillance sites, whereas the other 17, although not part of the National AMR surveillance network, recorded AMR-related data. Data for 663 602 isolates obtained from 580 038 patients were analyzed. A complete record of the 11 CAPTURA priority variables was obtained from 45.5% (5/11) of government hospitals, 63.6% (7/11) of private hospitals, and 54.6% (6/11) of public-private hospitals networked with NPHL for AMR surveillance. Similarly, 80% (8/10) of clinics and 54.6% (6/11) of laboratories outside the NPHL network recorded complete data for the 10 Global Antimicrobial Resistance and Use Surveillance System (GLASS) priority variables and 11/14 CAPTURA priority variables. Retrospective review of the data identified areas requiring additional resources and interventions to improve the quality of data on AMR in Nepal. Furthermore, we observed no difference in the priority variables reported by sites within or outside the NPHL network, thus suggesting that policies could be made to expand the surveillance system to include these sites without substantially affecting the government's budget.

A simple undergraduate laboratory exercise for teaching the role of sentinel-level clinical microbiology testing in biological threat identification.

Undergraduate students in the biomedical sciences are mostly unaware of how clinical microbiology laboratories handle suspected agents of bioterrorism or emerging infectious diseases. The Public Health Security Bioterrorism Preparedness and Response Act of 2002 requires the US Department of Health and Human Services (HHS) to maintain a list of microbes that pose serious biological threats to human health and safety, including Tier 1 agents with the potential for use in bioterrorism. The Laboratory Response Network (LRN), founded by the Centers for Disease Control and Prevention, the Federal Bureau of Investigation, and the Association of Public Health Laboratories, coordinates the response of sentinel, reference, and national laboratories to these biothreats. The sentinel laboratories, which comprise most hospital-based and commercial laboratories, are the first to encounter a suspicious agent. For this reason, the LRN has published a series of testing guidelines to assist the sentinel laboratories in deciding whether a microbial isolate should be considered potentially hazardous and thus sent to a reference or national laboratory for further characterization. Here, we describe a simple laboratory exercise that teaches sentinel-level testing requirements in the context of an applied setting of a potential outbreak of anthrax that would require a sentinel laboratory to recognize a potential threat, attempt to rule it out, and refer to a national laboratory for identification.

Identification of a partnership model between a university, for-profit, and not-for-profit organization to address health professions education and health inequality gaps through simulation-based education: A scoping review protocol.

Healthcare providers in rural and remote (R&R) areas of Canada do not have the same access to skills development and maintenance opportunities as those in urban areas. Simulation-based education (SBE) is an optimal technique to allow healthcare providers to develop and maintain skills. However, SBE is currently limited mainly to universities or hospital-based research laboratories in urban areas. The purpose of this scoping review is to identify a model, or components of a model, that outline how a university research laboratory can collaborate with a for profit and not-for-profit organization to facilitate the diffusion of SBE into R&R healthcare provider training. This scoping review will be guided by the methodological framework introduced by Arksey and O'Malley in 2005 and the Methodology for Joanna Briggs Institute Scoping Reviews. Ovid MEDLINE, PsycINFO, Scopus, Web of Science, and CINAHL will be searched for relevant articles published between 2000 and 2022, in addition to grey literature databases and manual reference list searches. Articles describing a partnership model or framework between academic institutions and non-profit organizations with a simulation or technology component will be included. Titles and abstracts will be screened, followed by a full-text screening of articles. Two reviewers will participate in the screening and data extraction process for quality assurance. Data will be extracted, charted, and summarized descriptively to report key findings on potential partnership models. This scoping review will provide an understanding on the extent of existing literature regarding the diffusion of simulators for healthcare provider training through a multi-institutional partnership. This scoping review will benefit R&R parts of Canada by identifying gaps in knowledge and determining a process to deliver simulators to train healthcare providers. Findings from this scoping review will be submitted for publication in a scientific journal.

Diagnostic Accuracy of a Rapid SARS-CoV-2 Antigen Test Among People Experiencing Homelessness: A Prospective Cohort and Implementation Study.

