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PLoS By Category | Recent PLoS Articles
Critical Care and Emergency Medicine - Infectious Diseases - Non-Clinical Medicine - Pathology

Revolutionizing Clinical Microbiology Laboratory Organization in Hospitals with In Situ Point-of-Care
Published: Tuesday, July 19, 2011
Author: Stéphan Cohen-Bacrie et al.

by Stéphan Cohen-Bacrie, Laetitia Ninove, Antoine Nougairède, Rémi Charrel, Hervé Richet, Philippe Minodier, Sékéné Badiaga, Guilhem Noël, Bernard La Scola, Xavier de Lamballerie, Michel Drancourt, Didier Raoult

Background

Clinical microbiology may direct decisions regarding hospitalization, isolation and anti-infective therapy, but it is not effective at the time of early care. Point-of-care (POC) tests have been developed for this purpose.

Methods and Findings

One pilot POC-lab was located close to the core laboratory and emergency ward to test the proof of concept. A second POC-lab was located inside the emergency ward of a distant hospital without a microbiology laboratory. Twenty-three molecular and immuno-detection tests, which were technically undemanding, were progressively implemented, with results obtained in less than four hours. From 2008 to 2010, 51,179 tests yielded 6,244 diagnoses. The second POC-lab detected contagious pathogens in 982 patients who benefited from targeted isolation measures, including those undertaken during the influenza outbreak. POC tests prevented unnecessary treatment of patients with non-streptococcal tonsillitis (n?=?1,844) and pregnant women negative for Streptococcus agalactiae carriage (n?=?763). The cerebrospinal fluid culture remained sterile in 50% of the 49 patients with bacterial meningitis, therefore antibiotic treatment was guided by the molecular tests performed in the POC-labs. With regard to enterovirus meningitis, the mean length-of-stay of infected patients over 15 years old significantly decreased from 2008 to 2010 compared with 2005 when the POC was not in place (1.43±1.09 versus 2.91±2.31 days; p?=?0.0009). Altogether, patients who received POC tests were immediately discharged nearly thrice as often as patients who underwent a conventional diagnostic procedure.

Conclusions

The on-site POC-lab met physicians' needs and influenced the management of 8% of the patients that presented to emergency wards. This strategy might represent a major evolution of decision-making regarding the management of infectious diseases and patient care.

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