Medical Microbiologyisachallengingprofessiondealswithall aspectsof infection,throughinitial
diagnosis,totreatment.Itinclud...
patternsand effective reporting? A goodcontrol on the benchwork bySeniorMicrobiologistskeeps
everybodyundercheck.
All unco...
program supportsroutine entryof susceptibilitytestresultsperformedbydiskdiffusion,MIC,
and/orEtest or byHi comb methodThe ...
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Emerging diagnostic challenges in microbiology

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EMERGING DIAGNOSTIC CHALLENGES IN MICROBIOLOGY

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Emerging diagnostic challenges in microbiology

  1. 1. Medical Microbiologyisachallengingprofessiondealswithall aspectsof infection,throughinitial diagnosis,totreatment.Itincludeshandsonbenchworkinthe laboratory,whichisoftenneglected and close involvementwithclinical staff inavarietyof acute and communitysettingstoeffectively manage infectionsandensure effective surveillance andinfectionpreventionandcontrol acrossthe healthcare community. Unlike manyothermedical specialitiesthe Microbiologydepartmentsare neglectedby Governmental andseveral private Medical colleges.Andouryoungergenerationof Microbiologists shouldadaptto the changingscenarioto acquire theirspace inMedical Profession,whichcontinues to be competitive anddrivenbycommercialinterestsaswell. UpcomingMicrobiologistsshouldrealise thatnodayis the same inmedical microbiologypractice and eachday bringsitsownchallengesanduncertainty. The goal of microbiologicevaluationisto provide accurate,clinicallypertinentresultsinatimelymanner. Howeveroptimal utilizationof the available resourcesisthe needof the hour,whichcanbe implementedwithdedicatedpractice whichinclude - 1. Scientificsterilizationpractiseswill certainlycutshortthe rate of infectionreduce the coststothe hospital andreducesmorbidityandmortality.The recentdocumentonSterilizationreleasedbyCDC Atlantawithtitle GuidelineforDisinfectionandSterilizationinHealthcare Facilities, 2008 will clarify all the doubtsof practice,includingthe decreasingrole of biohazardouschemicalanduse of environmentallysafe agents.Fumigationwhichwe practice withoutknowingitsbiohazardsneedsa rethinking.Microbiologistsshouldlearnmore; educatethe ParamedicalandNursingstaffswhoare our greaterpartnersininfectioncontrol. 2. Specimencollectionandasepticprecautionsincollectionisamajorconcernto validmicrobiology reporting,several lifethreateningsepticcomplicationsincludingbloodculturesinbacterial infectionsare contaminateddue tolapsesinspecimencollection.A frequentlycontaminatedblood culture reportslossesthe confidence of PhysiciansonMicrobiologyDepartments. Delayedreportsdue toineffective,age oldculture methods,certainlyaconcerntopatientsand treatingphysician. 3. Bacteriologydepartmentsshouldbe updated,asmostof the life threatening infectionsare bacterial indevelopingworld,effectiveearlydiagnosisreduce the costof antibacterial agents,on manyoccasionsare mostcostlierthanhospital occupancyrates.Howeveritiscertainlyneedof the hour. Benchwork. Is the mostimportantcomponentof the DiagnosticMicrobiologyTypical tasks:include logsin sample orspecimennotingdate,time,andteststobe performed;basedonquantitative growth
  2. 2. patternsand effective reporting? A goodcontrol on the benchwork bySeniorMicrobiologistskeeps everybodyundercheck. All uncommonisolatesshouldbe studiedtospecieslevel withextendedbiochemical testing,andwill be a boonto publishcase reportsingoodacademicjournals. All uncommonisolatesshouldnotbe reportedwithoutthe wisdomof the seniorMicrobiologists. All upcomingMicrobiologistsshouldseekthe helpof reference centresforassistance andguidance as all we thinkmay notbe correct. 4. The diagnosticworkonMycobacteriologyandMycologylagsthe advancesto the growingneeds of the physicians. Tuberculosisbeingamajorhealthprobleminthe country,yetnodedicated laboratoriestodiagnose the disease beyondsmearexamination,andincreasingdrugresistant tuberculosisisaconcernto the treatingphysician.The attentionanddedicatedworkof the young Microbiologistswill certainlysupportedbyeveryone. Howeverwe certainlyneednew generationof Microbiologiststotake upthe Tuberculosisrelatedwork. 