Detection strategies in vulnerable populations such as people experiencing homelessness (PEH) need to be explored to promptly recognize severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreaks. This study investigated the diagnostic accuracy of a rapid SARS-CoV-2 Ag test in PEH during two pandemic waves compared with gold standard real-time multiplex reverse transcription polymerase chain reaction (rtRT-PCR). All PEH ≥ 18years requesting residence at the available shelters in Verona, Italy, across two cold-weather emergency periods (November 2020-May 2021 and December 2021-April 2022) were prospectively screened for SARS-CoV-2 infection by means of a naso-pharyingeal swab. A lateral flow immunochromatographic assay (Biocredit® COVID-19 Ag) was used as antigen-detecting rapid diagnostic test (Ag-RDT). The rtRT-PCR was performed with Allplex™ SARS-CoV-2 assay kit (Seegene). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated as measures for diagnostic accuracy. Overall, 503 participants were enrolled during the two intervention periods for a total of 732 paired swabs collected: 541 swabs in the first period and 191 in the second. No significant differences in demographic and infection-related characteristics were observed in tested subjects in the study periods, except for the rate of previous infection (0.8% versus 8%; p < 0.001) and vaccination (6% versus 73%; p < 0.001). The prevalence of SARS-CoV-2 in the cohort was 8% (58/732 swabs positive with rtRT-PCR). Seventeen swabs were collected from symptomatic patients (7%). Among them, the concordance between rtRT-PCR and Ag-RDT was 100%, 7 (41.2%) positive and 10 negative pairs. The overall sensitivity of Ag-RDT was 63.8% (95% CI 60.3-67.3) and specificity was 99.8% (95% CI 99.6-100). PPV and NPV were 97.5% and 96.8%, respectively. Sensitivity and specificity did not change substantially across the two periods (65.1% and 99.8% in 2020-2021 vs. 60% and 100% in 2021-2022). A periodic Ag-RDT-based screening approach for PEH at point of care could guide preventive measures, including prompt isolation, without referral to hospital-based laboratories for molecular test confirmation in case of positive detection even in individuals asymptomatic for COVID-19. This could help reduce the risk of outbreaks in shelter facilities.

Multi-year antimicrobial-resistance trends in urine Escherichia coli isolates from both community-based and hospital-based laboratories of an Australian local health district

Efforts to monitor and combat antimicrobial resistance (AMR) are typically focused on the hospital-based laboratory setting. The aim of this study was to longitudinally examine and compare trends in AMR among urine Escherichia coli isolates from a private community-based laboratory and a public hospital-based laboratory in an Australian local health district. A total of 108 262 urine E. coli isolates from a public hospital-based laboratory (N=34 103) and a private community-based laboratory (N=74 159) in a single health district between 2007-2019 were analysed. Linear regression was used to identify significance of change in AMR rates in both laboratories independently and detect any significant interaction of each setting in proportional change over the study period. Similar AMR trends were detected among urinary E. coli isolates in private community-based laboratory and public hospital-based laboratory settings over 12 y. AMR rates were consistently higher in the public hospital-based setting. Ampicillin was the only antibiotic for which the E. coli resistance trend did not significantly change over the time period in either laboratory setting. All other antibiotics showed a significant increase in AMR rates over time in both settings. AMR rates in both the private community-based laboratory and public hospital-based laboratory settings increased over time and were consistently higher in the public hospital-based laboratory setting. Since private laboratories handle the vast majority of pathology volumes in community outpatient settings in Australia, interventions incorporating the community-based laboratory setting are critical to addressing AMR in the community.

Clinical Testing for Tumor Cell-Free DNA: College of American Pathologists Proficiency Programs Reveal Practice Trends.

