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Microbiology 'All Grown Up'

Advancements in automated and rapid technology for the microbiology laboratory are here

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Vol. 21 • Issue 12 • Page 40

Microbiology is a laboratory that stood alone for a long time. While labs all around acquired machines that could aid in the day's workflow by performing manual tests, not one piece of instrumentation could be found in microbiology (except for the standard microscope on a benchtop and an incubator). The work was labor intensive and results took at least 24 hours before cultures were grown up enough to begin identification of bacteria. Microbiology technologists had no choice but to perform the work themselves because the technology was simply not available to them.

It was not until 1991 with the invention of the first continuous monitoring blood culture system by Biomerieux (BacT/Alert) that automated instrumentation found a place in microbiology. For the first time, an instrument was able to examine blood culture bottles completely independent of a technologist. While an explosion of instrumentation did not occur, slowly new instruments found a place in the day to day workflow. These pieces of equipment provided advanced, rapid antibiotic sensitivity results, expanded databases for better phenotypic identification, automated platforms to diminish repetitive motions by technologists, and ultimately decreased overall tech time.

A Revolution

Now the microbiology lab is experiencing a great revolution in regards to technology. New technology is bringing a level of automation to the lab that has never been experienced before and turnaround time's doctors dreamt about.

But what is behind the sudden urge to bring automation to a laboratory that has for so long successfully survived without it? Many laboratories stand on the precipice of a large retirement boom, continuously increasing workloads and decreasing numbers of new, skilled microbiologists graduating from accredited programs. Combining all of these factors together creates the need for an immediate solution.

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Enter automation in the preanalytical area of microbiology laboratories. Automation allows lab managers to re-assign valuable technologists to areas of the lab where they can better utilize their interpretational talent and focus on resulting high value work. Instruments can automatically process specimens, bringing standardization to streaking, streamlining workflow, allowing better specimen traceability, and improving overall productivity. More advanced systems can bring plates directly to incubators, view and monitor plates via digital imaging, and utilize preferred identification and susceptibility methods of the lab.

Automatic Specimen Processor

In 2008, Copan introduced the WASP® (Walk Away Specimen Processor) as the new way to automate plating and streaking of all microbiology specimens. In 2010 the next-generation WASP became the first instrument to allow laboratory personnel to load all samples onto a conveyor, then walk away while the machine scans the tubes and processes the specimens entirely, ultimately sending them out on an exit conveyor with the plates ready to incubate, says Copan executive vice president Norman Sharples. Copan advertises the WASP as having a throughput equivalent to two or three full-time people.1 The company was able to address the issue of the many different types of specimens that come to the microbiology lab by developing the Copan ESwab. The ESwab is a liquid-based collection system that allows swabs to be utilized in an automatic plating instrument. This makes the WASP the first instrument of its kind to use a single universal platform to automatically process bacteriology specimens, including swabs, urine, feces or any liquid sample, regardless of the specimen's container style or specimen type.2 The WASP also has the capability to make a gram stain, label and inoculate enrichment broth tubes, and process different specimen types at one time - a urine specimen, followed by a body fluid, followed by an ESwab. This eliminates the need to batch same specimen types.

A second option is bioMérieux's Previ Isola instrument. The Isola features an output of 180 plates per hour and advanced robotics to inoculate, streak and label specimens. A comb is used to inoculate media, ensuring the customer that comb technology inoculates the maximum agar surface, that optimum pressure-controlled contact with the agar is maintained and that a standard quantity of inoculum is used every time.1 The comb technology is a change to the traditional four quadrant streaking that most technologists are trained on; isolated colonies are consistently observed, allowing for more efficient culture workup and less time spent re-isolating poorly manually streaked plates (Table).

Additional benefits to installing front- end automation include reducing repetitive stress and fatigue to technologists by eliminating the need to open, sample and close specimen containers. Barcodes and direct connection to the hospital's LIS allows specimens to be loaded directly into the specimen processor. An accurate time of receipt and inoculation is obtained, removing the significant lag time between when a specimen comes into the lab and when it is actually processed. This, in turn, allows a technologist to determine a true incubation time.

Automation for the front-end processing area will continue to grow rapidly. Planting and streaking instrumentation was just the first step; automation will move well beyond these two methods. Diagnostics companies such as Copan and bioMérieux, as well as Becton Dickinson and Netherlands-based Kiestra, are in the process of creating full lab automation set ups. These companies are offering solutions that fully automate the microbiology laboratory, using conveyors to continuously move samples from the planting and streaking area to automatic incubation to remote image analysis and digital workup.3

Mass Spectrometry

Rapid identification methods for bacterial and fungal organisms have reached a new peak with the creation of instruments that can identify organisms in minutes compared to traditional biochemicals that can take 6-48 hours. While usage is still research use only, Matrix-Assisted Laser Desorption Ionization - Time-of-Flight Mass Spectrometry (MALDI-TOF MS) is being analyzed by several labs to see how the technology can impact future workflow.

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MALDI-TOF MS is a technique used to simultaneously screen a multitude of molecules and determine their identity by analyzing their individual mass-to-charge ratio. These molecular "signatures" can be used for rapid bacterial and fungal identification (ID) from isolated colonies.4 The technology identifies organisms in small quantity and from growth seen in an overnight culture. Clinicians rejoice in the extremely rapid turnaround time and ability to treat patients more efficiently, thus reducing the use of unnecessary antibiotics or other treatments. The decreased time to identification is especially useful when identifying organisms resistant to standard antimicrobials. Healthcare providers will be able to modify treatment and offer a more targeted therapy.

Advantages to this method include the ability to make this instrumentation part of a complete lab automation set up or to more simply connect the technology to the lab's current ID and susceptibility machine. BioMérieux is developing integrated workflow solutions with its VITEK® 2 range to ensure optimal user convenience, full sample traceability and quality of results.4 Setting up an organism for identification requires no dilution and can be done on the benchtop by the technologist. With minimal tech time required, utilizing this technology into daily workflow should be seamless for more laboratories. As organisms continue to morph into new species and increase in pathogenicity, MALDI-TOF mass spectrometry will provide a rapid and advanced methodology in identification.

Making the Move Toward Automation

Big changes are coming as laboratories (both large and small) begin their move toward automation. Increased accuracy, more consistent quality, and reduced turnaround times to clinicians dramatically improve patient care. The technology available will allow for a smoother workflow, decreased cost and superior results for the patients behind each specimen.

Theresa Castellone is technologist specialist, Virology Laboratory, Rhode Island Hospital.

References

1. Fresh approach to micro - front end robotics. Available: www.cap.org/apps/cap.portal?_nfpb=true&cntvwrPtlt_actionOverride=%2Fportlets%2FcontentViewer%2Fshow&_windowLabel=cntvwrPtlt&cntvwrPtlt{actionForm.contentReference}=cap_today%2F0511%2F0511b_fresh_approach.html&_state=maximized&_pageLabel=cntvwr

2. WASP - General Information. Available: www.copanusa.com/index.php/products/wasp/general/

3. Automated specimen processing, robotic workup, remote image analysis, digital reporting... The future for microbiology? Available here: www.mlo-online.com/articles/201206/automated-specimen-processing-robotic-workup-remote-image-analysis-digital-reporting-the-future-for-microbiology.php

4. July Connection: Newsletter -Mass Spectrometry: Cutting Edge Microbial Identification. Available here: www.biomerieux-usa.com/servlet/srt/bio/usa/dynPage?open=USA_NWS_CNN_2011_July&doc=USA_NWS_CNN_2011_July_G_FCK_1&pubparams.sform=0&lang=en




     

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