Fellowship Training for the Future Clinical Microbiology Laboratory Director.

Formal medical and public health microbiology (MPHM) fellowship programs play a key role in preparing future clinical microbiology laboratory directors for their leadership and management responsibilities. Given the continually evolving MPHM field, fellowships must remain adaptable to changes in the field, providing trainees with the opportunity to engage with newly emerging diagnostic modalities, while continuing to emphasize the "bread and butter" techniques of clinical microbiology. This article discusses the key components of a fellowship program and provides recommendations for incorporating educational best practices.

Experience of Indian association of medical microbiology external quality assurance scheme centre, New Delhi: Challenges and quality assessment of clinical microbiology laboratories.

Introduction: EQAS program at New Delhi under IAMM was started in January 2014 across North and North east regions of India with 217 participants, which grew up to 540 by 2018. Materials and Methods: In 2014, 4 analytes per year were sent for 3 exercises, i.e. smear culture and serology. 2018 onwards PT analytes were increased from 4 to 12 and comparative performance of techniques analysed. Results: Out of the 22 smears sent for gram staining, ZN staining, Kinyoun staining and Albert staining, completely correct results ranged between 29.55% - 79.9%, 94.3% - 99.2%, 35.5% & 93.8%, respectively. Correct results for culture isolate identification & susceptibility testing and serology exercises varied between 70 & 92.4% and 73.1 & 98.59%, respectively. In the year 2018, 470 responses were received for bacterial culture identification & antibiotic susceptibility testing out of which manual and automated systems were used by 54% & 46% and 52.5% & 47.5% participants, respectively. Techniques used in BBV assays for HBsAg, HCV & HIV found all methods like ELISA, ELFA, CLIA and Card Test performing similarly. The major challenges in running the EQA program included requirement of large amount of specimens for PT item preparation, stability in hot and humid conditions and timely delivery of PT challenges in remote parts of the country. Conclusion: A large number of the participating laboratories (77%) had an overall score of >80% for all exercises, demonstrating acceptable baseline performance of EQAS registered laboratories. However, continued EQAS participation could further improve the quality of results.

Methodological approach towards a Gap Assessment of the Serbian microbiology system in the function of surveillance in line with EU standards and acquis.

INTRODUCTION: Italian and Serbian Health authorities performed an in-depth Gap Assessment of the Serbian microbiology system in the function of communicable disease surveillance using a methodology adapted to context and information needs. METHODS: There were two study phases: a capacity based survey and an equipment mapping survey. Invited participants included national health authorities, heads of national reference laboratories and of public/private diagnostic laboratories in Serbia. Findings were analysed preliminarily and identified gaps were discussed, prioritized and validated through two ad hoc workshops involving all concerned institutions. RESULTS: The Gap Assessment was performed between September and December 2017. The overall response rate was 69% for phase one and 74% for phase two. Identified gaps were assessed as highly relevant during the project workshops. DISCUSSION: Gaps and priorities were highlighted, validated, and studied with a suitable level of detail to develop a concrete action-plan. The same methodological approach could be used to monitor progress in Serbia as well as in other EU candidate countries.

[Analysis of proposals received and funded in discipline of microbiology of the National Natural Science Foundation of China in 2016].

We summarized proposals submitted and funded in the discipline of microbiology of the Department of Life Sciences of National Natural Science Foundation of China in 2016. The traits and concerns in different sub-disciplines as well as distinctive funding programs were addressed, and the prior funding fields were prospected. The information may provide references for researchers who apply funding at the discipline of microbiology.

The chilean network of microbial culture collections: establishment and operation / Red chilena de colecciones de cultivos microbianos: establecimiento y operación

According to the data available at the World Data Center for Microorganism-WDCM from the World Federation for Culture Collection-WFCC, Chile has four registered culture collections that preserve 2777 microbial strains. At the global point of view, the culture collections in Chile are in different level of operation regarding its own infrastructure and compliancy with quality standards for preservation of strains and for services provide. The absence of funding to support the preservation of the Chilean microbial assets is a key issue for the development of the Chilean bioeconomy. Considering this, the Chilean culture collections started working together to establish the Chilean Network of Microbial Culture Collections (RCCCM, acronym in Spanish). In this note, the establishment and operation of the RCCCM is presented and discussed.