Clinical testing for tumor cell-free DNA (cfDNA) has evolved rapidly, but no practice guidelines exist. To summarize cfDNA laboratory practices based on self-reporting and assess preanalytical, analytical, and postanalytical trends that may influence the quality, accuracy, and consistency of cfDNA testing. Data were derived from the College of American Pathologists cfDNA proficiency testing program submitted by 101 participating laboratories from 2018 to 2019. Most laboratories performing clinical circulating tumor DNA testing are commercial/nonhospital (71.2%; 72 of 101) and international (77.2%; 78 of 101) laboratories. Commercial laboratories had higher monthly test volumes than hospital-based laboratories (median, 36 versus 7-8) and tended to have larger gene panels (median, 50 versus 11 genes) when panel-based testing was offered. The main clinical indications include therapy selection and treatment/disease monitoring. Plasma is the most commonly accepted specimen, which is predominantly collected in cell-stabilizing tubes. Equal proportions of laboratories use next-generation sequencing (NGS) and non-NGS methods to assess key genes, including EGFR, BRAF, KRAS, NRAS, and IDH1. Most laboratories reported a lower limit of detection (LLOD) of 0.5%, variant allele frequency or less, which did not differ by method, NGS or non-NGS, except for EGFR. Sixty-five percent (17 of 26) of laboratories using the US Food and Drug Administration (FDA)-approved non-NGS EGFR assay report analytical sensitivities higher than 0.5%, as compared to 15% (16 of 104) of laboratories using an alternative NGS or non-NGS method. There is also a wider range in LLODs obtained for the FDA-approved EGFR assay than nonapproved assays. These results highlight emerging practice trends and serve as a foundation to initiate future practice recommendations.

Choice of tools for routine malaria diagnosis among diagnostic Centres in Urban settings of Anambra State, Nigeria.

As malaria elimination efforts continue to show promise, the diagnostic services require constant review to ensure effective treatment. This study was aimed at determining the choice of tools for routine malaria diagnosis in Anambra State. The research was a cross sectional study carried out in 2019 and 2021, using the total population sampling technique to enrol diagnostic centres. Data were collected using pretested questionnaire, and analysed using Mann-Whitney U test, Kruskal-Wallis H test and Chi-square test at a 5% significance level. Microscopy and RDT usage were 73.6% and 68.1% respectively, with 41.8% overlap (p &gt; 0.05). Overall RDT usage was higher, 69.7% than Microscopy usage with 63.6% in Hospital-based Laboratories (p &gt; 0.05). Overall Microscopy usage, ranging from 72.5% to 80.0% was higher than RDT in Private Laboratories, Government-owned Laboratories and Private-owned Laboratories (p &gt; 0.05). SD-Bioline® (38.7%) and Carestat® (35.5%) were the most commonly used RDTs (p &lt; 0.05). Overall usage of thick and thin blood films were: 74.6% and 37.3% respectively, with 11.9% overlap (p &lt; 0.05). Giemsa stain had higher, 78.0% usage in preparing thick blood films than Field stain with 22.0 % (p &lt; 0.05). Usage of Giemsa, Leishman and Field’s stain for thin blood film were: 64.0%, 20.0% and 16.0% respectively (p &lt; 0.05). All the diagnostic centres (100%) report positive and negative results as ‘seen’ and ‘not seen’; with 3.0% of them identifying Plasmodium species while 97.0% report as ‘malaria parasite’ (p &lt; 0.05). Regarding intensity, 1.5% of the diagnostic centres use ‘parasite count / μl of blood’ while 98.5% adopted ‘plus system’ (p &lt; 0.05). Only Microscopy and RDT are used for routine diagnosis of malaria in the study area. However, not all the Microscopy components are used fully and according to standard. Reasons for the choice of tool / their components were given.

Old Adversary, New Challenges: Childhood Lead Exposure and Testing.

Old Adversary, New Challenges: Childhood Lead Exposure and Testing.

Evaluation of Diagnostic Microbiology Capacity and Barriers in Testing for HIV and TB at Peripheral Hospital-Based Laboratories in Oyo-State, Nigeria.

