Medical Microbiology Laboratory Research Articles

Use of MALDI-ToF Mass Spectrometry for Identification of Leptospira.

Medical microbiology has used phenotypical and metabolic criteria to identify bacterial pathogens for decades. However, no such criteria have been applied to identify leptospires at the species level. In the recent years, matrix-assisted laser desorption/ionization time-of-flight (MALDI-ToF) mass spectrometry (MS) has emerged as new tool for the identification of bacterial species in the medical microbiology laboratory. This technology has rapidly gained more and more popularity. Actually, this technique is sensitive and economic, saving both labor and bench costs, but also rapid, significantly reducing turnaround time from isolation to identification. MALDI-ToF MS provides an unprecedented tool for the rapid identification of Leptospira at the species level.

Prevalence of cystic echinococcosis in humans in Erzincan Province

Aim: A study was carried out in human patients with suspicion of cystic echinococcosis. Echinococcosis granulosus is a zoonotic disease that causes cystic echinococcosis in humans and animals. The disease caused by adult or larval stages of tapeworms of the genus Echinococcus family.Material and Methods: 1,102 blood samples sent to Erzincan Binali Yildirim University, Mengucek Gazi Training and Research Hospital Medical Microbiology Laboratory between January 2011 and December 2018 with suspicion of cystic echinococcosis were centrifuged at 1500 rpm for 10 minutes. Serum samples were tested immediately by indirect hemagglutination test in order to detect specific antibodies.Results: 248 of 1,102 blood samples of patients were found to be infected with cystic echinococcosis for the 9-year of period (an average annual incidence of 10.48 per 100,000 inhabitants). Conclusion: It is understood that hydatid disease is decreasing in the province, but there is always a risk of increases in cystic echinococcosis for humans.

Incidence, clinical implications and impact on public health of infections with Shigella spp. and entero-invasive Escherichia coli (EIEC): results of a multicenter cross-sectional study in the Netherlands during 2016\u20132017

BackgroundShigella spp. and entero-invasive E. coli (EIEC) use the same invasive mechanism to cause diarrheal diseases. Public health regulations apply only to Shigella spp. infections, but are hampered by the lack of simple methods to distinguish them from EIEC. In the last decades, molecular methods for detecting Shigella spp. and EIEC were implemented in medical microbiological laboratories (MMLs). However, shigellosis cases identified with molecular techniques alone are not notifiable in most countries. Our study investigates the impact of EIEC versus Shigella spp. infections and molecular diagnosed shigellosis versus culture confirmed shigellosis for re-examination of the rationale for the current public health regulations.MethodsIn this multicenter cross-sectional study, fecal samples of patients suspected for gastro-enteritis, referred to 15 MMLs in the Netherlands, were screened by PCR for Shigella spp. or EIEC. Samples were cultured to discriminate between the two pathogens. We compared risk factors, symptoms, severity of disease, secondary infections and socio-economic consequences for (i) culture-confirmed Shigella spp. versus culture-confirmed EIEC cases (ii) culture positive versus PCR positive only shigellosis cases.ResultsIn 2016–2017, 777 PCR positive fecal samples with patient data were included, 254 of these were culture-confirmed shigellosis cases and 32 were culture-confirmed EIEC cases. EIEC cases were more likely to report ingestion of contaminated food and were less likely to be men who have sex with men (MSM). Both pathogens were shown to cause serious disease although differences in specific symptoms were observed. Culture-negative but PCR positive cases were more likely report travel or ingestion of contaminated food and were less likely to be MSM than culture-positive cases. Culture-negative cases were more likely to suffer from multiple symptoms. No differences in degree of secondary infections were observed between Shigella spp. and EIEC, and culture-negative and culture-positive cases.ConclusionsNo convincing evidence was found to support the current guidelines that employs different measures based on species or detection method. Therefore, culture and molecular detection methods for Shigella spp. and EIEC should be considered equivalent for case definition and public health regulations regarding shigellosis. Differences were found regarding risks factors, indicating that different prevention strategies may be required.

Retrieval and re-evaluation of previously diagnosed chronic hepatitis C infections lost to medical follow-up in the Netherlands.