De acuerdo con los datos disponibles en el World Data Center for Microorganism-WDCM de la Federación Mundial para la Colección de Cultivos - WFCC, Chile tiene cuatro colecciones de cultivos registradas que preservan 2777 cepas microbianas. Desde el punto de vista global, las colecciones de cultivos en Chile se encuentran en diferentes niveles de operación con respecto a su propia infraestructura y cumplimiento con estándares de calidad para la preservación de las cepas y para los servicios que proporcionan. La ausencia de financiamiento para apoyar la preservación de los activos microbianos chilenos es un tema clave para el desarrollo de la bioeconomía chilena. Considerando esto, las colecciones chilenas de cultivos comenzaron a trabajar conjuntamente para establecer la Red Chilena de Colecciones de Cultivos Microbianos (RCCCM). En esta nota se presenta y discute el establecimiento y funcionamiento de la RCCCM.

[Analysis of proposals received and funded in discipline of microbiology of the National Natural Science Foundation of China from 2011 to 2015].

Based on a wrap-up of the research proposals received and awards made during 2011 through 2015 in the discipline of microbiology of the Department of Life Sciences, National Natural Science Foundation of China, this article presents a statistic analysis of award recipient institutions and main research trends, and attempts a prospective prioritization of the funding areas from the points of encouraging interdisciplinary research, optimizing funding instruments and strengthening talent training, with a view to providing reference for scientists and researchers in the field of microbiology.

[Funding in 2012 for Division of Microbiology by National Natural Science Foundation of China].

We provide here an overview of proposals applied and projects funded by the division of microbiology, department of life sciences, National Natural Science Foundation of China in 2012. We analyzed the traits and problems in different sub-disciplines, and illustrated the stimulating policy for future funding. This overview provides reference for Chinese researchers to apply relevant funding for projects in microbiology.

[Analysis and prospect of projects funded in discipline of microbiology (NSFC) from 2006 to 2010].

The overview of projects funded by general programs,key programs and national science fund for distinguished young scholars in discipline of microbiology, National Natural Science Foundation of China (NSFC) from 2006 to 2010 was recommended. Some important characters such as the distribution of projects in different subjects, organizations, regions and research fields were analyzed. Some important research fields which should be supported in "The Twelfth Five-Year Plan" was also put forward. The goal of the paper is to provide information of funding in NSFC for researchers in the field of microbiology.

[Current infectious disease care in Spain]. / La asistencia infectológica actual en España.

Despite the specialist activity of Infectious Diseases not being officially recognised, the majority of the hospitals in the autonomous communities of Spain are equipped with structures, with significant heterogeneity among them, to be able to offer high quality care in these diseases. The main characteristics of and Infectious Diseases Department is its important healthcare activity, more than in other officially recognised medical specialities, and also its important interrelationship with other services in the hospital which is clearly horizontal healthcare. Furthermore, the aforementioned infectious disease care units have developed important activities in the arena of community and public health and, in collaboration with health authorities, contribute to the rational use of antimicrobials and the relationship with Primary Care. The future of specialists in infectious diseases, when they are officially recognised, will be the creation of clinical management units in every health institution with the objective of coordinating all the specialised health care, both in the hospital environment and in its health area of influence.

INFOBIOMED: European Network of Excellence on Biomedical Informatics to support individualised healthcare.

INFOBIOMED is an European Network of Excellence (NoE) funded by the Information Society Directorate-General of the European Commission (EC). A consortium of European organizations from ten different countries is involved within the network. Four pilots, all related to linking clinical and genomic information, are being carried out. From an informatics perspective, various challenges, related to data integration and mining, are included.

A model for consolidation of clinical microbiology laboratory services within a multihospital health-care system.

To determine the cost-effectiveness of consolidating clinical microbiology services in a three-hospital health-care network while maintaining high-quality laboratory services, a retrospective review of the total costs of maintaining separate clinical microbiology laboratories within our health-care system was compared to the cost of providing these services after consolidation. Turnaround times before and after consolidation were compared to assess efficiency of the consolidated services. Input of clinicians was also solicited to ensure that quality of services and customer satisfaction remained high. The results of the consolidation project show that the net fiscal saving because of consolidation of clinical microbiology services within our health-care system will be approximately 100,000 dollars per fiscal year. This value includes increased courier charges as well as personnel savings. Although fiscal savings are an integral part of any laboratory consolidation plan, the financial considerations must be balanced by quality of service. The response to consolidation from clinicians was decidedly mixed before implementation of the plan because of fear of increased turnaround times and limited access to laboratory information. The consolidation process, however, was smooth with few physician complaints. The consolidation of our clinical microbiology services illustrates that significant financial savings can be achieved without compromise of efficiency or quality of service.