ABSTRACTThe prevalence of tuberculosis (TB) and human immunodeficiency virus (HIV) coinfection in Nigeria is currently around 19.1%. This indicates that the two diseases are still a burden on the nation”s health. The aim of this study was to evaluate the diagnostic microbiology capacity and the barriers in performing assay for TB and HIV at peripheral district-level hospital-based laboratories in Oyo State, Nigeria. Diagnostic microbiology capacity was estimated using a scale of 100-point where scores ≤ 49% were categorized as low, 50–79% fair and ≥80% good. Barriers to diagnosis were summarized in proportions. The diagnostic microbiology capacity revealed that 6 (35.3%) and 11 (64.7%) of the laboratories had “fair” and “low” capacity, respectively, to detect TB in cerebrospinal fluid/sputum. In testing for HIV, 3 (17.6%) of the laboratories had “fair capacity” and 14 (82.4%) had “low capacity” to detect CD4 count and HIV antibodies in blood serum. The major diagnostic barriers in almost all (94.1%) the laboratories were lack of culture supplies and nonavailability of reagents/testing kits. There was no diagnostic microbiology service with good capacity to facilitate case detection of HIV and TB at the peripheral hospitals. Hence there is a need to improve the supply of reagents, culture stock and testing kits. This will facilitate the detection of TB and HIV cases in peripheral communities.IMPORTANCE This study provided a snapshot knowledge of testing capabilities and commodity availability at state laboratories. The findings should inform the action of stakeholders to improve diagnostic microbiology capacity, consequently enhancing diagnostic measures in detecting human immunodeficiency virus and Mycobacterium tuberculosis.

Preanalytical errors in a satellite stat laboratory: A Six Sigma analysis of seven years’ data

BackgroundThere have been few reports regarding the frequency and types of preanalytical errors in stat laboratories, in particular those occurring in the satellite laboratory setting. The impact of this error type on laboratory performance in this environment is largely unknown. We assessed the performance of a stat laboratory serving a population of predominantly elderly patients with suspected or established diagnoses of cancer using Six Sigma methodology and compared the results to previous work on this subject. MethodsWe performed an observational retrospective study using data from the period 2013–2020. The clinical setting was a satellite laboratory supporting an outpatient medical clinic. The type and frequency of each type of preanalytical error were compiled and were used to derive the quarterly error rate. Overall and quarterly performance were calculated using Six Sigma methodology. ResultsDuring the study period 1314 preanalytical errors were identified from 247,271 laboratory tests (0.5% of total test volume). There was a steady decrease in the error rate over the course of the study period, ranging from 1.4% in 2013 to 0.14% in 2020, despite a 290% increase in quarterly test volume during this period. The most common error types encountered were order error, hemolysis, collection error, and lab accident. Conclusion1) The overall performance of a satellite laboratory with a stat testing menu is comparable to hospital-based laboratory stat testing. 2) The most frequent error types encountered in satellite laboratory stat testing differ from those found in hospital-based laboratories. 3) There was an overall improvement in laboratory performance based on Six Sigma methodology.

Adequacy of Surgical Pathology Reports of Colorectal Carcinoma and Its Significance.

IntroductionColorectal cancer is the fifth most common cancer in the world. For loco-regionally confined disease surgery is the definitive treatment. An adequate surgical pathology report is mandatory for the selection of adjuvant therapy. The objective of this study is to analyze whether adequate information is provided or not in the surgical pathology reports of colorectal carcinoma as according to College of American Pathologists (CAP) guidelines.MethodThis is a cross-sectional study carried out in the Department of Clinical Oncology, Jinnah Postgraduate Medical Center (JPMC) Karachi, tertiary care hospital in Pakistan. The duration of the study was from February 2020 to January 2021. A total of 153 surgical pathology reports issued by 11 different hospital-based laboratories after definitive surgery was assessed to look at its concordance rate with the checklist adapted from the CAP guidelines.ResultsOut of 153 surgical pathology reports, clinical information was provided in 72.5% of reports. Details of tumor extension were present in 88.2%, tumor margin in 75%, surgical procedure in 79%, and tumor deposits in 39.2% of reports. Macroscopic details including tumor perforation and evaluation of mesorectum were documented in 51.6% and 53.5% of the reports respectively. Details regarding perineural invasion along with lymphovascular invasion were present in 81.6% and 93% of the reports, respectively. The treatment effect was documented in only 25% of reports and regional lymph node status has been described in 85% of reports. Parameters described in all surgical pathology reports were: tumor site, tumor type, histologic type, and histologic grade. The pathological stage of the disease was documented in 91.5% of the reports.ConclusionThis study concluded that surgical pathology reports of the majority of pathology laboratories were not fully adhered to the checklist provided by the CAP guidelines. This will affect post-operative management along with the prediction of disease prognosis.

