Executive Summary: 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

Abstract

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, 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; or into 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 specific 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.

Culture if spikes? Indications and yield of blood cultures in hospitalized medical patients

“…4,5 Unfortunately, physicians are poor at predicting which hospitalized patients have BSI, 6,7 and published guidelines do not provide clear indications for the use of blood cultures. 8 As a result, current practice follows a "culture if spikes" paradigm, whereby inpatient providers often obtain blood cultures in the setting of any fever. This is the most common anticipatory guidance communicated between providers, involving up to 75% of written sign-out instructions.…”

Stratégies de réduction de l’utilisation des antibiotiques à visée curative en réanimation (adulte et pédiatrique)

“…Chez l'adulte, comme chez l'enfant en dehors de la période néonatale, devant plusieurs hémocultures positives à SCNmR, il faut probablement décider d'un traitement en tenant compte de la gravité des malades, de l'immunodépression, de l'antibiotype (Accord fort). La plupart des recommandations internationales [113,114] [121]. Par ailleurs, une étude « exposés-non exposés » a comparé la daptomycine avec la vancomycine (taux résiduel médian à 17,6 mg/L) pour traiter des bactériémies à SARM avec une CMI à la vancomycine supérieure à 1 mg/L.…”

Electronic Nose in the Detection of Wound Infection Bacteria from Bacterial Cultures: A Proof-of-Principle Study

“…Bacterial cultures are not indicated in case of common and uncomplicated forms of SSTI that are treated in an outpatient setting [9]. In more severe or complicated infections requiring hospitalization, Gram stain and bacterial cultures are considered the standard of care [7].…”