Integration of Diagnostic Microbiology in a Model of Total Laboratory Automation

BACKGROUND: Although automation has become widely utilized in certain areas of diagnostic testing, its adoption in diagnostic microbiology has proceeded much more slowly.OBJECTIVE: To describe our real-world experience of integrating an automated instrument for diagnostic microbiology (Walk-Away Specimen Processor, WASPLab) within a model of total laboratory automation (TLA).METHODS: The implementation process was divided into 2 phases. The former period, lasting approximately 6 weeks, entailed the installation of the WASPLab processor to operate as a stand-alone instrumentation, whereas the latter, lasting approximately 2 weeks, involved physical connection of the WASPLab with the automation.RESULTS: Using the WASPLab instrument in conjunction with the TLA model, we obtained a time savings equivalent to the work of 1.2 full-time laboratory technicians for diagnostic microbiology. The connection of WASPLab to TLA allowed its management by a generalist or clinical chemistry technician, with no need for microbiology skills on the part of either worker. Hence, diagnostic microbiology could be performed by the staff that is already using the TLA, extending their activities to include processing urgent clinical chemistry and hematology specimens. The time to result was also substantially improved.CONCLUSIONS: According to our experience, using the WASPLab instrument as part of a TLA in diagnostic microbiology holds great promise for optimizing laboratory workflow and improving the quality of testing

Streptococcus salivarius meningitis after dental care: case report

Introduction. Streptococcus salivarius is a common commensal of the oral mucosa, associated with infections in different sites. Meningitis due to this species are described in a few occasions . In this study refer to a case recently diagnosed in our hospital for treatment of a subsequent dental caries. Case report. A man of 35 years, presents to the emergency room with fever, headache, confusion, marked nuchal rigor.Anamnesis is the treatment of dental caries on the previous day.The blood count showed 24.7x109 / L with WBC 22.9x109 / L (92.9%) neutrophils. The lumbar puncture CSF noted cloudy with 15.0 x 109 / L WBC, glicorrachia 5 g / L, protidorrachia 6.5 g / L. Microscopic examination showed numerous granulocytes and prevalence of Gram-positive cocci.The pneumococcal antigen was negative.The blood cultures before starting antibiotic therapy, were negative. CSF was isolated from the culture of a Streptococcus salivarius. To antibiotic therapy started in the ED, after lumbar puncture is associated with the Ampicillin Ceftriaxone and continued for 15 days to improve the patient’s general condition, then resigned in the 17 th day. Materials and methods. From CSF inoculated in blood agar plates and chocolate agar alpha hemolytic colonies were isolated, catalysis negative, optochin resistant. The biochemical identification performed with Phoenix (BD) and confirmed by PCR Pan bacterial (16S rDNA) bacterial strain identified as Streptococcus salivarius.The antibiogram performed with Phoenix (BD) according to the CLSI guidelines indicated sensitivity to penicillin, vancomycin, cefotaxime, cefepime, and chloramphenicol. Conclusions. Meningitis by Streptococcus salivarius was found in a few cases, mainly related to the transmission of health personnel from the oral cavity during lumbar punctures performed without the use of surgical masks. The following bacterial meningitis in dental treatment having a low incidence and often fatal course be suspected by history.The patient should be further investigated because the infection may indicate a compromised immune unknown (Diabetes, HIV...)

Group A rotavirus surveillance before vaccine introduction in Italy, September 2014 to August 2017

IntroductionGroup A rotaviruses (RVA) are the leading cause of acute gastroenteritis (AGE) in young children, causing ca 250,000 deaths worldwide, mainly in low-income countries. Two proteins, VP7 (glycoprotein, G genotype) and VP4 (protease-sensitive protein, P genotype), are the basis for the binary RVA nomenclature. Although 36 G types and 51 P types are presently known, most RVA infections in humans worldwide are related to five G/P combinations: G1P[8], G2P[4], G3P[8], G4P[8], G9P[8].AimThis study aimed to characterise the RVA strains circulating in Italy in the pre-vaccination era, to define the trends of circulation of genotypes in the Italian paediatric population.MethodsBetween September 2014 and August 2017, after routine screening in hospital by commercial antigen detection kit, 2,202 rotavirus-positive samples were collected in Italy from children hospitalised with AGE; the viruses were genotyped following standard European protocols.ResultsThis 3-year study revealed an overall predominance of the G12P[8] genotype (544 of 2,202 cases; 24.70%), followed by G9P[8] (535/2,202; 24.30%), G1P[8] (459/2,202; 20.84%) and G4P[8] (371/2,202; 16.85%). G2P[4] and G3P[8] genotypes were detected at low rates (3.32% and 3.09%, respectively). Mixed infections accounted for 6.49% of cases (143/2,202), uncommon RVA strains for 0.41% of cases (9/2,202).ConclusionsThe emergence of G12P[8] rotavirus in Italy, as in other countries, marks this genotype as the sixth most common human genotype. Continuous surveillance of RVA strains and monitoring of circulating genotypes are important for a better understanding of rotavirus evolution and genotype distribution, particularly regarding strains that may emerge from reassortment events