Harmful biological agents intentionally used in enterprises in Poland based on the National Register of Biological Agents

This work presents intentional use of harmful biological agents based on the National Register of Biological Agents (in Polish abbreviated as KRCB) as of July 2020. Generally, KRCB is a central database gathering notifications of intentional use of biological agents classified as risk groups 2-4 at work. Notifications were sent by 672 enterprises, including for diagnostic - 63%, research - 30% and industrial purposes - 7%. The largest number of notifications were sent by hospital-based diagnostic laboratories - 34%, laboratories other than hospital-based - 34%, and higher education and research units - 15%. In total, 7077 workers (88% women, 12% men) were exposed to biological agents intentionally used at work. The following bacteria were most frequently used: Escherichia coli (with the exception of non-pathogenic strains) - 4394 (62%) exposed workers, Staphylococcus aureus -4122 (58%), and Pseudomonas aeruginosa - 3726 (53%). Biological agents recognized by the International Agency for Research on Cancer as carcinogenic were used in 107 enterprises (16%), including the following viruses: hepatitis B virus (HBV) - 25 enterprises (4%), hepatitis C virus (HCV) - 24 (4%), human immunodeficiency virus type 1 (HIV-1) - 18 (3%), Epstein-Barr virus (EBV) - 10 (1%), human papilloma virus (HPV) - 5 (1%), human herpes virus type 8 (HHV-8) - 3 (<1%), human T-lymphotropic virus type 1 (HTLV-1) - 3 (<1%), as well as bacteria Helicobacter pylori - 18 (3%) and parasites Schistosoma haematobium - 1 (<1%). While KRCB is a unique source of information on biological agents intentionally used in workplaces, it also provides an important link in the chain of information on occupational exposure to harmful agents in Poland. Med. Pr. 2021;72(2):131-43.

Drug resistance phenotypes and genotypes in Mexico in representative gram-negative species: Results from the infivar network.

AimThis report presents phenotypic and genetic data on the prevalence and characteristics of extended-spectrum β-lactamases (ESBLs) and representative carbapenemases-producing Gram-negative species in Mexico.Material and methodsA total of 52 centers participated, 43 hospital-based laboratories and 9 external laboratories. The distribution of antimicrobial resistance data for Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae complex, Acinetobacter baumannii complex, and Pseudomonas aeruginosa in selected clinical specimens from January 1 to March 31, 2020 was analyzed using the WHONET 5.6 platform. The following clinical isolates recovered from selected specimens were included: carbapenem-resistant Enterobacteriaceae, ESBL or carbapenem-resistant E. coli, and K. pneumoniae, carbapenem-resistant A. baumannii complex, and P. aeruginosa. Strains were genotyped to detect ESBL and/or carbapenemase-encoding genes.ResultsAmong blood isolates, A. baumannii complex showed more than 68% resistance for all antibiotics tested, and among Enterobacteria, E. cloacae complex showed higher resistance to carbapenems. A. baumannii complex showed a higher resistance pattern for respiratory specimens, with only amikacin having a resistance lower than 70%. Among K. pneumoniae isolates, blaTEM, blaSHV, and blaCTX were detected in 68.79%, 72.3%, and 91.9% of isolates, respectively. Among E. coli isolates, blaTEM, blaSHV, and blaCTX were detected in 20.8%, 4.53%, and 85.7% isolates, respectively. For both species, the most frequent genotype was blaCTX-M-15. Among Enterobacteriaceae, the most frequently detected carbapenemase-encoding gene was blaNDM-1 (81.5%), followed by blaOXA-232 (14.8%) and blaoxa-181(7.4%), in A. baumannii was blaOXA-24 (76%) and in P. aeruginosa, was blaIMP (25.3%), followed by blaGES and blaVIM (13.1% each).ConclusionOur study reports that NDM-1 is the most frequent carbapenemase-encoding gene in Mexico in Enterobacteriaceae with the circulation of the oxacillinase genes 181 and 232. KPC, in contrast to other countries in Latin America and the USA, is a rare occurrence. Additionally, a high circulation of ESBL blaCTX-M-15 exists in both E. coli and K. pneumoniae.