Many individuals previously diagnosed with chronic hepatitis C virus (HCV) infection are likely to be lost to medical follow-up and, therefore, remain untreated despite new highly effective drug treatment, direct acting antivirals. We aim to identify and retrieve these chronic HCV-infected individuals to re-evaluate them and offer treatment. Possible chronic HCV infections were identified from test results of the medical microbiological laboratory, notifications to the public health service, and the hospital registries over the past 15 years were checked in South Limburg, the Netherlands. Individuals were contacted based on the physician-patient relationship of the gastroenterologist or microbiologist (retrieval). Individuals were informed about the new treatment options, offered an HCV-RNA test, and if still positive, referred to the gastroenterologist for treatment (re-evaluation). In total, 689 individuals with a positive anti-HCV test in the past were identified, 308 (45%) were eligible for retrieval, 90 (29%) of them were retrieved, 34 (38%) of those retrieved were re-evaluated, 19 (56%) of those tested were HCV-RNA positive, and 12 (63%) of these individuals were offered treatment. During every step of the retrieval chain, many patients were lost. Nevertheless, with substantial effort, we were able to identify, retrieve, and positively re-evaluate a limited number of individuals with a possible chronic HCV infection who were lost to medical follow-up (19 patients). With this case-finding approach, we were able to prevent potential severe complications in these patients and contribute to a small step in the eradication of HCV in the Netherlands.

Retrospective Analysis of Microbial Colonization Patterns in Central Venous Catheters, 2013-2017.

Objectives This study was performed to provide epidemiological information on microbial colonization in central venous catheters (CVCs). Methods CVCs submitted to Medical Microbiology Laboratory from January 1, 2013, through October 1, 2017, which met our criteria would be included for analysis. Quantitative culture was used for CVCs. The results of culture and related information on CVCs were collected and recorded in detail. The prevalence was calculated, and related factors were analyzed statistically. Results A total of 2020 CVCs were submitted for culture and eligible for analysis. Positive microbial culture occurred in 379 catheters with 18.7% (379 of 2020) prevalence of colonization. There were 23 microbial genera and 45 organisms detected. Among the isolated organisms, there were 39 kinds of isolated bacteria and 6 kinds of isolated fungi. Acinetobacter (19.8%) predominated in total isolated microorganisms, followed by Staphylococcus epidermidis (11.3%) and Candida albicans (10.3%). There were no significant differences in isolated organisms and fungal species between different sexes (X2 = 2.365, P = 0.50). Conversely, there were significant differences in isolated bacterial and fungal species between different wards and years (X2 = 124.046, P = 0.000; X2 = 77.064, P = 0.000). A total of 107 (5.3%, 107/2020) CVCs were associated with a diagnosis of central line-associated bloodstream infection (CLABSI). The most common organisms in causing CLABSI were Acinetobacter (23.4%), S. aureus (13.1%), and Candida albicans (12.1%). Conclusion The prevalence of microbial colonization in CVCs is still significant and even has gradually changed over time. The study provides a new view of microbial colonization pattern in CVCs and a prevalence of CLABSI, which will facilitate catheter-related infection prevention and control in clinic.

Treatment of a Non-healing Wound Formed After a Faulty Injection with the Larvae of Lucilia sericata

Because of the risk of intramuscular (IM) injection, the healthcare staff who will be injecting should know the anatomy of the region to be treated well and should do well in choosing the region. Most of the common IM injection complications are due to the lack of information and the use of inappropriate technique. A.Ö., who is 48-year old male with gout disease, had a pain so the injection of a diclofenac sodium bulb was done by his mother at his home 5 months ago and a wound was formed in this region afterwards. The patient was given a trimetoprim+sulfametoksazol intravenous vial (İV) 2*1, and the wound has grown and deepened although conventional wound treatments have been applied. When the patient applied to our policlinic on 24.03.2017, the patient had a 8x5x2 cm, infected, and purulent wound on his right hip ¼ in the lower outer quadrant. A sample was taken from the wound and sent to the medical microbiology laboratory. According to the wound size and depth, 500-600 first stage sterile larvae of Lucilia sericata were placed directly on the wound. Pseudomonas aeruginosa (P. aeruginosa) was proliferated in first wound culture. Gram positive difteroid rods were proliferated in the material taken before the 4th session, P. aeruginosa was not proliferated. The wound of the patient was healing with 12 sessions larvae treatment in 2 months. As a result; Larval Debridement Therapy (LDT) with L. sericata larvae may be an option for the treatment of any non-healing wound that is infected with antibiotic-resistant bacteria.

