This document discusses how microbiologists can improve clinical care through better laboratory reporting. It emphasizes providing accurate, clinically relevant results and clear interpretive comments to aid clinician decision making. Effective communication between the laboratory and clinicians is key. The document also highlights challenges such as information overload, confusion over terminology, and ensuring rapid reporting, especially for ICU patients.

1. How Microbiologists should report the
laboratory results to improve clinical care
Guest talk@ RAPM
Rajkot 2017
Dr.T.V.Rao MD
12/19/2017 Dr.T.V.Rao MD

2. FROM PAST TO FUTURE
WE ARE IN TRANSITION
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3. WHAT IS A REPORT
•Writing lab reports is part of
learning to be a scientist, and
provides you with experience in
writing in a scientific style similar
to that used in articles published
in Text books scientific journals.
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4. Future of Biology Changed with
PCR
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5. Career in Transition from Clinics to
Laboratory
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6. Infectious Diseases
are many limited by our knowledge,
facilities and ignorance?
•Bacterial
•Viral
•Fungal
•Parasitic
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7. 3 great ideas to improve
the diagnostic
microbiology
• Were the reports provided
are accurate?
• Were they clinically
relevant?
• Could we improve?
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8. Supporting Laboratory Results
• Viral
• Identification of virus
• Normal or Decreased WBC Count
• Increased Lymphocyte Count
• Parasitic
• Identification of parasite
• Increased Eosinophil Count
• Bacterial
• Identification of bacteria
• Increased WBC Count
• Increased Neutrophil Count
• Left-shift in Neutrophil Cell Line
• Increased CRP
• Increased Sed-Rate
• Fungal
• KOH Prep Test
• Identification of fungal elements
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9. Think before reporting
Microbiology results we
perform has many limitations
• To determine significance
of result requires
knowledge of the
patient’s clinical
status
• The report should
encourage communication
between clinician and
medical microbiologist
12/19/2017 Dr.T.V.Rao MD

10. Microbiology is not a accurate Science
• To determine significance
of result requires
knowledge of the patient’s
clinical status The report
should encourage
communication
•GOOD
COMMUNICATION ?
Makes a difference
12/19/2017 Dr.T.V.Rao MD

11. Key points - 1
• Microbes are infectious agents not visible to the naked eye
• Widespread in nature and some cause human disease
• Diagnosis of infection by the microbiology laboratory has two
important functions
•Clinical
• Epidemiological surveys within and outside the Hospital
•The laboratory should determine the most
frequent microbes causing infections, including
HAI pathogens
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12. Why Plan?
• Laboratory requirements relate to investigation objectives
• confirm a diagnosis to document an infection?
• document a common source?
• provide information to help clinical management (antibiotic
resistance)?
•What laboratory tests help answer the
objective(s)?
•What specimens are required for the laboratory
test(s)?
•What’s the sampling strategy?
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13. Definition of Terms
• Normally sterile site: sites in the human body that are normally free
from organisms or foreign material, e.g. blood, joint, brain, etc.
• Unsterile site: sites in the human body that generally harbor
microorganisms, e.g. gut, oral cavity, nose, skin, etc
•Specimen: a sample of tissue (blood, urine, etc.) that may or may not
contain organisms
•Isolate: a population of organisms (bacteria) that has been separated
from a mixture
• Serotype: a group of closely related organisms with distinct
characteristics.
• Assay: A test to detect or quantify a substance in a sample.
Dr.T.V.Rao MD
12/19/2017

14. Laboratory Reports
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15. Simplifying Laboratory
Test Interpretation
•WE SHOULD REPORT
THE LABORATORY TEST
RESULTS AND MAKE
MATTERS SIMPLE
•WE ADVICE AND
SUGGEST
•WE IGNORE TOO
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16. Laboratory Tests
▪Detection Methods
oMicroscopy
oCulture
oAntigen test*
▪ Identification Methods
o PCR*
o Viral load*
o PFGE
o Genotyping
▪ Serology
▪ Antimicrobial susceptibility
▪ Ancillary tests
Dr.T.V.Rao MD
12/19/2017

17. DEFINITION of
• Critical results are results that
are considered potentially life
threatening unless acted
upon promptly. Fast
communication matters ?
• Urgent results are results that
are not critical but
sufficiently significant to alert
the health care provider
12/19/2017 Dr.T.V.Rao MD

18. Culture
The process of growing and propagating organisms in a media
that is conducive for their growth.
Pros:
• Confirm the organism
• Reproduce the organism and use
for additional testing
Cons:
• Delay in confirmation
• Require viable organism
• Difficult for fastidious organisms
S. pneumoniae on blood agar plate
Dr.T.V.Rao MD
colony
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19. HOW TO USE THE LABORATORY
• Reports to the clinician from
the clinical microbiology
service can provide comments
that interpret isolate
significance, provide
antimicrobial susceptibility
interpretation and provide
antimicrobial management
advice
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20. Microbiology Differs from other
Laboratory services
•'How is this result
to be explained to
the clinician?' is an
equally important
question, as yet
little discussed.
12/19/2017 Dr.T.V.Rao MD

