title: Revolutionizing clinical microbiology laboratory organization in hospitals with in situ point-of-care.
abstract: 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.
  
  
  RESULTS
  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.
authors.affiliation: Fédération de Microbiologie Clinique, Assistance Publique des Hôpitaux de Marseille-Pôle des Maladies Infectieuses, Hôpital la Timone, Marseille, France.
authors.forename: Stéphan
authors.initials: S
authors.lastname: Cohen-Bacrie
authors.forename: Laetitia
authors.initials: L
authors.lastname: Ninove
authors.forename: Antoine
authors.initials: A
authors.lastname: Nougairède
authors.forename: Rémi
authors.initials: R
authors.lastname: Charrel
authors.forename: Hervé
authors.initials: H
authors.lastname: Richet
authors.forename: Philippe
authors.initials: P
authors.lastname: Minodier
authors.forename: Sékéné
authors.initials: S
authors.lastname: Badiaga
authors.forename: Guilhem
authors.initials: G
authors.lastname: Noël
authors.forename: Bernard
authors.initials: B
authors.lastname: La Scola
authors.forename: Xavier
authors.initials: X
authors.lastname: de Lamballerie
authors.forename: Michel
authors.initials: M
authors.lastname: Drancourt
authors.forename: Didier
authors.initials: D
authors.lastname: Raoult
mesh_terms: D019411:Clinical Laboratory Techniques; D004769:Enterovirus Infections / Q000175:diagnosis; D005260:Female; D006760:Hospitalization; D006801:Humans; D007700:Kinetics; D007755:Laboratories, Hospital / Q000458:organization & administration*; D007902:Length of Stay; D008829:Microbiology / Q000458:organization & administration*; D010346:Patient Care Management / Q000458:organization & administration; D019095:Point-of-Care Systems / Q000458:organization & administration*