Chlamydia trachomatis bacterial load, estimated by Cq values, in urogenital samples from men and women visiting the general practice, hospital or STI clinic.

BackgroundThe bacterial load of Chlamydia trachomatis (CT) is assumed to play a role in transmission and sequelae. We assessed urogenital CT cycle quantification (Cq) values, as an indicator for CT load, of men and women diagnosed by general practitioners (GPs), hospital physicians and the STI clinic.MethodsUrogenital CT-positive samples (n = 2,055 vaginal swabs, n = 77 cervical swabs, n = 1,519 urine samples and n = 19 urethral swabs) diagnosed by GPs, hospital physicians and the STI clinic from the Maastricht Medical Microbiology Laboratory were included (2012–2016). The outcome measure ‘urogenital Cq values’ was used as an inversely proportional measure for CT load. Among all patients, multivariate linear regression analyses were used to assess primary determinants for mean urogenital Cq values, stratified by sex. Additional clinical determinants were assessed among STI clinic patients.ResultsIn men, mean urogenital Cq values were similar between GPs, hospital physicians and the STI clinic (32.7 and 33.5 vs. 32.7; p>0.05). Women visiting the GP had lower urogenital Cq values than women visiting the STI clinic (30.2 vs. 30.9; p = <0.001). Women visiting the hospital had higher urogenital Cq values than women visiting the STI clinic (32.4 vs. 30.9; p = <0.001). Among STI clinic women, urogenital Cq values were lower in women with concurrent anorectal CT and in rectally untested women compared to anorectal CT-negative women (30.7 and 30.6 vs. 33.9; p = <0.001).ConclusionMen visiting different STI care providers had similar urogenital Cq values, which could be an indicator for similar CT loads. The lower Cq values of women visiting the GP compared to women visiting the STI clinic could be an indicator for higher CT loads and likely higher transmission potential. Notably, urogenital Cq values of STI clinic women were much lower (>3 Cq) when STI clinic women also had anorectal CT. This finding could indicate higher urogenital CT loads and likely higher chances of transmission and sequelae.

Investigation of blaOXA-48-like genes in carbapenemase producing Klebsiella spp. isolates

The emergence and spread of multi-drug-resistant (MDR), extended-spectrum beta-lactamase (ESBL) producing carbapenem-resistant members of Enterobacteriaceae family has become a worldwide health problem. Carbapenem resistance caused by blaKPC, blaNDM gene regions are sporadic and blaOXA-48 gene region is endemic in our country. Theaim of this studywasto determine the presence ofblaOXA-232, blaOXA-181, blaOXA-162, blaOXA-204, blaOXA-244, blaOXA-163, blaOXA-245genesin OXA-48 like carbapenemase producing Klebsiella pneumoniae isolates. The isolates used inthisstudy wereprovidedfrom theMedical Microbiology Laboratory collection ofSakaryaUniversity SakaryaTraining and Research Hospital. Identification and antibiotic susceptibility tests were determined bytheVITEK 2® automatedsystem (biomerieux, France) andthecarbapenemase production of isolateswasdetermined bythe modified Hodgetest.Minimal inhibitor concentration (MIC) values were determined with broth microdilution method.The isolates containingtheblaOXA-48-like gene region wereidentifiedbyreal-time polymerase chain reaction (Rt-PCR) method using consensus primers.In "High ResolutionMelting Analysis(HRMA)"methodcarried outby using "Type-it HRM PCR" (Qiagen, Hilden, Germany) kit, isolates which showed a deviation in melting temperatures (Tm) wereselected with the suspicion of OXA-48 variant.The sequence analysis (ABI 3500, Applied Biosystems, USA) wascarried out to determine which variants were present in these isolates. Compatibility of MIC valueswas determinedbetween VITEK 2® andthemicrodilution method with the rate of 82% for imipenem, 77% for meropenem and 90% for ertapenemincarbapenemase-producing K.pneumoniaeisolates.In 45 of 100 K.pneumoniaeisolates,theblaOXA-48-like gene region was found to be positive by the Rt-PCR method. For the determination of OXA-48 variants, these 45 isolates were evaluated by HRMA method.The sequence analysis revealed that 41 (91.2%) isolates contained blaOXA-48/blaOXA-245 gene regions, while2 (4.4%)isolates were found to containblaOXA-181gene regionsand2(4.4%) isolateswere found to contain blaOXA-244 gene regions.This is the first study to determine OXA-48 and OXA-244 positivity in blaOXA-48-like gene regions in Turkey. As a result of this study, the OXA-48-like gene region was found to be 45%, of which 4.4% had blaOXA-181 and 4.4% had blaOXA-244 gene regions. The detection of blaOXA-48-like gene regions will guide for the selection of antibiotics in critical patient groups.