Evaluation of diagnostic microbiology capacity and barriers in testing for HIV and TB at peripheral hospital-based laboratories in Oyo-state, Nigeria

Background: Tuberculosis (TB) and human immunodeficiency virus (HIV) are two interrelated infectious diseases that continue to threaten public health in several parts of the world. In Nigeria, a maximum of 52,000 people died from HIV and TB in 2017 which suggests that the two diseases are still a burden on the nation's health. This study sought to evaluate the diagnostic microbiology capacity and barriers in testing for HIV and TB at peripheral government-owned secondary hospital-based laboratories in Oyo State, Nigeria. Methods and materials: This study used a descriptive cross-sectional design to evaluate 17 government-owned secondary hospital-based laboratories in Oyo State. A WHO laboratory assessment tool was used to evaluate the study laboratories. Diagnostic capacity was measured on a scale of 100-point in which scores ≤49% were rated low, fair (50–79%), and good (≥80%). A score of 0, 50 and 100 were assigned to no, partial and yes responses respectively and the average score was calculated. Results: Evaluation of diagnostic capacity showed that 11 (64.7%) and 6 (35.3%) of the laboratories had ‘low’ and ‘fair’ capacity respectively to test sputum or cerebrospinal fluid for TB. For HIV, 14 (82.4%) of the laboratories had ‘low capacity’ and 3 (17.6%) had ‘fair capacity’ to test serum for HIV antigen and blood for viral load. Analysis of the type of assay performed at the laboratories indicated that 9 (52.9%) of the laboratories could carry out acid-fast bacilli (AFB) smear using Ziehl-Neelsen stain, 8 (47.1%) Rhodamine/Auramine stain and no laboratory could perform AFB culture and sensitivity. Seven (41.2%) of the laboratories could carry out a serological test for HIV and 3 (17.6%) could test blood for viral load. More than 50% of the laboratories reported that unavailable testing kits/reagents for HIV/TB and lack of culture facilities for AFB were the diagnostic barriers responsible for the ‘low’ and ‘fair’ capacity observed in the laboratories. Conclusion: The low capacity of laboratories in this state underscores the need for interventions to improve the supply of testing kits, reagents and culture facilities which will enhance prompt detection of HIV and TB cases.

Modeling Pathology Workload and Complexity to Manage Risks and Improve Patient Quality and Safety

Anatomic pathology (AP) laboratories provide critical diagnostic information that help determine patient treatments and outcomes, but the risks of AP operations and their impact on patient safety and quality of care remain poorly recognized and undermanaged. Hospital-based laboratories face an operational and risk management challenge because clinical work of unknown quantity and complexity arrives with little advance notice, which results in fluctuations in workload that can push operations beyond planned capacity, leading to diagnostic delays and potential errors. Modeling the dynamics of workload and complexity in AP offers the opportunity to better use available information to manage risks. We developed a stock-and-flow model of a typical AP laboratory operation and identified key exogenous inputs that drive AP work. To test the model, we generated training and validations data sets by combining data from the electronic medical records and laboratory information systems over multiple years. We demonstrate the implementation of 10-day AP work forecast generated on a daily basis, and show its performance in comparison with actual work. Although the model somewhat underpredicts work as currently implemented, it provides a framework for prospective management of resources to ensure quality during workload surges. Although full implementation requires additional model development, we show that AP workload largely depends on few and accessible clinical inputs. Recognizing that level loading of work in a hospital is not practical, predictive modeling of work can empower laboratories to triage, schedule, or mobilize resources more effectively and better manage risks that reduce the quality or timeliness of diagnostic information.

