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Empowering Microbiologists with Innovative Technologies for Clinical Impact
With antibiotic resistance continuing to be one of the largest global public health threats, the microbiology lab plays a critical role in patient care and stewardship efforts. In this webinar, hear from three experienced microbiologists as they address challenges in today’s lab environment. Discover firsthand how they ensure efficiency in their workflow for rapid identification (ID), antimicrobial susceptibility testing (AST), and software integration. Plus, see how they identify difficult organisms in a timely manner, and what technologies enable them to meet both patient needs and antibiotic stewardship goals.
Key learning objectives:
- Understand how laboratories that use the ‘DxM Trio’ can impact and provide benefits to hospital antibiotic stewardship programs
- Discover three benefits to laboratory efficiency and workflow through seamless ID, AST, and middleware integration
- Explore the clinical value of rapid identification of unusual microbial species
Don’t miss our Q&A session at the end of the video where participants submitted real-time questions for our speakers.
Interested in learning more about the DxM Trio laboratory solution? Visit now
| Speaker/Time Stamp | Speech |
| Dora Wells (00:01): | Hello and a very warm welcome to everyone joining us for today's SelectScience webinar, Empowering Microbiologists with Innovative Technologies for Clinical Impact. My name is Dora Wells, and I'll be moderating today's presentation. |
| (00:13): | With antibiotic resistance continuing to be one of the largest global public health threats, the microbiology lab plays a critical role in patient care and stewardship efforts. Ensuring microbiology labs are equipped with the most cutting-edge technologies enables advanced techniques, precise analysis, and ultimately improved patient care. |
| (00:31): | This webinar is hosted by Bruker and Beckman Coulter. These companies are leaders in the microbiology space, providing their customers with top-of-the-range solutions for microbial identification and antimicrobial susceptibility testing. |
| (00:44): | Bruker is a global leader of innovation, specializing in technologies and diagnostic solutions that shed light on the microbial world. Since the introduction of the MALDI Biotyper over a decade ago, Bruker has revolutionized microbial identification through continuous innovation and unsurpassed performance. |
| (01:05): | Beckman Coulter is a global leader in the clinical diagnostic space, with its solutions found in hospitals, reference laboratories, and physician offices settings around the globe. The company strives to improve patient care through delivering smarter, faster diagnostic solutions. |
| (01:21): | Synergizing their specialities, Beckman Coulter and Bruker teamed up in 2015 to create the DxM Trio. This solution allows real-time detection of emerging antibiotic resistance on MicroScan panels, run on the WalkAway system, providing accuracy and confluence in results, rapid identification within minutes and the largest organism library on the market using MALDI-TOF technology with the Bruker MALDI Biotyper, sirius System, and heightened security features across the platform. |
| (01:52): | Today we will discuss how laboratories that use the DxM Trio can impact and provide benefits to hospital antibiotic stewardship programs, identify three benefits to laboratory efficiency and workflow through seamless identification, antimicrobial susceptibility testing, and middleware integration, and explain the clinical value of rapid identification of unusual microbial species. |
| (02:16): | So I'm delighted to be joined by today's speakers, Dr. Joseph Campos, Director of the Microbiology Laboratory and Infectious Disease Molecular Diagnostics at the Children's National Hospital, Felicia Maida, Senior Technologist in the Microbiology Laboratory at Lahey Hospital and Medical Center, and Danaille Gustafson, Laboratory Section Head of Microbiology at Williamson Health. |
| (02:38): | After the presentations, we'll move on to our question-and-answer session. Please feel free to ask any questions for the Q&A session at any time during the webinar. You can submit your question at the speech bubble icon to the left of your screen. So now, without further delay, let's introduce our speakers. First up, we've got Joseph Campos on the line. |
| (02:56): | Hi, Dr. Campos. Thanks for joining us today. So can you just start off by telling the audience a little bit about you and your institution? |
| Joseph Campos (03:07): | Well, I'm the Director of the Microbiology Laboratory and Molecular Diagnostics Infectious Disease Laboratory here at Children's National Hospital located in Washington, DC. I've been here in that capacity for 38 years now. So I've watched a lot of things change in clinical microbiology, especially in my laboratory. |
| (03:34): | The hospital itself, as you could tell by the name, is dedicated to the care of children. We have 323 beds, inpatient beds, and an awful lot of outpatient clinics, both here in the hospital building and in the surrounding community of the Washington DC Metropolitan Area. |