Chest physicians' and microbiologists' awareness and demand for drug monitoring in the treatment of TB.

There is a role for therapeutic drug monitoring (TDM) to achieve the optimum therapeutic concentration of anti-tuberculous drugs. This work aimed to determine the current awareness of TDM in TB control among chest physicians and to estimate the demand for this service. Responses from a sample of chest physicians in the West Midlands revealed that 60% were aware of TDM and 33% had used it. Responses were received from half of a UK group of microbiologists who reported a median of nine requests in the past year. It appeared that more was known about services for rifampicin and streptomycin than other first-line drugs. There appears to be a need for both increased awareness among potential service users and for coordination of assay services.

Impact of an infection consultation service for bacteraemia on clinical management and use of resources.

Since 1993, the infection consultation service for bacteraemia has seen 310 patients in the Medical and Surgical Directorates at Ninewells Hospital and Kings Cross Hospital. A random sample of 100 was audited. Case-notes were incomplete for five patients, leaving 95 fully-audited patients. Clinical outcome measures were death from infection, and readmission within 2 weeks of discharge. Initial treatment was inconsistent with antibiotic policy in 46 patients (48%). Antibiotic treatment was changed in 37 (80%) of these patients: increased in intensity in 19 (41%) and decreased in 18 (39%). Changes were also made in 30 (61%) of the 49 patients whose initial treatment was consistent with sepsis policy-increased in seven (14%) and decreased in 23 (47%). Median daily antibiotic costs were lowered in patients whose initial treatment was consistent with sepsis policy (pounds 10.10 vs. pounds 7.28, p = 0.0274). However, in the other patients, savings were balanced by increases (p = 0.7696). Consultation required one consultant session per week (3.5 h) and the audit required an additional 16 consultant sessions. Seven patients died, but only one death was directly related to infection. Six patients were readmitted to hospital within 2 weeks, in three due to recurrence of infection. Changes to treatment were recommended in the majority of patients, regardless of whether initial treatment complied with the sepsis policy. The service primarily redistributed resources rather than reducing costs. A fully audited service requires considerable consultant time, but we believe such time is well spent.

Quality management and the clinical microbiology laboratory.

Quality management in today's health care environment requires a fresh approach. Laboratories that have traditionally directed their efforts toward meeting the needs of physicians must now also satisfy the needs of society, the greater public health, and the agency's administrators. Technical advances must today be considered in the context of patient care cost-effectiveness or final outcomes. Examples of strategies for improving quality in the laboratory, such as seeking input from all individuals involved in interpreting or using laboratory test results, forming multidisciplinary committees for development of critical pathways, issuing surveys for assessing the level of satisfaction of the laboratory's customers, and providing visual feedback of the results of activities, are described.

[Current state and problems in the microbiology laboratory--organizing the laboratory].

The microbiological laboratory in the hospital has many roles including the rapid and precise identification of pathogenic bacteria in specimens, their antimicrobial susceptibility tests, microbial antigen detection using immunological methods and DNA hybridization methods, surveillance of bacterial milieu of the hospital environment, monitoring quality control of microbiological methods, to educate microbiological skills of staffs, the economical management of laboratory and so on. The last two issues are our major concerns. Improvement of the microbiological skills of the staff is most important in the laboratory, but is a time-consuming. From our experience, a technical expert, intermediately skilled technicians and beginners should always work in the laboratory, together. On the other hand, the economical management of the microbiological laboratory is also another concern. Although the mechanization of procedures comes to mind, it is hard to improve the economical conditions in the laboratory. Because of the control of the machines is not completely automatic and requires the knowledges and decisions of technical experts, the work force and running cost can not be reduced. As the technical expert can economize in the use of media or tests for identification of pathogens, good training of beginners into skillful successors, is important.