Characterization of Staphylococcus aureus Small Colony Variant (SCV) Clinical Isolates in Zaria, Nigeria

Staphylococcal isolates from specimen submitted to the Medical Microbiology laboratory of Ahmadu Bello University Teaching Hospital, Zaria were collected over a period of 6 months (February-July 2012), characterized by microbiological standard procedures and the S. aureus small colony variant (SCV) isolates were isolated. The antibiotic susceptibility pattern of the isolates was determined by the Kirby-Bauer-CLSI modified disc agar diffusion (DAD) technique. The SCV isolates were assessed for the carriage of four virulence genes; sdrE (putative adhesin) icaA (intracellular adhesin) hlg (hemolysin), Cna (collagen adhesin). A total of 258 non-duplicate staphylococcal isolates made up of 219 (84%) S. aureus and 39 (15%) coagulase-negative staphylococci (coNS) where obtained. A total of 48 (22%) isolates were determined to be S. aureus SCV mainly from wound/abscess (31%). S. aureus SCV isolates were generally resistant to all the nine antibiotics tested with only minimal sensitivity to tigecyclin (10.4%) and ciprofloxacin (18.8%). Statistically, there was no significant difference between the microbial load and the different antibiotics that were used, (P ≥0.05). None of the S. aureus SCV isolates carried the four virulence genes which were tested in this study. The results have therefore proved that S. aureus small colony variant exist in our environment and they are more resistant to most antimicrobial agent than their wild type.

Vertebral osteomyelitis due to Candida species.

We have noted an increased number of cases of vertebral osteomyelitis secondary to Candida species over the past few years at our facility. Our aim was to identify and review these cases to elucidate risk factors, treatment regimens and outcomes. We performed a retrospective chart review using our electronic medical record and microbiology laboratory database to identify cases of vertebral osteomyelitis due to Candida at a single teaching hospital from 2006-2018. We found 15 cases of Candida vertebral osteomyelitis. The majority of cases were due to Candida albicans and affected either the lumbar or the thoracic spine. Injection drug use and previous spine surgery were the two most common risk factors identified. Treatment was largely with intravenous antifungal induction followed by prolonged therapy with oral fluconazole. There was no short-term mortality though we lacked long-term follow-up on most patients. The number of vertebral infections due to Candida may be increasing. This may be partially driven by both a rise in intravenous drug use as well as the growing rate of spine surgery. Management following currently available guidelines seems favorable, though further studies are necessary to determine the optimal treatment regimen.

Quality Assurance In The Medical Microbiology Laboratory

Abstract In each laboratory, a quality assurance program should be developed in order to obtain reliable results and to fulfil the requirements of quality standards in the field of microbiological laboratory tests. Microbiological diagnostics makes it possible to determine the etiological agent of infection and allow the selection of an appropriate therapy. The quality of test results are affected by pre-laboratory, laboratory and post-laboratory steps, which should be checked regularly. Constant internal quality control of performance in the laboratory and participation in external quality control programmes may ensure the quality of results. Internal quality control of the tests at all stages of routine microbiological diagnostics in the laboratory facilitates constant monitoring of the quality of results. Participation in interlaboratory external quality control programmes permits the quality of performance of tests routinely used in a laboratory to be assessed. 1. Introduction. 2. Quality assurance programme. 2.1. Factors affecting quality. 3. Internal quality control. 3.1. Quality control of identification tests. 3.2. Internal quality control of antimicrobial susceptibility testing and detecting resistance mechanisms. 3.3. Internal quality control of automated systems for identification and susceptibility testing. 4. External quality control. 4.1. External quality assurance programme participation rules. 5. Summary

Prevalence of Group B Streptococcus Colonisation and Antimicrobial Susceptibility Pattern among Pregnant Women Attending a Tertiary Health Facility in Ogun State, Southwest Nigeria.