| (03:59): | So we're a full service microbiology laboratory. Our laboratory operates on a 24 by 7 basis. When I say 24 by 7, that's exactly what I mean. We underwent a lean reorganization of our laboratory back in 2010. Since then, we've had culture plate readers that are on duty every minute of every day. We read cultures when they are ready to be read. We don't say, "Oh, we'll wait for the day shift to come in and take over this culture." |
| (04:41): | So I have technologists even at 3:00 in the morning setting up identification and antibiotic susceptibility tests, because that's the right time to do it. The organisms are ready. We adapt our schedule to the organism schedule, not vice-versa. |
| Dora Wells (05:03): | Great. Thanks, Joseph. Thanks for sharing that. And so, as you were saying, because Children's National is a pediatric center of excellence, you must often encounter patients with quite unique pathogens. So can you tell us a little bit about a particularly interesting case? |
| Joseph Campos (05:19): | Yes. One of our more interesting cases in the past year occurred in a relatively newborn infant. I think the infant was around two months of age. The infant, along with parents, were visiting relatives in India and, while there, had a great time. However, on the flight back to the United States from India, the baby became rather ill with profuse watery diarrhea. |
| (05:59): | It turned out, to make a long story short, that the baby had developed cholera, had acquired cholera in India, and became symptomatic during the flight home, which, unfortunately, the parents of the child ran out of diapers because they were changing them so quickly. The airline was very good from what I heard in helping them out. |
| (06:26): | But at that time, it was a mystery as to what was causing the child's problem. When they landed in Washington DC, they brought the child here promptly, and we began our testing using a multiplex PCR assay for enteric pathogens that we offered here. We set up cultures. We were able to isolate the Vibrio cholera from the patient's stool sample and identify it rapidly using our mass spectrometer, MALDI system. So that was a once-in-a-career kind of patient that we had here just in the past year. |
| Dora Wells (07:11): | Wow. What an interesting story. That's great to hear that the child is feeling better. That must have been quite an exciting event using that MALDI. Can you tell us a little bit more about how you used the MALDI and the impact to clinical care? |
| Joseph Campos (07:29): | Well, the MALDI has enabled us to identify culture isolates very rapidly with our 24 by 7 laboratory. We run MALDIs around the clock. So when the colonies are sufficiently grown to allow us to set up a MALDI, that's when we set it up. |
| (07:51): | I can tell you our clinicians are just delighted to have the identification of organisms based on the MALDI testing as rapidly as we provide them. It allows them to make clinical decisions, patient care decisions more rapidly than if we were relying on biochemical identification of organisms. |
| (08:19): | It's been so popular. In our laboratory, our technologists love identifying organisms in this fashion, and we ended up recently acquiring a second mass spectrometer, MALDI mass spectrometer, so that we have both of them running quite often during the 24-hour workday. And of course, one can serve as a backup to the other in case we have any instrument downtime. |
| Dora Wells (08:51): | Great. Thanks for that, Joseph. Just switching gear a little bit to resistance gene detection, because this has gained a bit of traction recently in many laboratories, do you feel that phenotypic susceptibility testing still plays a critical role in patient management? |
| Joseph Campos (09:07): | Absolutely. Phenotypic susceptibility testing is still the test of choice in our laboratory. Of course, there's been quite a bit of activity in the last few years to try and shorten the time to obtaining phenotypic susceptibility results. We have one such system in our laboratory that allows us to identify MICs of blood culture isolates in seven hours, rather than waiting what would be 18 hours with our conventional MIC on a determination system. |
| (09:54): | Again, having results available that soon on a 24 by 7 basis. We set those rapid susceptibility tests up when they're ready to be set up. |
| (10:07): | Since we are a teaching hospital, a question I always receive when I talk about how we do things here is, is there anybody around to act on the results? Because we're a teaching hospital, we have medical personnel on the premises caring for each inpatient the entire time that they're here. So, yes, our susceptibility results are seen and acted upon by our clinical colleagues on a 24 by 7 basis. |
| Dora Wells (10:43): | Great. Thanks for that. Finally, so based on your experience from implementing MicroScan AST with MALDI ID, what would your advice be to others not using this full solution? |
