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Novel workflow ideas to exclude or identify urinary tract infections – while the patient waits

Novel workflow ideas to exclude or identify urinary tract infections – while the patient waits. Assoc . Prof. Arzu İLKİ,MD Department of Clinical Microbiology Marmara University School of Medicine.

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Novel workflow ideas to exclude or identify urinary tract infections – while the patient waits

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  1. Novel workflow ideas to exclude or identify urinary tract infections –whilethepatientwaits Assoc. Prof. Arzu İLKİ,MD Department of ClinicalMicrobiology Marmara University School of Medicine

  2. Urinary tract infection (UTI) is one of the mostcommonlyencounteredinfectiousdiseases.

  3. Urineculturesareamongthemostfrequentcultures in clinicalmicrobiologylaboratories. • Urine cultures account for the majority of theworkload in the clinical microbiology laboratory.

  4. Urineculture is thegoldstandardforthediagnosis of UTI. • Howeverresultsaregenerallyobtained at 24-48 hours.

  5. May result in Empiricantimicrobialtherapy Unnecessaryorinadequateantibioticuse Antibioticresistance

  6. Negative cultures accountfor at least 80% of urine samples, • Toruleoutdiagnosis of urinarytractinfection… morerapid but reliablemethodsotherthancultureareneeded. • Today, manydifferentautomatedmethodsavailable

  7. Sysmex UF1000i • The Sysmex UF-100 has recently been improved to the SysmexUF-1000i.

  8. Sysmex (fluorescence flowcytometer) a well-knownsystemfor urinalysis • Recently, newanalytical features suitable for microbiologicaldiagnostics SysmexUF1000i

  9. SysmexUF1000i • Thereare 2 chambers; 1 forsedimentanalysisand 1 formicrobes. • Bacterial detection and counting are performed by theanalyzer in a dedicated analytical channel with a specific reagentsystem. • Thisseparate bacterial chamber: prevents interference with human body cells , improves thedetection of bacteriabycountingchannels.

  10. Performance of Sysmex UF-1000i at Marmara UniversityHospital ClinicalMicrobiologyLaboratory

  11. Urinesamples sent forculture August-December 2013 • Inclusioncriteria: Clearurinesamples (Not turbid/cloudy)

  12. UrineSamples SysmexUF1000i Gram staining Culture

  13. 2437 urinesamples; 1148(47.1%) 736(30.2%) 553(22.7%)

  14. Interpretation of Urine Cultures:

  15. Urinecultureresults… 22,1% Pathogen Contaminant 71,8%

  16. SysmexUF1000i • Resultswereevaluatedaccordingtothe cutoffvalues as: leucocyte>=5/μl & bacteria>10/μl.

  17. ForFemales (n:736) NPV 98% Decrease in 40% workload

  18. ForChildren (n:1148) NPV 99% Decrease in 60% workload

  19. ForMales (n:553) NPV 100% Decrease in 65% workload

  20. RESULTS SysmexUF1000i showed a • Highnegativepredictivevalue (99.4%) • Lowpositivepredictivevalue 11%

  21. RapidDetection of CultureNegativeUrineSamples: Impact of Fluorescence Flow Cytometry Arzuİlki, RamazanAyaş, GünerSöyletir Marmara University Faculty of Medicine, Department of Medical Microbiology, Istanbul,Turkey.

  22. Can SysmexUF1000i resultshelp samedayreporting forpositiveurinesamples?

  23. SysmexUF1000i positivegrowth(≥105cfu/ml) Vitek MS + AST Samedayreporting

  24. Workflow 4 ml urine Centrifugation(2000g, 30 seconds) Centrifugation of supernatant (15500g, 5 minutes) Washing of pellet with deionized water,twice Pellet onto MALDI TOF, air drying and addition of 1µL matrix solution

  25. Preliminaryresults

  26. Theseresultsshowthat…. • 105and 106 is not sufficient • >107 can be used but requiringmethodmodification Furtherstudiesareneeded…

  27. Promisingresultsobtainedfromourstudy • usethesystem in routineclinicalmicrobiologyworkflow,

  28. Aim.. • Excludeallthe sterile urinesandcultureonlytheoneshavingbacteria • Diminishtheworkload of laboratoryandtoincreasethecosteffectiveness of theprocedures.

  29. Differentcutoffvaluesforbacteriaandleucocytewereevaluatedtodetermine NPV

  30. Evaluation of DifferentCutoffValues

  31. CONCLUSION • Negativeresults at most 10 min. afterthearrival of thesampletothelaboratory. • Workload Cutoffresults 1/3-2/3 diminish • Costsaving (approx. half of theculture)

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