Background:Genital colonisation by group B Streptococcus (GBS) in pregnant women in their third trimester has been shown to be a known risk factor for morbidity and mortality among newborns.Aim:The aim of the study was to determine the prevalence of GBS colonisation among pregnant women in Abeokuta, its associated sociodemographic factors, and the neonatal outcome among exposed babies.Design:Longitudinal cohort study.Setting:Department of Obstetrics and Gynaecology, Federal Medical Centre, Abeokuta, Ogun State.Methodology:One hundred sixty pregnant women presenting for routine antenatal care between 35 and 41 weeks were recruited consecutively. Swabs were taken from the vagina and then the rectum using a single swab. The samples were processed at the hospital's Medical Microbiology Laboratory using standard microbiological methods. Babies whose mothers were positive had their bodies swabbed and the samples sent for GBS isolates. They were also screened for early-onset neonatal sepsis with C-reactive protein.Results:Prevalence of GBS vaginal colonisation was 4.3%. There was no significant association between GBS colonisation status and age, level of education, or occupation; however, women of parity ≤1 had significantly higher prevalence of GBS colonisation than those of parity ≥2. There was no incidence of GBS infection observed in the babies. The GBS isolates were 100% sensitive to cefuroxime and 83.3% resistant to ampicillin.Conclusion:The prevalence of GBS is low in our environment. The organisms were highly sensitive to cefuroxime, erythromycin, and ceftriaxone. Routine screening of all pregnant women may be unnecessary. However, women at risk of GBS who present in labour without a recent GBS screening should be offered intrapartum prophylactic cefuroxime.

Circulating serotypes and antimicrobial susceptibility pattern of Vibrio cholerae isolates from insurgency-stricken Maiduguri, northeastern Nigeria

Background: Cholera has continued to be a global threat to public health largely due to lack of social development. In endemic areas, outbreaks usually occur when war or civil unrest disrupts public sanitation services contaminating food and water supplies. Extensive and injudicious use of antimicrobials has led to the emergence of Vibrio cholerae strains that are resistant to several antibiotics. Aim: This study aims to highlight the recent cholera outbreak in the northeastern Nigeria and its characteristics, regarding the circulating serotypes and the antibiotic susceptibility of the isolates. This information is important for the effective control of future outbreaks using vaccination and antibiotics. Materials and Methods: We retrospectively reviewed 102 consecutive fresh diarrheic stool samples at the University of Maiduguri Teaching Hospital, Maiduguri, Nigeria, from July to December 2018. All samples were analyzed by culture and serology according to standard procedures. Antimicrobial susceptibility testing was performed with the Kirby-Bauer disk diffusion method on Mueller-Hinton agar. Results: Stool samples from 102 suspected cholera cases were received in the medical microbiology laboratory department for evaluation. Males made up 54% of the study population, aged 3 months to 70 years. Most of the cases were from camps harboring large numbers of internally displaced persons. Serotyping revealed that the sero group Ogawa was responsible. The strains were 100% sensitive to amikacin, ciprofloxacin, and cefotaxime, with varying resistance to trimethoprim/sulfamethoxazole and tetracycline. Conclusion: Our study highlights the continuing social problems associated with cholera epidemics and the significance of regular serologic and antimicrobial resistance surveillance of V. cholerae strains in our environment for proper management of cases.

The Australian Group on Antimicrobial Resistance (AGAR)

The Australian Group on Antimicrobial Resistance (AGAR) is a collaboration of clinicians and scientists working in diagnostic medical microbiology laboratories located across Australia. The group gathers information on the level of antimicrobial resistance (AMR) in bacteria causing important and life threatening infections and is a key component of Australia's response to the problem of increasing AMR. It defines where Australia stands with regard to antimicrobial resistance in human health.

