A Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2013
Recommendations by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM)a
Clinical Infectious Diseases Advance Access published July 10, 2013
The critical role of the microbiology laboratory in infectious disease diagnosis calls for a close, positive working relationship between the physician and the microbiologists who provide enormous value to the health care team.
This document, developed by both laboratory and clinical experts, provides information on which tests are valuable and in which contexts, and on tests that add little or no value for diagnostic decisions
Sections are divided into
anatomic systems, and etiologic agent groups
Anatomic system
including:
. Bloodstream Infections and Infections of the Cardiovascular System, Central Nervous System Infections, Ocular Infections, Soft Tissue Infections of the Head and Neck, Upper Respiratory Infections, Lower Respiratory Tract infections, Infections of the Gastrointestinal Tract, Intraabdominal Infections, Bone and Joint Infections, Urinary Tract Infections, Genital Infections, and Skin and Soft Tissue Infections
Etiologic agent groups including
Tickborne Infections, Viral Syndromes, and Blood and Tissue Parasite Infections.
Each section contains
introductory concepts, a summary of key points, and detailed tables that list suspected agents; the most reliable tests to order; the samples (and volumes) to collect in order of preference; specimen transport devices, procedures, times, and temperatures; and detailed notes on specic issues regarding the test methods, such as when tests are likely to require a specialized laboratory or have prolonged turnaround times.
There is redundancy among the tables and sections, as many agents and assay choices overlap.
The document is intended to serve as a reference to guide physicians in choosing tests that will aid them to diagnose infectious diseases in their patients.
Three phases of laboratory testing
Patient variables Specimen variables Preanalytic Collection Handling Processing Analytic Performance of selected laboratory test Test reporting variables Postaalytic Recording Reporting Interpreting
Criteria for rejecting samples
Mismatch of information on the label and the request Inappropriate transport temperature Excessive delay in transportation Inappropriate transport medium specimen received in a fixative dry specimen sample with questionable relevance /no confirmed indication Insufficient quantity Leakage
Specimens may be rejected for the following reasons:
Specimens lacking two unique identifiers Improperly labelled specimen Unlabelled specimen Incomplete information on the requisition Sub-optimal specimen, i.e.: - Leaking - Inappropriate specimen container - Insufficient quantity of specimen - Inappropriate collection device - Inappropriate transport medium
Cont.
Duplicate microbiology samples received on the same day, i.e. multiple stool, sputum specimens Integrity of sample compromised by effects of uncontrolled transport temperatures, i.e. freezing, heating Specimen delayed in transit Test no longer available/performed by the Laboratory Specimen submitted is inappropriate for test requested.
QUALITY CONTROL IN MICROBIOLOGY LABORATORIES
Microbiology laboratories shall use quality control procedures to ensure the accuracy, reliability and reproducibility of the various tests used in the isolation, identification and antimicrobial susceptibility testing of microorganisms, and in the performance of serological testing.
The extent of quality control testing done will be determined by the scope of clinical testing performed in each laboratory.
All laboratories performing microbiology shall have appropriate internal quality control procedures using CLSI guidelines for antibiotic susceptibility testing and quality control of media.
a) The most recent update of the following CLSI documents should be followed:
M22 Quality Assurance for Commercially Prepared Microbiological Culture Media (ii) M100 Performance Standards for Antimicrobial Susceptibility Testing (iii) M2 Performance Standards for Antimicrobial Disk Susceptibility Tests (iv) M7 Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria that Grow Aerobically (v) M11 Methods for Antimicrobial Susceptibility Testing of Anaerobic Bacteria (i)
b) Identification panels should be quality controlled according to the manufacturer's recommendations. c) ATCC organisms shall be used for proper quality control of media and of antimicrobial susceptibility testing.
CLSI: Clinical and Laboratory Standards Institute ATCC: American Type Culture Collection
All laboratories performing microbiology shall demonstrate and document their efforts to meet the standards established by CLSI guidelines and quality control using appropriate organisms.
