Archive for January 3, 2017

Cost Analysis of Implementing Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry Plus Real-Time Antimicrobial Stewardship Intervention for Bloodstream Infections

Journal of Clinical Microbiology January 2017 V.55 N.1 P.60-67

Twisha S. Patel, Rola Kaakeh, Jerod L. Nagel, Duane W. Newton, and James G. Stevenson

aDepartment of Pharmacy Services, University of Michigan Hospitals and Health Centers, Ann Arbor, Michigan, USA

bDepartment of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, Michigan, USA

cDepartment of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, USA

Studies evaluating rapid diagnostic testing plus stewardship intervention have consistently demonstrated improved clinical outcomes for patients with bloodstream infections.

However, the cost of implementing new rapid diagnostic testing can be significant, and such testing usually does not generate additional revenue.

There are minimal data evaluating the impact of adding matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) for rapid organism identification and dedicating pharmacy stewardship personnel time on the total hospital costs.

A cost analysis was performed utilizing patient data generated from the hospital cost accounting system and included additional costs of MALDI-TOF equipment, supplies and personnel, and dedicated pharmacist time for blood culture review and of making interventions to antimicrobial therapy.

The cost analysis was performed from a hospital perspective for 3-month blocks before and after implementation of MALDI-TOF plus stewardship intervention. A total of 480 patients with bloodstream infections were included in the analysis: 247 in the preintervention group and 233 in the intervention group.

Thirty-day mortality was significantly improved in the intervention group (12% versus 21%, P < 0.01), and the mean length of stay was reduced, although the difference was not statistically significant (13.0 ± 16.5 days versus 14.2 ± 16.7 days, P = 0.44).

The total hospital cost per bloodstream infection was lower in the intervention group ($42,580 versus $45,019). Intensive care unit cost per bloodstream infection accounted for the largest share of the total costs in each group and was also lower in the intervention group ($10,833 versus $13,727). Implementing MALDI-TOF plus stewardship review and intervention decreased mortality for patients with bloodstream infections.

Despite the additional costs of implementing MALDI-TOF and of dedicating pharmacy stewardship personnel time to interventions, the total hospital costs decreased by $2,439 per bloodstream infection, for an approximate annual cost savings of $2.34 million….



January 3, 2017 at 7:48 am

The Added Cost of Rapid Diagnostic Testing and Active Antimicrobial Stewardship: Is It Worth It?

Journal of Clinical Microbiology January 2017 V.55 N.1 P.20-23

Erin McElvania TeKippe

Departments of Pathology and Pediatrics, University of Texas Southwestern and Departments of Pathology and Laboratory Medicine, Children’s Health, Dallas, Texas, USA

Rapid diagnostic testing reduces the turnaround time for pathogen identification in the clinical microbiology laboratory, but the impact on patient care and hospital costs is a matter of speculation.

Patel et al. (J. Clin. Microbiol. 55:60–67, 2017, investigate the impact of matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) in conjunction with active antimicrobial stewardship to determine if implementation is indeed worth the added costs.


January 3, 2017 at 7:46 am

The Brief Case: Bacteremia Caused by Helicobacter cinaedi

Journal of Clinical Microbiology January 2017 V.55 N.1 P.5-9

Allen C. Bateman and Susan M. Butler-Wu* Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA

Carey-Ann D. Burnham, Editor Washington University School of Medicine


A 61-year-old male with relapsed multiple myeloma presented to clinic with fatigue and chills.

The patient had undergone two rounds of autologous stem cell transplantation in 2012 and was undergoing chemotherapy with pomalidomide, cyclophosphamide, and dexamethasone.

He was admitted for neutropenic fever (absolute neutrophil count of 1.4 × 109/liter, temperature of 38.4°C). His physical exam was normal, and he denied any other symptoms.

Two sets of blood cultures were obtained (VersaTREK Redox; Trek Diagnostic Systems), and the patient was started on levofloxacin, vancomycin, and cefepime.

His fever subsided after 24 h, and he was discharged home to complete a 30-day course of oral levofloxacin…


January 3, 2017 at 7:44 am

A Rose by Any Other Name: Practical Updates on Microbial Nomenclature for Clinical Microbiology

Journal of Clinical Microbiology January 2017 V.55 N.1 P.3-4


Colleen S. Kraft, Alexander J. McAdam, and Karen C. Carroll

aDepartment of Pathology and Laboratory Medicine, Division of Infectious Disease, Emory University, Atlanta, Georgia, USA

bDepartment of Laboratory Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA

cDivision of Medical Microbiology, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

The clinical microbiology laboratory stands at the interface between basic science, including the study of phylogeny, and applications of science in the very practical world of medical care.

In this context, it is important that laboratory reports balance scientific accuracy with medical utility, and it is particularly difficult to do this in the naming of microorganisms.

New organisms are discovered and named, and our understanding of the relationships between known organisms improves, resulting in the reclassification and renaming of organisms as they are sorted into the correct groups.

In this issue of Journal of Clinical Microbiology, we are pleased to provide several minireviews that are intended to help clinical microbiologists keep up-to-date with changes in nomenclature for bacteria (1), parasites (2), viruses (3), and fungi (4).

Most of these minireviews focus on human pathogens, but the minireview on viruses includes those affecting nonhuman animals.

An article about mycobacterial nomenclature is in preparation and will be published in Journal of Clinical Microbiology when available. The idea for this informative resource was proposed by Dr. Karen Carroll at the editors’ meeting in 2015.

The editors enthusiastically agreed these reviews would be a useful resource for clinical microbiologists, infectious diseases physicians, laboratory technologists, pharmacists, and infection preventionists, in addition to fostering discussion and teaching of trainees and students.

Several editors volunteered to write the articles, and we plan to update these minireviews every 2 years if they prove to be as useful as we expect….


January 3, 2017 at 7:43 am

Yersinia virulence factors – a sophisticated arsenal for combating host defences.

F1000Res. 2016 Jun 14;5. pii: F1000 Faculty Rev-1370.

Atkinson S1, Williams P1.

Author information

1Centre for Biomolecular Sciences, School of Life Sciences, University of Nottingham, Nottingham, UK.


The human pathogens Yersinia pseudotuberculosis and Yersinia enterocolitica cause enterocolitis, while Yersinia pestis is responsible for pneumonic, bubonic, and septicaemic plague.

All three share an infection strategy that relies on a virulence factor arsenal to enable them to enter, adhere to, and colonise the host while evading host defences to avoid untimely clearance.

Their arsenal includes a number of adhesins that allow the invading pathogens to establish a foothold in the host and to adhere to specific tissues later during infection.

When the host innate immune system has been activated, all three pathogens produce a structure analogous to a hypodermic needle. In conjunction with the translocon, which forms a pore in the host membrane, the channel that is formed enables the transfer of six ‘effector’ proteins into the host cell cytoplasm.

These proteins mimic host cell proteins but are more efficient than their native counterparts at modifying the host cell cytoskeleton, triggering the host cell suicide response.

Such a sophisticated arsenal ensures that yersiniae maintain the upper hand despite the best efforts of the host to counteract the infecting pathogen.


January 3, 2017 at 7:41 am


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