Evaluation of Toxoplasma gondii Seropositivity and the Results of IgG Avidity Test of Patients with Suspected Toxoplasmosis

Introduction: Toxoplasma gondii is an obligate intracellular protozoan belongs to the phylum Apicomplexa. T. gondii has two parts in lifecycle. While the sexual part of the lifecycle occurs in domestic and wild cats, asexual part occurs in any mammal. Eating undercooked meat containing tissue cysts or drinking water contaminated with oocytes from feline feces cause toxoplasmosis infection. Clinically, infections can go unnoticed or could cause signs and symptoms vary depending on the immune status of the patient and the clinical setting like ocular disease or congenital toxoplasmosis. Aim: The aim of this study was to investigate the seroprevalance of Toxoplasma gondii IgG and IgM in patients with suspected toxoplasmosis. Materials and Methods: In this study, seropositivity of antibodies against T.gondii in patients with suspected toxoplasmosis was retrospectively evaluated in Medical Microbiology Laboratory of Selcuk University Medical Faculty between January 2013 and December 2016. Anti- T. gondii immunoglobulin M (IgM), immunoglobulin G (IgG) antibodies and IgG avidity tests were studied in 7051 serum samples by using the VIDAS (BioMérieux, France) kits and the Enzyme Linked Fluorescence Assay technique. Results: In all 7051 patients, seropositivity rates of anti- T. gondii IgM and IgG antibodies were 2.44 and 29.53 %, respectively. High avidity rate was 78.36 % in 171 patients. Seropositivity rates of toxoplasma IgM antibodies in female and male patients were 2.80 and 1.14%, while IgG seropositivity rates were 34.17 and 22.91 %, respectively. Conclusions: T he importance of searching the seropositivity of toxoplasmosis, which is still considered as an important health problem in especially reproductive women, must be emphasized. In addition, measures should be taken to raise awareness of hygiene in our region in terms of water, foods and sanitation.

Plasmid Profile of Multi-drug Resistant Phenotypes of Pseudomonas aeruginosa Isolated among Patients with Indwelling Catheter in Northeastern Nigeria

Aims: This study was carried out to analyze the plasmid profile of multidrug resistant Pseudomonas aeruginosa isolated among catheterized patients attending the University of Maiduguri Teaching Hospital.&#x0D; Place of Study: Department of Medical Microbiology (Laboratory Section), University of Maiduguri Teaching Hospital and Department of Biological Sciences, Abubakar Tafawa Balewa University, Nigeria.&#x0D; Methodology: 244 samples (catheter tip, urethral swab, urine) were collected from catheterised patients and investigated via microscopy and culture on Blood agar and MacConkey agar. Suspect Pseudomonas aeruginosa isolates were further confirmed using biochemical tests. Kirby bauer disc diffusion test was used to determine the antimicrobial susceptibility pattern. Isolates confirmed to be multidrug resistant (MDR) were subjected to plasmid profile analysis using agarose gel electrophoresis.&#x0D; Results: 21 yielded Pseudomonas aeruginosa which gives a recovery rate of 8.6%. A significant proportion was isolated from catheter tip samples collected from male patients (33.33%). The association between sex of patient and sample type in the isolation of Pseudomonas aeruginosa was statistically significant (X2 = 10.76, df = 2, P &lt;.01). Isolates were most-sensitive/least-resistant to Ofloxacin and Ampiclox, and least-sensitive/most-resistant to Penicillin. All isolates identified were multi-drug resistant (MDR) with an average resistance rate of 3.28 antimicrobials per isolate. Plasmid analysis revealed that 57.14% of isolates possessed similar plasmid with a DNA fragment size of 300bp and a molecular weight of 31 ng/10 µl.&#x0D; Conclusion: We establish a very high rate of multidrug resistance among Pseudomonas aeruginosa isolates. Plasmid profile analysis of MDR Pseudomonas aeruginosa observed revealed a high plasmid prevalence rate and since most isolates cannot express the resistance marker after plasmid curing, we suggest that this is indicative of the plasmidial origin of such a marker.

Internal and external quality control in the medical microbiology laboratory

Culture media play a very important role in bacteriology as they are used in the isolation, identification and antimicrobial susceptibility testing. It is essential that the quality of media be safeguarded to have a successful microbiology laboratory. Microorganisms usually show typical morphological appearance and properties on solid media. Variations in the composition of the medium may alter this appearance and properties. There is therefore a need to ensure good quality media, which is capable of giving satisfactory results by ensuring a proper quality management system. Often times, majority of laboratories prepare their media for routine diagnostics and research purposes. Therefore, it is essential that certain parameters of media are checked thoroughly before they are considered suitable for laboratory use. Control methods are discussed in details in this report.

