Role of the clinical microbiology laboratory in the diagnosis of infections.
The proper use and interpretation of clinical microbiology test results may be complicated but critical to the care of cancer patients. The microbiology laboratory director is often available to offer advice concerning the differential diagnosis, choice of specimens, as well as the optimal stains and cultures to facilitate diagnosis. Additionally, the rapid interpretation of Gram-stained smears provides useful, occasionally lifesaving, information relative to the etiologic diagnosis and empiric antimicrobial therapy. The microbiology laboratory director should also provide further interpretation of culture and antimicrobial testing results that allow the clinical service to focus on the most critical data. Person-to-person or telephone conversations discussing important laboratory information should be followed up by a written summary report placed in the patient's chart so all services involved share the same interpretation (Figure 2). The clinical service has an important responsibility to communicate with the laboratory to optimize care of the patient with cancer. The laboratory compiles data collected from groups of patients that is available and useful to physicians. Review and discussion of test utilization is essential for cost-effective, quality health care. This may include analysis of blood cultures documenting an acceptable level of contamination, appropriate number collected per day, and sufficient blood volume per culture. In addition, information about changing resistance patterns or nosocomial transmission can be provided to the clinician. As patients with malignancies become more complex and their infections increasingly difficult to treat, regular interaction between the laboratory and clinician is likely to improve patient care.
Department of Pathology, Northwestern University Medical School, Evanston Hospital, Illinois, USA.
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D003937:Diagnosis, Differential; D006801:Humans; D016867:Immunocompromised Host; D008826:Microbial Sensitivity Tests; D008828:Microbiological Techniques; D009894:Opportunistic Infections / Q000175:diagnosis* / Q000276:immunology / Q000382:microbiology; D011237:Predictive Value of Tests; D013048:Specimen Handling / Q000379:methods; D013997:Time Factors