5. The anaerobicculture workremainsleastattemptedandyoungergenerationof Microbiologists shouldexplorethisdivisionof bacteriologyasmanyanaerobes are developingdrugresitance. Reportingthe MicrobiologyResults Reportingthe resultsshouldbe done withcautionasthe Physiciansare notfamiliarwithwhatreally we meanand mattersto be made clear andunderstandable.The greatestcommunicationgap betweencliniciansandmicrobiologistsremainwithterminology. Molecularmethodsisdiagnosisof Infectiousdiseases The PCR is the mostsensitive of the existingrapidmethodstodetectmicrobialpathogensinclinical specimens.Inparticular,whenspecificpathogensthatare difficulttoculture invitroorrequire a longcultivationperiodare expectedtobe presentinspecimens,the diagnosticvalue of PCRis knownto be significant.However,the applicationof PCRtoclinical specimenshasmanypotential pitfallsdue tothe susceptibilityof PCRtoinhibitors,contaminationandexperimental conditions. It isknownthat the sensitivityandspecificityof aPCRassay isdependentontargetgenes,primer sequences,whichare expensive.Howevermolecular methodsare mosttalked,highlyexpensive and creatingdedicatedlaboratoriescontinuestobe difficultinoureconomyIf modernmethodsof moleculardiagnosticsare notimplementedwe will we outof scene inModernMedicine. Computerdocumentationwithuse of WHONET Continuoussurveillance of local antimicrobial susceptibilitypatternsisamustfor combating emergingantimicrobial resistance.WHONETisan effective computerizedmicrobiologylaboratory data managementandanalysisprogramthatcan provide guidance forempirictherapyof infections, alertcliniciansof trendsof antimicrobialresistance,guide –the antibioticpolicydecisionsand preventivemeasures.The programfacilitatessharingof dataamongstdifferenthospitalsbyputting each laboratorydataintoa commoncode and file format,whichcanbe mergedfornational or global collaborationof antimicrobialresistance surveillance.Allthe documentationcanbe stored retrievedandanalysedwiththe freelyavailablesoftware fromWHO,justneedingcomputerThe
  3. 3. program supportsroutine entryof susceptibilitytestresultsperformedbydiskdiffusion,MIC, and/orEtest or byHi comb methodThe majorityof laboratoriesinthe Armedforcesuse comparative discdiffusiontechniquesbasedonStokesorKirbyBauermethodtodetermine antibioticsensitivity.Interpretationguidelinesformoststandardizedtestingmethodologiesare built intothe system. WHONET workingmake youfamiliarise withoptimal drugchoice,zone sizes,easiertounderstandin interpretationinprecise reporting. Tele diagnosticservicesinInfectiousDiseases Whena laboratorywouldlike assistance inidentifyingaparasiticorganism, orconfirmationof a presumeddiagnosis,andtheyhave accesstoa digital camera,theycan use telediagnosis.Tele diagnosisinvolvesemail transmissionof data,suchas digital imagescapturedfromsamplesand clinical andtravel history,toCDC.Response tothese inquiriescanbe providedinamatterof minutestohours. If you are a Microbiologist ora Pathologistandwanttouse telediagnosisassistance*,please visitthe DiagnosticAssistance sectiononthe DPDx Website. Caringfor self isequallyimportant Our healthanddisease isaconcern to usand familymemberapartfromthe society.All Bio hazardousmicro-organismsandmaterialstobe handledwithcaution.Be achampionto promote the “Universal Precautions”make the bestcontributionsinpreventionof infectioninyourown workingarena. Publishingyourwork Alwayspublishyourgenuine workinJournalsandperiodicals;donotgetdisappointedif youcannot publishinareputedjournal.Nowthere are goodqualityonline MicrobiologyJournals(e-Journals) and periodicalswhichare indexedandavailable foryourrescue.Everyattempttopublishanarticle makesyourealise where we have toimprove andbygoingthroughgoodreferenceswe cancertainly improve ourselves. Internetande-learning. All youngandseniorprofessionalsshouldreferthe goodpotential of informationhighway,the Internetandgetthe bestout it.E-learningshouldbe ournextoptiontoknow whatthe worldis thinkingabout.Iconsideritisthe bestemergingoptionforimprovingourknowledge in Microbiology. Article availableonwww.ariclesbase.com * Dr.T.V.RaoMD professorof MicrobiologyFreelance writer

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