| Joseph Campos (10:59): | Well, my advice would be to look into doing this. It has made such a big difference here to our clinicians to have these results so rapidly. |
| (11:15): | Now another question that I hear often from colleagues around the United States at least is, "Well, how do you convince the hospital leadership to spend the kind of money that needs to be spent to acquire a MALDI system?" What I usually do is I describe situations such as the one I gave earlier with our cholera baby, and explain how having MALDI here to identify organisms rapidly and understand what is going on with the patient rapidly can be lifesaving. |
| (11:57): | We've had a number of instances, fortunately, perhaps not the one I just described but others that I could describe, in which our rapid 24 by 7 microbiology laboratory testing has saved patient lives. To me, how do you put place value on a patient's life? When I explain that to our leadership, there's just no argument. The cost of the instrumentation is much, much smaller than the value of saving a patient's life. |
| Dora Wells (12:40): | Great. Thank you so much for sharing your experience today, Joseph. So next up, Felicia Maida is here from Lahey Hospital and Medical Center to talk to us about her adoption of MALDI and Sepsityper. Okay, Felicia, could you just start by telling the audience a little bit about your institution? |
| Felicia Maida (13:00): | So my name is Felicia Maida, and I work at Lahey Hospital and Medical Center in Burlington, Mass., which is about 20 miles northwest of Boston. Our institution serves about 3,000 patients daily. We have 335 inpatient beds. We have an ambulatory care center, a 24-hour emergency department. I believe it was last year, we have qualified to become a trauma I center. So we are also a trauma 1 center for our area outside of Boston. Yeah, it was 2019 actually that we opened the trauma center. |
| (13:49): | The hospital is a little different where it's divided. One side is inpatient beds, and then the other side are clinics. So that's why we're able to see so many patients here. So the clinics are open at 9:00 to 5:00, and then, needless to say, the hospital is open 24 hours, seven days a week. |
| (14:06): | So actually it's a nice setup in the sense that the patients can come into the clinic side, they have a doctor, and they need to go to the emergency room. If something happens, then they can just get admitted and they're all in one place at once. So that's pretty much what our hospital looks like, I guess. |
| Dora Wells (14:27): | Great. Cool. Thanks a lot for that. And so, what was your motivation to become an early adopter of the MALDI-TOF technology? |
| Felicia Maida (14:37): | So back in 2014, my manager and the director of our lab, mostly the director, had researched and found out about the MALDI. So him and my manager traveled out to New York and they visited a hospital site to actually see how it worked, what they would need in order for it to be brought into our hospital and adopt it. So that was back in 2014. They really liked it. And so, then they started their conversation with Bruker as to how and when they could bring this instrument into our hospital. |
| Dora Wells (15:19): | Okay, great. That sounds interesting. And so, looking back then, how would you compare your microbiology efficiencies from then to now? How has that changed the way you do micro? |
| Felicia Maida (15:30): | Okay. So anybody that knows me, I've done a few webinars, they'll know that the MALDI for us is the best thing that has ever happened. I can compare it to ... It's like sliced bread. It's just a wonderful instrument for us. |
| (15:45): | So prior to MALDI, we would grow the organisms, then we ... It takes 24 hours to grow it. Then another 24 hours to identify it. So bringing the MALDI-TOF in, it allowed us to actually identify the organisms on the same day. So you would start your work at 7:00 in the morning and by noon, 12:00, 1:00, depending on how much work you had, you could have identifications on all those organisms that were able to be put into the patient's charts. The providers and clinicians were able to start any kind of a treatment plan that they needed knowing what the organism was versus waiting another 24 hours for them to have any idea what was growing. |
| Dora Wells (16:30): | Cool. Great. Thanks for that insight. And so, now switching gears slightly, so you are an early adopter of the Sepsityper. So how has that changed the workflow on the blood bench? Do you have any interesting case studies that you'd like to share as an example? |
| Felicia Maida (16:45): | Yes, actually we do. So Sepsityper came to us back in 2016. It was just research use-only side when we actually did our validation. Our validation was performed from December of 2016 to February of 2017. This was huge for us in the microbiology lab. |
| (17:12): | I'll just give you a little back flow of what happened, is originally you would have a blood culture. It would go positive. You would do the gram stain and you would put it to the plates. You have to wait 24 hours for those plates to grow in order to get the identification. So even with the MALDI, it took 24 hours. We would put it on the MALDI, we'd identification. That was great. |