21. Tips when reviewing a laboratory
report
IS IT A INFECTION
• Is the organism (or disease)
reportable?
• When was the specimen
obtained in relation to
onset of illness?
• Was the source from a normally
sterile site?
• Were antibiotics used prior
to specimen collection?
Dr.T.V.Rao MD
12/19/2017

22. LIST OF
CRITICAL
RESULTS
• ·Positive results from direct
examination (e.g., Gram stain) of
normally sterile body
• fluids/sites, including blood, CSF and
tissue.Positive culture results for
normally sterile body fluids/sites,
including blood, CSF and tissues.
• ·Malaria
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23. 'Is it significant
•'Is it significant?' is
the question posed,
implicitly or
rexplicitly, whenever
a culture from a
patient has yielded a
micro-organism.
12/19/2017 Dr.T.V.Rao MD

24. Antimicrobial Susceptibility
MIC (minimum inhibitory concentration)
• lowest concentration of antimicrobials
that will inhibit the growth of organisms.
MICs are important to confirm resistance of
organisms to an antimicrobial agent.
Methods:
• Disk diffusion test
• E test
• Broth dilution test
Dr.T.V.Rao MD
MIC
12/19/2017

25. Reporting susceptibility reports
•Consider:
Recommendations for
therapy at each stage
of reporting
Adding interpretive
comments
Keep it clinically
relevant
12/19/2017 Dr.T.V.Rao MD

26. Utilization of Culture Reports
•Review of culture
reports in 1050
hospitalized patients
Only 7% of culture
results resulted in a
change of therapy
• Ref Edwards et al Arch Intern Med 1973
12/19/2017 Dr.T.V.Rao MD

27. Why many Antimicrobial susceptible
results are not used by clinicians?
•Information overload multiple specimens
from different sources eg from ICU in a
critical patient,
Reports more allied to the laboratory than
to the clinician
Confusion between accuracy and clinical
relevance
Common laboratory terms cause confusion
• Ref Edwards et al Arch Intern Med 1973
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28. a laboratory result cannot be confusing
factor
try solving the problem
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29. Faster Results in ICU Care
•The establishment of
best practice
procedures for rapid
microbiological
evaluation is critical
to delivering timely
and accurate
information
12/19/2017 Dr.T.V.Rao MD

30. Laboratory reports in ICU Care
• Intensive care units are an
area of particular importance,
as the control of resistance in
these units can affect other
areas of the hospital. The
clinical microbiology
service should therefore
pay particular attention to
services provided to these
areas.
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31. How Surveillance Data helpful
• The clinical microbiology
service provides
surveillance data on
resistant organisms for
infection control
purposes. Try implement
the WHONET software
with inclusion of CLSI
GUIDELINES,
12/19/2017 Dr.T.V.Rao MD

32. The Wisdom of Microbiologists a great
contribution
•Microbiology reports
should also include a range
of comments to help
clinicians distinguish
infection from
contamination or
colonisation (i.e.
antimicrobial therapy is
therefore not required)
12/19/2017 Dr.T.V.Rao MD

33. SOME BEST
CHOICES FOR
CLINICANS
• 1 If your patient is getting
better… continue the same
treatment
2. If your patient is not getting
better… change your therapy
• 3 If you do not know what you
are doing… don’t do anything
(Ask a friend for help!)
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Dr.T.V.Rao MD

34. Challenges with Automation
•Rushing to introduce
automation without
careful planning to
account for existing
clinical processes is the
Achilles’ heel of any
health IT implementation
12/19/2017 Dr.T.V.Rao MD

35. Interpretative reporting of microbiology
•Interpretative reporting
of microbiology results
entails the addition of a
comment to the report,
giving the likely
significance of the
organism(s) isolated and,
where necessary,
specific advice on
therapy.
12/19/2017 Dr.T.V.Rao MD

36. How much our Reports accepted ????
•The use of
interpretative
comments appended to
microbiology reports
has been shown to
allow clinicians to make
informed decisions
based on such reports.
12/19/2017 Dr.T.V.Rao MD

37. Parasitology & Mycology
• Direct Examination
• Macroscopic and Microscopic
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38. Education of Clinicians a challenging task
•There is clearly a need
for education of
clinicians regarding
indications for
sending specimens
and applying results
to patient
management.
12/19/2017 Dr.T.V.Rao MD

39. Alert organism reports
• Identify possible agreed ‘alert’ microorganisms
• Methicillin-resistant Staphylococcus aureus (MRSA)
• Vancomycin-intermediate S.aureus (VISA)
• Vancomycin-resistant enterococci (VRE)
• MDR Pseudomonas aeruginosa
• MDR Acinetobacter baumannii
• MDR Mycobacterium tuberculosis
• ESBL enterobacteria
•Clostridium difficile
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40. Writing style in lab reports
•When writing a lab report it is important you use
a scientific writing style. This means you should
aim for writing that is clear, objective, accurate and
brief.
•It is best to use short simple sentences rather than
long complicated ones that have the potential to
confuse the reader. Although you will need to use
specialist terms in your report, you should also use
familiar non-technical terms where possible
12/19/2017 Dr.T.V.Rao MD

