Clinical Microbiology Newsletter最新文献

MALDI-ToF MS has become a cornerstone of the clinical microbiology laboratory. The reliability and ease-of-use of these instruments make them a popular choice of study to expand their applications and increase efficiency. The use of artificial intelligence has rapidly expanded in recent years and efforts are underway to integrate this technology into the clinical microbiology laboratory to expand the applications of MALDI-ToF MS and advance beyond current limitations in the identification of clinical isolates. At the same time as the rise of AI, clinical laboratories are facing pressure to increase efficiency due to the critical shortage of qualified laboratory personnel. Studies examining the performance of simplified testing workflows seek to help laboratorians do more with less. The improvement and creation of additional databases is also improving the rate of successful identifications. This review seeks to provide an update on recent developments around these topics.

The accurate diagnosis of ocular infections hinges on precise specimen collection, handling, communication, and strategic prioritization of testing methods. This review highlights the intricate eye anatomy clinical microbiologists should know to understand ocular collection techniques and diagnostic strategies. It explores limitations regarding specimen volume, offers insight into optimal ocular sample collection and processing, recommends optimal diagnostic strategies for a wide breadth of ocular pathogens, explores the utility of antimicrobial susceptibility testing, and emphasizes the necessity of robust collaboration between laboratory specialists and ocular healthcare providers to ensure superior ophthalmic care.

Medical microbiology is a dynamic science essential to the clinical diagnosis and management of infectious diseases. Medical microbiologists serve as content experts in bacteria, fungi, viruses, and parasites as they pertain to human infections. There are several different paths one may take to become the director of a medical microbiology laboratory, the most common of which are enrollment in an Accreditation Council for Graduate Medical Education (ACGME)-approved fellowship for applicants with medical degrees or an American Society for Microbiology (ASM) Subcommittee on Post-Graduate Education Programs (CPEP) fellowship for those with a Ph.D., M.D., Sc.D., D.O. and Dr. P.H. Upon completion of either track, fellows are eligible to sit for the American Board of Medical Microbiology (ABMM) examination. Additional eligibility tracks are available for equivalent training experiences in Canada and also through non-fellowship medical microbiology experience.

A day in the life of a medical microbiology fellow can vary drastically but can typically be summarized by three primary responsibilities in descending order of effort: clinical service, research, and teaching. A medical microbiology fellowship represents an opportunity to acquire new knowledge, apply what you have learned, and develop the skills necessary to direct a laboratory. While all fellowship programs lead to eligibility for the ABMM examination, certain aspects are unique to the training experience at each program. Here, we present the distinct perspectives of four current medical microbiology fellows, highlighting the common themes and diversity of experiences leading up to and during fellowship.

Chagas disease is a chronic infection by the protozoan parasite Trypanosoma cruzi. The epidemiology of the disease results from the distribution of its arthropod vector, the triatomine bug, throughout Latin America and the southern United States, as well as migration of chronically infected individuals worldwide. In mammals, the parasite cycles through an extracellular infective form and an intracellular replicative form with tropism for cardiac and gastrointestinal (GI) tissues. Over decades, the low-grade inflammatory response can lead to cardiomyopathy and GI dysmotility disorders. This natural history necessitates presentation-dependent diagnostic approaches for clinical workup and risk-based screening, as well as blood donor and organ transplant screening. Implementing effective Chagas disease testing in the U.S. is an increasing topic of interest but is hindered by low provider awareness, few FDA-cleared assays, and limited laboratory capacity for multi-step confirmatory testing. This article provides a clinically focused review of Chagas disease, outlines the current status of clinical testing in the U.S., and reports on new innovations in diagnostics and research that may impact the field.

Cervical cancer screening recommendations proposed by natural societies and organizations have been reviewed and revised numerous times over the last decade. The most recent guidelines from the American Cancer Society and U.S. Preventive Services Task Force added human papillomavirus (HPV) primary screening for women starting at age 25 or 30 years, respectively, and ending at age 65 for those with an adequate history of negative screening. Cervical cancer screening for HPV has significantly reduced the incidence of cervical cancer. Currently, the majority of cervical cancers are reported among women who have never been screened or who were under-screened. Many organizations and institutions have explored different strategies to improve screening participation among the difficult-to-reach populations, including community outreach and specimen self-collection for HPV testing.

Human schistosomiasis is caused by trematode parasites of the genus Schistosoma. Four species and two distinct clinical syndromes are relevant to humans, including S. haematobium, which is associated with urogenital schistosomiasis, whereas S. mansoni, S. mekongi, and S. japonicum are responsible for intestinal schistosomiasis. These flukes reside in the venous plexus of the human bladder and in mesenteric veins and release eggs that, when trapped in tissues, cause inflammation and fibrosis. More specifically, S. mansoni, S. mekongi, and S. japonicum can cause intestinal inflammation, hepatosplenic periportal fibrosis, portal hypertension, and esophageal varices that can bleed and cause death. In contrast, S. haematobium, a recognized carcinogenic organism, can drive bladder carcinoma and contribute to infertility and cervical cancer. Additionally, schistosomiasis can cause general anaemia, stunted growth, and cognitive impairment.

Despite the chronic complications associated with schistosomiasis, public awareness in areas of non-endemicity is limited, and travelers rarely consider risk of infection. We describe the diagnostics available in areas of endemicity, as well as in reference laboratories, to diagnose schistosomiasis in returning travelers or migrants to resource-rich locations.

Antibiotics are the most widely used treatment for infections yet there has been minimal antibiotic discovery in recent years despite rising drug resistance and treatment failures. A better understanding of antibiotic pharmacokinetics (PK) and pharmacodynamics (PD), along with the development of novel dosing strategies, such as extended (EI) and continuous infusions (CI), has helped to overcome these barriers. Studies have consistently demonstrated that EI/CI administration of beta-lactams and vancomycin in particular, improves PK-PD target attainment compared to intermittent infusions. However, the effects of EI/CI on clinical outcomes, including efficacy and safety, remain controversial. Emerging data focus on patient populations with altered PK that may benefit from EI/CI beta-lactams or vancomycin (e.g., critically ill, cystic fibrosis, or outpatient parenteral antibiotic therapy). Logistical barriers limit EI/CI use in practice, including intravenous access, drug stability and drug incompatibility. This review highlights beta-lactam and vancomycin PK-PD, EI/CI dosing strategies and relevant evidence for practice.