| (17:35): | With the Sepsityper, you're actually taking the blood itself. So the blood bottle goes positive, you make your gram stain, you'll know, for instance, it's gram-positive cocci in clusters. The way that we report is gram-positive cocci in clusters suggesting Staph. So we give the clinicians and the providers an idea of what the organism is based on the gram stain. |
| (17:57): | So this would be gram-positive cocci in clusters suggesting Staph. We would then take one ml of the blood. We would add a lysis to it, we would spin it, we'd have a pellet, decant the supernatant, use that pellet, do a wash on it, decant that, and then we would have a pellet. We were able to take that pellet and put it onto the MALDI, which is the Sepsityper, on the research side, and able to identify the organism. So within a matter of, say, 25 minutes versus 24 hours, we were able to give them the identification from the Sepsityper. |
| (18:36): | Back in 2021, they were able to get FDA approval for the clinical side. So just backstepping a little bit, when we did it on the research side, we could only sign the organism out as a preliminary due to it being on the research side. |
| (18:54): | In 2021, we did another validation. That one only took about four weeks. When we identified it on the clinical side, we were able to just come out and say what the organism was. |
| (19:06): | So, for instance, going back to my gram-positive cocci in clusters suggesting Staph, one of the coolest things that we were able to identify was ... We had reported it as Staph. When we did the Sepsityper, it came out as an Aerococcus urinae. So actually cool because we're telling them that it's a Staph species when realistically it's part of the Strep species. |
| (19:28): | So we were able to let them know within 25 minutes that instead of it being a Staph species, now you're dealing with the Strep species, and they were able to change their treatment plan for this patient. So that was actually really cool the very first time that we saw something like that. |
| Dora Wells (19:45): | Yeah, that's cool. Yeah, great to see how important it has been for your workflows. And so, finally, moving on, I know you are a longtime user of the MicroScan and MALDI. So how has implementation of these solutions impacted your workflows? |
| Felicia Maida (20:01): | So, again, technology is just a wonderful thing. I've been in the field for 32 years, so it's come a long way since I started. And so, with the MicroScan and the MALDI pairing together, we have ... It's a system that's called LabPro Connect. |
| (20:18): | So it took a while ... The computer system, they had to update everything, and for us to learn it took a little bit. But once we learned it, it was a great tool. The workflow is just so much easier. We can order our organism right on the computer that we're sitting on. It goes right into the MALDI. The MALDI then will identify, it sends it over to MicroScan. MicroScan sends it back into our Beaker system. |
| (20:46): | So it's very easy to use. Like I said, it's just a great tool for us. Since we've adopted it, it's in the workflow. It's very smooth. People we prioritize ... So the blood bench always uses the MALDI first, and then we have anaerobes that use it after that. Then our other benches, urine cultures, and our miscellaneous bench usually can wait a little bit. We want to get those priority patients out first before we do other stuff. |
| Dora Wells (21:19): | Okay, great. Thanks a lot for that, Felicia. Finally, we're joined by Danaille Gustafson from Williamson Health. Hi, Danaille. So if, first of all, you could just briefly introduce yourself and tell the audience a little bit about your institution. |
| Danaille Gustafson (21:35): | Okay. I would like to introduce myself. I'm Danaille Gustafson. I'm the Microbiology Section Head at Williamson Medical Center. We're a part of Williamson Health System. |
| (21:48): | Williamson Health System is a 203-bed hospital. We're a non-for-profit community hospital about 20 miles south of Nashville, Tennessee. We have both adult and children's ER. We have a children's hospital, which is 16 beds. We have a Bone and Joint Institute of Tennessee, a very large Williamson Medical Group physician practice. We also have orthopedic and vascular service lines. |
| (22:20): | We are currently in an expansion which will double our emergency room. We're going to add additional OB, med-surg, and CCU beds to our hospital. |
| (22:36): | Williamson Medical Center lab does an annual volume of testing of about 1.8 million tests per year. We see about 50 to 60 positive blood cultures per month. |
| Dora Wells (22:52): | Great. Thanks a lot for that, Danaille. It sounds like there's a lot of interesting developments going on at your hospital. So can you tell us a little bit about your approach to justifying the implementation of the Bruker MALDI technology? |
