b'How has the role of the laboratory changed inHow have clinical laboratories used advances to affect managing the challenge of antimicrobial resistance? patient care when it comes to antibiotic prescribing?We in the laboratory have always played a key role inTrying to implement these technologies seamlessly into patient antibiotic stewardship. It starts with things as simple ascare has been a challenge. For example, in our institution we antibiotic cascading, reporting the most narrow-spectrumwere able to get the time for reporting results on blood cultures antimicrobial agents, then expanding them once you run intodown from 36 hours to two hours using rapid tests. We were resistance problems. getting the results out there, but the time for getting someone to With the formation of what are now mandated antimicrobialacknowledge these results and use them in patient care? It was stewardship teams, clinical laboratories are even more involvedstill 36 hours. Clinicians werent ready to receive and act on in antibiotic choices. Theres now an outward facing arm of thethe information.laboratory in the healthcare system that has direct interactionThis shows why its critical to have a line of communication to with clinicians. clinicians to make sure they know what the laboratory is offering and can do the right thing with the information.How has the technology changed?In the last 15 years weve seen the advent of rapid diagnosticWorking collaboratively with our antimicrobial stewardship tests. Many of them are molecular, with some phenotypic.program and our pharmacy team we were able to significantly Rapid tests allow us to predict antibiotic susceptibility beforeimprove the time frame in which antibiotic changes were made. conventional susceptibility results are available, usually within aIt was a combined effort that changed antibiotic usage in few hours of isolating the organism. our institution.A couple of technologies have fed into that, including MALDI-TOF,This example shows how the technology came first, but the which combines matrix-assisted laser desorption/ionization withnext step was just as critical: Understanding how to make time-of-flight mass spectrometry to rapidly identify organisms.sure clinicians were doing what you expected them to do with Many laboratories have transitioned from traditional biochemistrythat information.techniques to identifying organisms through MALDI-TOF, and forAt our institution, we started with mecA and Staphylococcus good reason. It shrinks the time from getting an organism isolatedaureus. After a year, people got comfortable with it, and then we and performing an identification from a day or two to a few hours. went onto the next thing, and the next thing, and the next, adding With some organisms, the susceptibility profile is rathernew tests to the menu.predictable based on the identification. For example, if youHow is molecular technology changing the ways isolate a Group A Streptococcus, you know its highly likelylaboratories work?to be susceptible to penicillin. For other organisms, like forI dont think it is about creating something disruptive in the field. Staphylococcus aureus, which is one of our bigger problems,Instead, it has been a steady progression.you dont know whether its susceptible to methicillin. You need some more information. Thats where molecular and/or rapidWhen I was in college, we were learning how to perform phenotypic tests come in. PCR-based tests that didnt make it into clinical laboratories until a decade later. Before we could use these kinds of technologies, we had to make sure testing could be performed in a clinical laboratory where not everybody is necessarily a molecular biologist.Thats where engineering advances have moved us forward, designing high throughput instruments with simple workflows.21 Molecular testing thermofisher.com/infectiousdisease Contents'