How to Optimize Activated Partial Thromboplastin Time (APTT) Testing: Solutions to Establishing and Verifying Normal Reference Intervals and Assessing APTT Reagents for Sensitivity to Heparin, Lupus Anticoagulant, and Clotting Factors.

The activated partial thromboplastin time (APTT) assay is a very common coagulation test, used for several reasons. The test is conventionally used for assessing the contact factor (intrinsic) pathway of blood coagulation, and thus for screening deficiencies in this pathway, most typically factors VIII, IX, and XI. The APTT is also sensitive to contact factor deficiencies, including factor XII, prekallikrein, and high-molecular-weight kininogen. The APTT may also be elevated in a variety of conditions, including liver disease, vitamin K deficiency, and disseminated intravascular coagulation. The APTT can also be used for monitoring unfractionated heparin (UFH) therapy, as well as for screening lupus anticoagulant (LA) or for assessing thrombosis risk. Which of these separate uses is important to a given laboratory or clinician depends on the laboratory and the clinical context. For example, UFH sensitivity is important in hospital-based laboratories, where UFH therapy is used, but not in hospital-based laboratories where low-molecular-weight heparin (LMWH) is largely employed or where UFH may be assessed by anti-factor Xa testing, or in private/community laboratories not associated with a hospital system. High sensitivity to (low levels of) factors VIII, IX, and XI is generally preferred, as their deficiencies are clinically significant. Also preferred, but not usually achieved, is low sensitivity to factor XII and other contact factors, as these deficiencies are usually asymptomatic. Nevertheless, a good knowledge of factor sensitivity is usually needed, if only to help explain the reasons for a prolonged APTT in a given patient, or whether factor testing or other investigation is required. A good working knowledge of reagents sensitivity to LA is also advisable, especially when the reagent is used as part of a LA test panel, or else as a "general-purpose screening reagent." The current report is aimed at providing some guidance around these questions, and is intended as a kind of "how to" guide, that will enable laboratories to assess APTT reagents in regard to their sensitivity to heparin, LA, and clotting factors. The report also provides some advice on generation of normal reference ranges, as well as solutions for troubleshooting prolonged APTTs, when performing factor testing or searching for inhibitors.

The shift in seasonality of legionellosis in the USA.

According to the Centers for Disease Control and Prevention (CDC), from 2000 to 2014, reported cases of legionellosis per 100 000 population increased by 300% in the USA, although reports on disease seasonality are inconsistent. Using two national databases, we assessed seasonal patterns of legionellosis in the USA. We created a monthly time series from 1993 to 2015 of reported cases of legionellosis from the CDC, and from 1997 to 2006 of medical claims of legionellosis-related hospitalisation in older adults from the Centers for Medicaid and Medicare Services (CMS). We split the study time interval into two segments (before and after 2003), and applied a Poisson harmonic regression model to each dataset and each segment. The time series of monthly counts exhibited a significant shift of seasonal peaks from mid-September (9.676 ± 0.164 months) before 2003 to mid-August (8.452 ± 0.042 months) after 2003, along with an alarming increase in the amplitude of seasonal peaks in both CDC and CMS data. The lowest monthly reported cases of legionellosis in 2015 (281) exceed the maximum value reported before 2003 (206). We also observed a discrepancy between CDC and CMS data, suggesting that not all cases of legionellosis diagnosed by hospital-based laboratories were reported to the CDC. Improved reporting of legionellosis is required to better inform the public and organise disease prevention.