in the name of god...advanced expert system presents testing results with high accuracy and...
TRANSCRIPT
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In the name of GOD
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Automated methods in the MicrobiologyLab-Issues and Troubleshooting!
Presented By: Dr B. Oboudi
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Background/history Plate streakers and Gram stainers Blood cultures Automated Susceptibility Testing Automated ID testing Automated Urine Analysers Molecular assays MALDI-TOF
Overview
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Background
Manual streaking of plates has not really changed sincesolid agar plates were first used
Microscopy is mostly unchanged Incubators while probably more reliable are essentially the
same Plate reading has not really changed over the years
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Obstacles to automation in Microbiology
Microbiology is too complex to automate: blood,sterile body fluids, urine, catheter tips, tissues,prosthetic devices, lower respiratory tract specimens Variations in the processing of specimens: tissue
digestion, urine colony count, impression smearspreparation Machines are programmable but humans are flexible Costs of automation Microbiology labs are small for automation
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Pre analytical
Specimen separators Media pouring Issues with each are unique
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Issues and solutions
Sterility at every point or risk of contamination Tubings need to be autoclaved UV light needs to be regularly inspected and
maintained
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Conventional blood culture
7 days
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Blood Cultures
Standard in most diagnostic labs, varying sizes. Better detection times More advanced media Reduced total incubation before calling a bottle a
final negative Suppliers: BacT/Alert (BioMerieux), BACTEC FX
(BD), Versa TREK
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Issues with blood culture systems
False positives due to high TLC count Continuous power supply needed Cost
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Conventional ID and susceptibility testing
24-48hours
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Automated ID and Sens
Automated ID testing available since 1977 Biochemical substrates miniaturised and read by
colorimetric or fluorometric means Available in many labs Multiple Antibiotics in different dilutions available on Cards
or panels to ascertain MIC Suppliers: Microscan Walkaway (Dade Behring) Vitek2
(BioMerieux) BD Phoenix (BD)
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Issues with identification systems
Pure culture Simple tests are not covered like oxidase, catalase,
motility, pigment production Variability of identification in rarer organisms Only organisms covered in database Inoculum size can affect MIC interpretations MICs of some antibiotics are not actual MICs but
extrapolations from related antibiotics
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Automated Urine Analysers
Automated Dip-strip inoculation and reading Cell counts performed automatically – either by flow
cytometry or (more recently) high resolution opticstaking pictures of cells High Negative predictive value for urine cultures
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Issues with urine analysers
Back to basics Appropriate specimen collection Early transport
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Molecular methods
GeneXpert- not just for TB, MRSA, C. difficile, etc.
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Issues with molecular methods
Cannot differentiate live from dead Negative results do not rule out infection
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MALDI-TOF(Matrix assisted LASER DesorptionIonisation-Time of Flight Mass spectrometry)
Protein based spectral identification of bacteria Identifications available in literally minutes – not hours Tiny amount of bacterial growth needed – not affected by
media or incubation conditions Minimal cost per test (in cents not even dollars), virtually no
consumables Suppliers : Bruker, BioMerieux
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Issues with MALDI-TOF
Pure culture In mixed cultures, will pick up the dominant
organism Antimicrobial susceptibility not possible Viruses not identified Identifies only organisms in database
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Plate Streakers
Select appropriate media Loads the samples Spreading the inoculum to obtain isolated single colonies
following incubation Suppliers: WASP (Copan) Previ-Isola (BioMerieux) Innova
(BD) and Inoqula (KIESTRA) Not all systems include Gram stain preparation
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DL-96II Microbial ID/AST System
Provide bacteria ID and AST tests results at thesame time with automated reading and analysisEffective identification of wide range coveringvast routine organisms (over 600 in total)including major clinical pathogenic bacteria andfungiAdvanced expert system presents testing resultswith high accuracy and instructive interpretation
Identification range: 5 categories of test cards covering Micrococcaceae, Streptococcus,Enterobacteriaceae, Non-fermentative bacteria, Yeast-like fungi
Test Principles: Identification: colorimetry / Susceptibility testing: turbidimetryThroughput: 60--120 sample per hourOptional Configuration : Automated sampling device, sampling 60-80 plates per hourPrinter: External printerInterface: 17 inch display , support LIS/HISEnvironmental temperature: 5℃--40℃Relative humidity: 10%--90%;Atmospheric pressure: 76kPa--106kPa;
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DL-Bt64 Auto Blood Culture System
Auto blood culture system for both blood and sterile body fluidspecimensExpendable modular design to meet different size laboratory’scapacity needsHigh sensitivity & specificity: able to detect anaerobic/aerobic andfungi for both adult and child, characterized for its excellentrecovery of fungiFAN bottle (Fastidious Antibiotic Neutralization ) with unique resindesign enables absorbing most of antibiotics, consequently risesup the sensitivity of detection rate.
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Test Principles: Colorimetry & CO2 sensor.Sample Type: Blood and various sterile body fluid specimens.Capacity: 64 bottles / 112bottles / 224 bottlesDetection Method: Adopt continuous swinging vibration mode, non-stopmonitoring. The system automatically reads the color data of the sensor at thebottom of each bottle every 10 minutes by each independent detectorReal-time detection and warning, with audio, visual and software alarm ofpositive samples or negative samples.Interpretation Method: Analyze sustained acceleration, Speed, Initialthreshold.Sample Loading:
Able to accept samples in random position and at any time in any rack.Able to resume the procedure if a sample is picked up and reinserted within 2
hours.Incubation detection period: to be set by the operator, and at most 7 days.
System hardware: Main instrument with 17' internal touch-pad, barcodescanner.
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DL-Bt 112 Auto Blood CultureSystem
Auto blood culture system for both blood and sterile body fluidspecimensExpendable modular design to meet different size laboratory’scapacity needsHigh sensitivity & specificity: able to detect anaerobic/aerobicand fungi for both adult and child, characterized for its excellentrecovery of fungiFAN bottle (Fastidious Antibiotic Neutralization ) with uniqueresin design enables absorbing most of antibiotics,consequently rises up the sensitivity of detection rate
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Test Principles: Colorimetry & CO2 sensor.Sample Type: Blood and various sterile body fluid specimens.Capacity: 64 bottles / 112bottles / 224 bottlesDetection Method: Adopt continuous swinging vibration mode, non-stopmonitoring. The system automatically reads the color data of the sensor at thebottom of each bottle every 10 minutes by each independent detectorReal-time detection and warning, with audio, visual and software alarm ofpositive samples or negative samples.Interpretation Method: Analyze sustained acceleration, Speed, Initialthreshold.Sample Loading:
Able to accept samples in random position and at any time in any rack.Able to resume the procedure if a sample is picked up and reinserted within 2
hours.Incubation detection period: to be set by the operator, and at most 7 days.
System hardware: Main instrument with 17' internal touch-pad, barcodescanner
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Way ahead………………..
Total lab automation???????
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Obstacles to automation in Microbiology
Microbiology is too complex to automate: blood,sterile body fluids, urine, catheter tips, tissues,prosthetic devices, lower respiratory tract specimens Variations in the processing of specimens: tissue
digestion, urine colony count, impression smearspreparation…….……….BUT THE SIMPLERMETHODS CAN BE AUTOMATED Machines are programmable but humans are flexible Costs of automation Microbiology labs are small for automation..........Not
all!!!
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CONCLUSION-TWO QUOTES
“The first rule of any technology used in a business is thatautomation applied to an efficient operation will magnifythe efficiency. The second is that automation applied to aninefficient operation will magnify the inefficiency.”
-Bill Gates
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CONCLUSION-TWO QUOTES
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THANK YOU
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