Practical Guidance for Clinical Microbiology Laboratories: Implementing a Quality Management System in the Medical Microbiology Laboratory

This document outlines a comprehensive practical approach to a laboratory quality management system (QMS) by describing how to operationalize the management and technical requirements described in the ISO 15189 international standard. It provides a crosswalk of the ISO requirements for quality and competence for medical laboratories to the 12 quality system essentials delineated by the Clinical and Laboratory Standards Institute. The quality principles are organized under three main categories: quality infrastructure, laboratory operations, and quality assurance and continual improvement. The roles and responsibilities to establish and sustain a QMS are outlined for microbiology laboratory staff, laboratory management personnel, and the institution's leadership. Examples and forms are included to assist in the real-world implementation of this system and to allow the adaptation of the system for each laboratory's unique environment. Errors and nonconforming events are acknowledged and embraced as an opportunity to improve the quality of the laboratory, a culture shift from blaming individuals. An effective QMS encourages "systems thinking" by providing a process to think globally of the effects of any type of change. Ultimately, a successful QMS is achieved when its principles are adopted as part of daily practice throughout the total testing process continuum.

Antibiotic Sensitivity Tests of Staphylococcus aureus Isolated from Different Clinical Specimens

The importance of Staphylococcus aureus as a persistent nosocomial and community acquired pathogen has become a global health concern. It has a remarkable capability of evolving different mechanisms of resistance to most antimicrobial agents. of the present study is to establish the incidence of S. aureus in different clinical specimens with theirantibiotic sensitivity pattern to various antibiotics in this locality.Sixty five consecutive isolates of S. aureus obtained from various clinical specimens between January and April 2016 sent to the Medical Microbiology Laboratory Department of Al-Hilla Teaching Hospital was confirmed by standard bacteriological procedures. An antibiotic sensitivity pattern was carried out by disc diffusion method. The female sex has the highest rate of infection (57%) compared to males (43%). Urine and wound infection had the highest frequency of S. aureus isolates (35.3) and (26.1) respectively in the study. The results show that S. aureus bacterium mostly sensitive to amikacin AK and rifampicin RA (65.7%) and (58.6%). S. aureus shows resistance to vancomycin and tetracycline antibiotics mostly (66%) and (64%)The results of the present study show that the aminoglycosides are effective in the management of Staphylococcus aureus infections including methicillin resistant strains in this environment.

Investigation of Parvovirus B19 IgM and IgG Positivity Rates in Pediatric Hematology Patients

AbstractHuman parvovirus B19 is a frequent etiologic agent causing erythema infectiosum in children. It has recently been suggested that parvovirus B19 may be latent after infection and cause reactive infections especially in immunosuppressed patients with hematological problems. In this study, we aimed to investigate the parvovirus B19 immunoglobulin M (IgM) and immunoglobulin G (IgG) seropositivity rates of patients evaluated in a pediatric hematology clinic. We retrospectively screened the laboratory results of parvovirus B19 IgM and IgG antibody assays of children less than 18 years, who consulted pediatric in-and-outpatient clinics between 2013 and 2016. Parvovirus B19 IgM and IgG antibodies were investigated in serum samples by using enzyme-linked immunosorbent assay method in the Medical Microbiology Laboratory. Parvovirus B19 IgM antibodies were detected in 109 of 602 patients attending pediatric hematology clinics (18.1%). Parvovirus B19 IgG antibody was detected in 244 of 952 patients attending pediatric hematology clinics (25.6%). Parvovirus B19 IgM and IgG positivity in samples from pediatric in-and-outpatient clinics other than pediatric hematology were 2.8% and 35.7%, respectively. Parvovirus IgM and IgG positivity in serum samples sent from the pediatric hematology clinic and outpatients was statistically significant compared with those sent from pediatric clinics other than pediatric hematology (p = 0.0001 and p = 0.0008, respectively). The higher detection rate of serum parvovirus B19 IgM positivity in patients under the follow-up of pediatric hematology clinics suggests that immune suppression-related viral reinfection or persistence may occur in these patients.