41. Communication solves many ill
understood ideas
• Encourage two way
communication with laboratory
• Employ terms that are readily
understood
• Communicate clinically relevant
results
• (probable infection or probable
contamination) State when
further clinical assessment
required
12/19/2017 Dr.T.V.Rao MD

42. Documenting and Auditing with WHO
NET
•The clinical
microbiology service
provides surveillance
data on resistant
organisms for infection
control purposes. Try
implement the
WHONET software with
inclusion of CLSI
GUIDELINES,
12/19/2017 Dr.T.V.Rao MD

43. GRWOING DEMANDS ON CLINICAL
MICROBIOLOGISTS
•The clinical microbiology
laboratory is being
challenged to do more
work, identify more
microorganisms, report
complex and changing
drug-related
information, automate
procedures,
12/19/2017 Dr.T.V.Rao MD

44. Technology developing faster than we
understand the pitfalls
• With change, though, as always,
there are challenges: technology
is developing at an almost too-
rapid pace, vast amounts of
information which are difficult to
manage and communicate are
being generated, standards either
do not exist or are not adequately
useful for many
targets/platforms,
12/19/2017 Dr.T.V.Rao MD

45. Growing Challenge to Medial
Microbiologists
• Many decisions in clinical
microbiology practice are not
being made using evidence
based information.
Ultimately, we need to be
able improve how we
communicate so that we
are more effective in our
ability to report results and
ensure appropriate
interpretation
12/19/2017 Dr.T.V.Rao MD

46. Using laboratory evidence to confirm a
diagnosis during an outbreak
•Short list potential etiologic agents (hypothesis generating)
according to:
•Epidemiological characteristics
•Clinical characteristics
•Setting
•Test for agents short listed (hypothesis testing)
• Positive test
• Negative test
•Use predictive values positive and negatives
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47. Whats the Clinical Benefit of our
reporting
•'How is this
result to be
explained to
the clinician?'
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48. Reporting Results
•Clinical microbiology
laboratory needs
include reporting
nonnumerical results,
such as the genus and
species name of an
identified organism.,
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49. qualitative, semiquantitative, and/or
quantitative data,
•Microbiology
results often
include
qualitative,
semiquantitative,
and/or
quantitative data,
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50. laboratory REQUEST is consolation
change of work culture
•Every microbiology
sample is a
consultation, Making
sure the report it is
accurate is good
Making sure the
report is clinically
relevant and clear
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51. Err is Human
• Sources of potential cases of
laboratory-related adverse
events include internal
laboratory incident reports, risk
management incident reports,
physician complaints and other
forms of physician collaboration,
and a variety of daily
information system reports
12/19/2017 Dr.T.V.Rao MD

52. Correction is Divine
•In the testing process
areas involving non-
laboratory personnel,
interdepartmental
communication and
cooperation are
crucial to avoid errors.
12/19/2017 Dr.T.V.Rao MD

53. TEAM EFFORT MAKES A GREAT
DIFFERENCE
•Therefore the entire
health care system must
be involved in improving
the total testing process.
There must be adequate
and effective training of
personnel throughout
the institution
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54. Who will Sign Laboratory Reports
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55. EMOTIONAL CJALLENGES IN
LABORATORY Medicine
• Very simply, Scott believes that the first step
should be to get rid of the emotions behind
the issue..
Step two is a close examination of the issues
behind the conflict. This rational thought
process is then (in step three) supplemented
by your intuition about the choices in front of
you. Overcoming Conflicts in the Lab—and Beyond
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56. HUMAN NEEDS MORE IMPORTANT
THAN OUR EGOSTIC FIGHTING
•You can't solve the
problem without
understanding the
human needs and
interests of the
people involved in
the conflict.
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57. Summary
•Basic understanding of a laboratory test
is key to maximizing its use.
•Laboratory tests have ‘strengths’ and
‘weaknesses’.
•Timing is everything!
(between disease onset and specimen
collection)
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58. MEDICAL LABORATORY
PROFESSIONALS WEEK
APRIL 22-28, 2018
• Medical Laboratory Professionals Week
(MLPW) provides the profession with a
unique opportunity to increase public
understanding of and appreciation for
clinical laboratory personnel.
• MLPW, which takes place the last full
week in April each year, is coordinated
by a collaborative committee with
representatives from 17 national clinical
laboratory organizations, including
ASCLS. Now in it's 43rd year,
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59. LIFE IS A GREAT FIGHT TO SURVVIE
MORE QUESTIONS THAN ANSWERS
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60. Younger Microbiologists Under stress and
accountability
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61. 12/19/2017 Dr.T.V.Rao MD

62. WHAT NEXT IN DIAGNOSIC MICROBIOLOGY
TOO MANY OPINIONS ARE A GREAT THREAT TO PROGRESS
OF Microbiology
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63. YOU ALL MADE A GRAND SUCCESS
CONGRATULATIONS
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64. 12/19/2017 Dr.T.V.Rao MD