Evaluation of Microbiological Performance and the Potential Clinical Impact of the ePlex® Blood Culture Identification Panels for the Rapid Diagnosis of Bacteremia and Fungemia.

Molecular rapid diagnostic assays associated with antimicrobial stewardship have proven effective for the early adaptation of empiric therapy in bloodstream infections. The ePlex® BCID (GenMark Diagnostics) Panels allow identification of 56 bacteria and fungi and 10 resistance genes in 90 min directly from positive blood cultures. We prospectively evaluated 187 sepsis episodes at Grenoble University Hospital and retrospectively analyzed the cases to measure the potential clinical impact of the ePlex BCID results. Identification of all pathogens was obtained for 164/187 (88%) bloodstream infections with 100% detection of antimicrobial resistance genes (17 blaCTX-M , 1 vanA, and 17 mecA genes). Only 15/209 (7%) strains were not covered by the panels. Sensitivity for detection of micro-organisms targeted by the RUO BCID-GP, BCID-GN, and BCID-FP Panels was respectively 84/84 (100%), 103/107 (96%), and 14/14 (100%). Interestingly, accurate identification of all pathogens was achieved in 15/17 (88%) polymicrobial samples. Retrospective analysis of medical records showed that a modification of antimicrobial treatment would have been done in 45% of the patients. Treatment modifications would have been an optimization of empiric therapy, a de-escalation or an escalation in respectively 16, 17, and 11% of the patients. Moreover, 11% of the samples were classified as contaminants or not clinically relevant and would have led to early de-escalation or withdrawal of any antibiotic. Detection of resistance genes in addition to identification alone increased escalation rate from 4 to 11% of the patients. Absence of the ePlex result was considered a lost opportunity for therapy modification in 28% of patients.

Organizational culture of Mississippi hospitals as perceived by laboratory professionals.

From 2006 through 2008, patient safety events cost the Medicare program $8.9 billion and were associated with 99,180 hospital deaths. Of the $2.5 trillion spent on healthcare in 2009, 2.3% or $57.5 million was spent on laboratory costs. Reduction of laboratory-associated errors to 3.4 errors per 1 million tests could save money and lives. The organizational culture of a facility has an impact on quality improvement implementation. Clinical laboratories in Mississippi were surveyed to determine the predominant culture type as perceived by the medical laboratory professionals. Of the 1200 surveys mailed to 90 facilities, 272 were returned complete. It was determined that although the individual participant return rate was 28.6%, 49 of the 90 hospitals or 54.4% of the Mississippi facilities were represented through one or more individual participant responses. The culture scores revealed the following distribution for the individual respondents: group/clan culture scores were predominant for 106 (39.0%), hierarchical culture scores for 94 (34.6%), rational/market culture scores for 36 (13.2%), and developmental/adhocratic culture scores for 24 (8.8%) of the individual respondents. The remaining 12 (4.4%) individuals reported blended or codominant culture scores with 50% claiming a group/clan and hierarchical split. The consolidation of the data to represent the 49 healthcare institutions revealed a different distribution, with 24 (49%) as hierarchical culture, 22 (44.9%) as group/clan culture, and 3 (6.1%) as rational/market culture. Mississippi hospital data parallels previous findings with either hierarchical or group being the predominant organizational culture.

A comparative study of four serological tumor markers for the detection of breast cancer.

Breast cancer is currently the third most common cause of cancer in the world. Circulating tumor antigens are often used as a minimally invasive tool for noting breast cancer progression. The objective of this study was to compare four tumor antigens (CA 15-3, CA 27.29, alpha-fetoprotein [AFP], and carcinoembryonic antigen [CEA]) for their diagnostic efficacy in breast cancer patients. It was hypothesized that CA 15-3 would proved to be superior to CA 27.29, CEA, and AFP in assay performance. Tumor marker assays were performed according to the manufacturers' directions. Assays used in this study were CA 15-3 and CA 27.29 (Fujirebio Diagnostics/Centocor Inc.), AFP (Abbott Inc.), and CEA (Hybritech Inc.). A total of 554 patient samples were obtained from an area hospital, plus 200 healthy adult samples which were used for the determination of normal reference intervals. The patients included patients with no disease (184), with non-malignant disease (11), with breast cancer (87), and with other types of cancer (272). Diagnostic percent sensitivities for each marker were: CA 15-3 (63%), CA 27.29 (39%), CEA (22%), and AFP (22%). Diagnostic specificities for each marker were comparable, ranging from 80-88%. Analytical parameters were evaluated for the assays and compared favorably. We concluded that CA 15-3 was the best tumor antigen for use as a diagnostic aid and monitoring agent.