| Danaille Gustafson (23:04): | Yes, I would be happy to. That was started, that process was started, before I arrived here. The laboratory administrator, her name is Patty Walton, she always is looking for new ideas and wants to keep us up on the most current and effective means to not only provide better testing, to also keep costs low. |
| (23:34): | One thing she noticed was that the Sepsityper ... We were using a multiplex blood culture identification system. It was great. It worked very well. It was very expensive. And so, she was tasked with looking at other options and she saw the Bruker MALDI-TOF and Sepsityper. |
| (23:55): | She realized that we should switch to that. It could save us about $65,000 per year with the current volume of positive blood cultures we had. It also allowed better identifications for things that weren't on the multiplex panel, and then we could deescalate some of the broad-spectrum antibiotics by ruling in or ruling out contaminant versus a true pathogen. |
| Dora Wells (24:29): | Great. Thanks a lot for that. I'll move on to the next question. So can you just discuss any challenges you encountered implementing MALDI and Sepsityper since you were so committed to this solution? |
| Danaille Gustafson (24:41): | Sure. The first thing they did was they developed an action plan, and that brought in administration. It brought in the laboratory, it brought in infectious disease, pharmacy, nursing, IT. It brought in a big team of people, and everyone needed to buy in. |
| (25:05): | That actually happened, which you don't always see. But everyone thought it would be a great idea, hospitalist, ER, everyone. |
| (25:17): | So what they did then was we started educating pharmacy, doctors, and nurses on when we give them an ID, what are they going to do with that and how to proceed from there? So that was a key part. We developed a system where every time we have a positive blood culture identified, our pharmacists get a text. And so, then they can look and see if the appropriate antibiotics are being used, or deescalate, whatever they need to do. |
| (25:54): | Our training within the laboratory was very slow. We started with just the day shift performing Sepsityper. We had been using MALDI for over a year, and we were quite comfortable with the process, but Sepsityper was a new piece. And so, we started that slow. I will go back and talk a little bit. |
| (26:21): | Our day shift, every person on the day shift is trained to work in two different departments at least, some are more. Our second and third shift cross-train across all four departments. So you have a lot of people who aren't really microbiologists doing some microbiology. And so, we wanted to make sure everyone understood the significance of doing Sepsityper and getting these results out, and how that implemented the antibiotic use. |
| (26:58): | Like I said, we started on day shift and we went ... We just did it Monday through Friday, because on the weekends, there's only one micro tech, and we thought it might be a little bit burdensome for that person. |
| (27:10): | Well, we quickly realized we could do it, and we did. Then we started adding second and third shift onto that. They struggled a bit. |
| (27:20): | We brought back in Bruker. They did some retraining, and our process has become pretty good. We have about an 80% to 90% success rate for identification, which I believe Bruker said anything over 80% is pretty good. |
| (27:40): | We provide feedback to our techs every month. I run a list of how many Sepsityper we perform, our success rate, any things that didn't work and why they didn't work. We do see a little bump in activity of non-successes, if you will, with Sepsityper. When we get a blood culture contamination rate that goes over 1.0, we tend to see things that don't ... Our contaminants, I guess, would be the best ID, and so they don't ID as well. |
| Dora Wells (28:24): | Great. Thanks a lot for sharing that. And so, what do you think is the impact of using MALDI ID with your MicroScan AST? So in terms of stewardship, selective reporting, leveraging antibiograms. |
| Danaille Gustafson (28:40): | I think it has really significantly improved the turnaround times. We usually can get an ID within a couple hours from positivity, and that lets our pharmacist or hospitalist, whoever's caring for that patient, to deescalate those broad spectrums and get them on a more pinpointed antibiotics. We're also doing studies right now to see if it's decreasing the length of stay as well, and I do not have that data available. |
| Dora Wells (29:19): | Great. Thanks a lot for that one. Just one more question. I was wondering if you have a case study or pharmacy impact example that you could share? |
| Danaille Gustafson (29:29): | I do. I have a couple of case studies. The first one was a bottle became positive. It was on the second shift. It was right around 1800, which is a lot ... Mealtime. So staff was a little bit low. |
