BLOOD CULTURE
Rapid diagnostics and AMR testing from the blood culture bench
Dr Neil Bentley OBE offers a personal reflection on the impact of rapid diagnostics and antimicrobial resistance testing from the blood culture bench.
Before I delve into rapid diagnostics and antimicrobial resistance testing (AST) in possible sepsis patients, I would like to indulge you a little into my world… When I started my microbiology career back in the early 1980s, the thought of same-day microbiology was just a pipe dream. We struggled with hand lenses, Craigie tubes, sugar reactions and don’t mention Stokes AST plates. Back then the Gram stain was always the first point of call, and we couldn’t just stick it through the Maldi! The introduction of API’s and E-Test strips were mind blowing back then! Did we trust the ‘blood culture machine’ above the Castaneda method? Well, we learned to live with it. Ask someone with grey hair in the Microbiology laboratory if you don’t understand the terminology in the preceding text, and be prepared to pull up a sandbag, I bet they will still know the API 20E code for an
E.coli! Same-day microbiology has been with us for some while now and is here to stay. With the advent of 24/7 working in some microbiology laboratories and automation solutions, we have been able to move from notional turnaround times (which were previously impacted on by the time and day of the week) to predictable turnaround times enabling timely patient care interventions. These same-day microbiology solutions have significantly improved patient care and outcomes in some cases, particularly in acute and emergency settings. But do we need it across all diagnostic microbiology? Is it beneficial? Can we
afford it? What value does it add? These were questions I was recently asked by an inquisitive politician. My answer may surprise some, as in the mainstay of routine diagnostic microbiology it’s a big fat ‘no’ it’s not required at present. It is always good to have a result quickly, but to have any impact that result needs to be acted on promptly, and sadly in my experience this is not the case, and probably not needed for how we currently run primary care services. However, in certain circumstances the need for a quick diagnostic microbiology result is very important and can be lifesaving. This
is particularly important in patients with sepsis and it’s not a mistake that most UK ambulances display the slogan: ‘Acting quickly can save 1,000s of lives from sepsis.’
Diagnosing and treating sepsis Sepsis has been known about for a long time now and was first described by Homer 750-800BC with the Greek word ‘sepo’ which means ‘I rot’.1
To date
sepsis is hard to diagnose and has a significant impact. In 2017 an estimated 48.9 million incident cases of sepsis were recorded globally and 11 million sepsis related deaths were reported, representing 19.7% of all global deaths.2 More locally and according to the UK Sepsis Trust, the annual burden of sepsis in the UK is around 245,000 cases with 48,000 sepsis related deaths. Moreover, around 80,000 people will suffer life-
UK Sepsis Trust ambassador Melissa Mead, MBE, with a London Ambulance Service vehicle displaying the Sepsis Trust messaging.
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