| (29:46): | The Sepsityper result became available at 1917, so about an hour and 15 minutes later. It was identified as Aeromonas hydrophila group. The multiplex system that we were using would not have picked this up, so we would only have been able to report it as a gram-negative rod. And it didn't grow well that following morning. So it would've been more than 24 hours, because we only read culture plates during the day. So it would've been the following day. So I think you're talking about 30-some hours to getting an identification by not having Sepsityper. So that cut down a huge amount for us. |
| Dora Wells (30:42): | Great. Thanks a lot for sharing your experience there, Danaille. So now it is time for the Q&A part of this session, where we open up the panel for audience questions |
| (30:56): | So the first question I've got here for our panel is, because MALDI identifies organism species that may be unfamiliar with your laboratory or to your clinicians, how do you manage educating everyone on the implication of these? If anyone has any insights they want to share. |
| Joseph Campos (31:21): | Oh, well, this is Dr. Campos. I'm happy to describe what we do. Because you're exactly right, we have learned that we're recovering organisms from cultures that have organisms that, frankly, some of them I've never heard of in my long, long years in clinical microbiology. |
| (31:46): | So when that happens, I generally go to the literature and see if there is anything clinically important about the organism. Then using my frequent contact with our infectious disease physicians, I explain to them what I have learned. Then they are the ones who generally communicate with the patient caregivers when they receive consultations on the case, to tell them more about the organism or any diseases, infections that it may be linked to. |
| Dora Wells (32:26): | Thanks for that, Joseph. Felicia or Danaille, do you have any insights you want to share? |
| Danaille Gustafson (32:34): | This is Danaille. We do exactly the same. We just report it and usually our ID calls in and says, "What on earth is this?" and they take it from there. |
| Dora Wells (32:48): | Thanks for that, Danaille. I'll move on to the next question for anyone to answer. So can MALDI identify pathogens at the strain level? |
| Danaille Gustafson (33:02): | My facility- |
| Joseph Campos (33:02): | No, I think- |
| Danaille Gustafson (33:03): | Oh, go ahead. |
| Joseph Campos (33:05): | No. Please, you go ahead. |
| Danaille Gustafson (33:08): | This is Danaille. My facility does not identify down to the strain level. There are many that do. You'll get a report of genus, species, and strain. We only report genus and species. |
| Dora Wells (33:23): | Thanks, Danaille. Is that the same for you, Joseph, or did you have- |
| Joseph Campos (33:25): | Yes, I was going to respond in a very similar way. |
| Dora Wells (33:29): | Great. |
| Felicia Maida (33:29): | We're the same at Lahey, just to the species. |
| Dora Wells (33:35): | Great. Okay. I'll move on to the next question then. So how can we interface between MicroScan and Bruker results? Do you have any insights on how we can cut timelines short to optimize our diagnostic workflows? |
| Felicia Maida (33:53): | So I can speak to this somewhat. It did involve LIS to come down. There were a lot of software that needed to be loaded onto our computer, so our LIS department had to be involved with that. We did a lot of trying to figure out how we were going to report from the MALDI, from the MicroScan, because sometimes the organism in the MALDI, if it hasn't been updated yet in the MicroScan, it doesn't crossover. So there are a lot of pieces to the puzzle. It does take a bit for it to all come together. But when it does come together, it all works wonderfully. |
| Dora Wells (34:41): | Great. Thanks for that insight. |
| Danaille Gustafson (34:43): | Oh, I'm sorry. I would like to say that we use the MicroScan LabPro software, and that was very easy. The field application specialist for MicroScan came in, and it just took a couple of hours for her to, as a non-technical person, talk to the Bruker and then go to our LIS system. It worked very smoothly very quickly for us. |
| Joseph Campos (35:11): | Yeah, we had a similar experience here. We use LabPro with our MicroScan system, which ... And then there's an interface to our Cerner PathNet laboratory information system, and it works. I mean our IT people here in the lab worked with our IT people at the hospital level, and they were able to establish a robust connection fairly quickly when we first went up with MALDI. Then as I mentioned in my talk, we added a second MALDI, and we now have both of them running and communicating through LabPro to our Cerner PathNet system very nicely. |
| Dora Wells (36:00): | Great. Thanks, everyone, for that. So the next question is on antibiotic-resistant species. So have any of you had any experience with detecting antibiotic-resistant species in your lab using MicroScan panels? |
| Joseph Campos (36:21): | Yes. Well, we do that here all the time. One of our most important activities in our microbiology lab is ... In fact, some may say is the most important activity is reporting antibiotic susceptibility and resistant results from our clinical isolates. |
| (36:42): | The MicroScan, which we've used for all 38 years that I've been here at Children's, has grown through the years in its capabilities. The company's been very good at keeping pace with the addition of new antibiotics to their panels. |
| (37:01): | There is a built-in lag because of the FDA regulations that require submission of data and approval of performance of these panels. But I've been pleased with, even with that limitation, how quickly we've been able to keep pace with the newer antibiotics that have come down the pike. |
| Dora Wells (37:29): | That's great to hear. Thanks for that. I'll move on to the next question. So what is the success rate of the Sepsityper at each of your facilities? Joseph, maybe you can go first. |
| Joseph Campos (37:43): | Sure. So in our laboratory, our first step after we do the gram stain and prepare the subcultures to agar media is we do use a blood culture identification multiplex PCR system, which, overall, identifies over 90% of our blood culture isolates. So we rely on that as our first step. Should we encounter an organism that is not identified by our multiplex BCID system, that's when we go to Sepsityper. |
| (38:24): | I've been very pleased with how efficiently that system works. Does it identify every last organism? No, but it's performing at a much better rate than I had been led to believe by some of my colleagues at other hospitals around the country. So Sepsityper here has been a very nice addition to identify organisms that our multiplex PCR system does not identify. |
| Dora Wells (38:55): | Thanks for that. Felicia, do you have anything to add on the success rate of the Sepsityper at your facility? |
| Felicia Maida (39:03): | Yes. So when we trained with Bruker, they said it's about a 70% rate that we would get an organism identification, and we pretty much are right at that 70% rate. We do tend to see the gram-negative rods do identify better, and I think it just has to do with that cell wall on the gram-positives. |
| (39:26): | So what we have done, we actually implemented a new blood culture instrument, and that instrument is much quicker in identifying any bacterial growth in the blood culture bottles. So we did encounter a little problem in the beginning because the organisms were not growing as much in the bottles because it was picking up such a minute fraction of what was in there. |
| (39:52): | So we found that we had to put our blood culture bottles into the incubator after they came off for about a half an hour to get that organism to multiply. So then we would have more organism to do the Sepsityper. |
| (40:05): | With that, we have gone straight to, for most of our gram-positives, the extraction reaction. So instead of just doing that quick step that I discussed earlier, it's an extraction, so it's pulling out more proteins. Since we've done that, we have seen our gram-positive identification rate increase. So, again, we definitely do fall on that 70% positivity rate, and the gram-negative rods do work better. |
| Dora Wells (40:33): | Thanks for that. Danaille, do you have anything to add? |
| Danaille Gustafson (40:37): | I agree with Felicia. We were actually told an 80% success rate by Bruker. We statistically stay between 80% to 90%. I think our highest was 93%, which is very good. I don't know that you would get any better using a multiplex system. Any gram-positive, we do incubate as well up to an hour. It just seems to work better. |
| Dora Wells (41:10): | Great, thank you. Maybe this is another one for you, Danaille, and feel free to chime in, anyone else. Did the identification doctors ever have issues with gene markers not being reported? |
| Danaille Gustafson (41:25): | There were only a few gene markers that were reported on multiplex. It was the mecA, the vanA and B, and I believe it was for ESBL. So the only one they were truly concerned about was the MRSA, MSSA. And so, we went with another company that will differentiate Staph aureus from MRSA in a positive blood culture. And so, we do that additional step if we get a Staph aureus. |
| Dora Wells (42:00): | Great. Thank you for that. Does anyone have anything to add? |
| Felicia Maida (42:05): | We do the same thing. If we have a gram-positive cocci in clusters suggesting Staph, we'll use the Sepsityper. If it's a coag-negative staph, we stop there. If it's a Staph aureus, we do have another instrument as well that will let our clinicians know whether there's a mecA gene or not. |
| Dora Wells (42:24): | Great. Thanks for that. I'll move on to the next question, which is about quality control for the Bruker technology in 48 wells. So is it necessary to use the BTS in the assigned well, or can we use it in other wells? |
| Felicia Maida (42:46): | It can be used anywhere on the target. |
| Dora Wells (42:51): | Perfect. That was a simple one. So I'll move straight onto the next one then. Can I have all your insights on the biggest challenge to the implementation of the Sepsityper? |
| Danaille Gustafson (43:06): | Our biggest obstacle during implementation was getting the laboratory tech buy-in. Believe it or not, everyone else was on board, and we had some resistance. They really liked the multiplex. It was hands off. You add the specimen and then, in an hour, you get results. |
| (43:27): | Sepsityper was a little more detailed and tech-intensive. They didn't love it at first, and we didn't have the best success rate initially. Some retraining, some incubating the bottles a little longer, our success rate has gone up. I think they're much happier now when they can see a positive result coming from their hard work. |
| (43:55): | On the second and third shift, I will see them come back the following day and say, "Oh, what grew? Did it work?" So there is much more buy-in now. |
| Dora Wells (44:07): | Thanks for that. Does anyone have anything else to add on challenges to implementation of the Sepsityper? |
| Felicia Maida (44:14): | For us, I would just say it's the training, trying to get everybody through the bench where we're short-staffed, which I'm sure most other hospitals are, because it does take a little bit of training for people, and they can sometimes be frustrated if it's not working. So I just try to tell them, "Remember, it's 70%. So don't feel bad if it's not working the first time." But other than that, everything else flowed very well for us. |
| Dora Wells (44:42): | Great. Joseph, what was your biggest challenge? |
| Joseph Campos (44:48): | Yeah, I think our experience is very similar to what the others have described. One thing that I'm interested in taking a look at is there are at least two companies that sell products in the US that claim that you can pretreat or you can run your blood culture broth through their systems to automatically and more efficiently purify the cell pellet that gets put onto the MALDI, and increases the percentage that give high index value identifications. We don't have either of those systems in our laboratory at the moment, but we are considering submitting a capital equipment request to bring in one or the other of those platforms to augment our use of the Sepsityper. |
| Dora Wells (45:54): | Great. Thanks for that. We have time for just a few more questions. And so, this one is more about the basic principles of this technology. So can someone provide a bit of insight? What is MALDI-TOF spectrometry? |
| Felicia Maida (46:17): | So I'll tell you what I understand it to be. So mass spec, so what's happening is you have the organism that you're putting on your little target, and then there's a layer of matrix that goes on. There's a laser that goes through that. What it's doing is it's breaking apart the actual organism, and the proteins are getting spit out, so to speak, into this tube. Then what is happening is due to mass spec, as the proteins come down, they're being weighed. Due to the weight of the proteins, it matches it up to what the organism identification is. |
| Dora Wells (47:05): | Great, thank you. Thank you for that. Does anyone have anything else to add on those principles? |
| Danaille Gustafson (47:11): | No, I think she covered the basic- |
| Joseph Campos (47:12): | Yeah, I think I would just add that it's ... In my simple-minded view of what's going on inside the mass spec is that when I describe it to our infectious disease fellows, I say if you've ever been a fan of Star Trek, the TV show or the movies, it's like a phaser. It vaporizes the organism pellet that has been applied to the grid. |
| (47:42): | The ionized proteins then are separated from one another on the basis of molecular weight. The peaks and valleys of the tracing that results from the proteins migrating up the mass spec are compared to a library, that is an extensive library these days, to find the best fit for what known organism has the closest tracing to what the unknown organism from the patient's culture generated. |
| (48:17): | To me, it's just incredible how quickly this can be done in the first place, just a matter of minutes, but also how comprehensive the list of organisms that this system can identify, spanning bacteria, many fungi. I think now we're starting to see some successes even with the hard-to-vaporize mycobacteria. So to me, it's one of the leading improvements in clinical microbiology in my long career in this field. |
| Dora Wells (49:01): | Great. Thanks a lot for that, Joseph. With that, I'm afraid I'm going to have to wrap it up there. But thank you again to Joseph, Felicia, and Danaille for today's informative discussions. Thank you to everyone joining us online and for your interesting questions. I hope that you've all found this a worthwhile session. |
| (49:20): | If you have any other questions, please do feel free to email me at editor@selectscience.net, and I will follow up with your questions for our speakers. Remember, you can also download a certificate of attendance in the related resources tab to the left of your screen. If you would like to listen again to today's webinar, or invite a friend to listen, it will be available to watch on demand in just a few days' time. Goodbye and thank you once again for joining us. |
