What is the role of the clinical microbiology laboratory in the care of diagnostically challenging OPAT patients? Illustrative cases and literature review

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Abstract

Optimal care of patients requiring long-term outpatient parenteral or oral antimicrobial therapy by infectious diseases (ID) specialists is facilitated by an accurate microbiologic diagnosis. Close collaboration between ID specialists and the clinical microbiology laboratory for routine or specialized molecular testing can result in more accurate diagnoses, streamlined antimicrobial regimens, and improved patient outcomes.

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Most cited references 14

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Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of america.

John Perfect, William E Dismukes, Françoise Dromer … (2010)

Cryptococcosis is a global invasive mycosis associated with significant morbidity and mortality. These guidelines for its management have been built on the previous Infectious Diseases Society of America guidelines from 2000 and include new sections. There is a discussion of the management of cryptococcal meningoencephalitis in 3 risk groups: (1) human immunodeficiency virus (HIV)-infected individuals, (2) organ transplant recipients, and (3) non-HIV-infected and nontransplant hosts. There are specific recommendations for other unique risk populations, such as children, pregnant women, persons in resource-limited environments, and those with Cryptococcus gattii infection. Recommendations for management also include other sites of infection, including strategies for pulmonary cryptococcosis. Emphasis has been placed on potential complications in management of cryptococcal infection, including increased intracranial pressure, immune reconstitution inflammatory syndrome (IRIS), drug resistance, and cryptococcomas. Three key management principles have been articulated: (1) induction therapy for meningoencephalitis using fungicidal regimens, such as a polyene and flucytosine, followed by suppressive regimens using fluconazole; (2) importance of early recognition and treatment of increased intracranial pressure and/or IRIS; and (3) the use of lipid formulations of amphotericin B regimens in patients with renal impairment. Cryptococcosis remains a challenging management issue, with little new drug development or recent definitive studies. However, if the diagnosis is made early, if clinicians adhere to the basic principles of these guidelines, and if the underlying disease is controlled, then cryptococcosis can be managed successfully in the vast majority of patients.

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Randomized Trial of Rapid Multiplex Polymerase Chain Reaction-Based Blood Culture Identification and Susceptibility Testing.

Ritu Banerjee, Christine B Teng, Scott A. Cunningham … (2015)

The value of rapid, panel-based molecular diagnostics for positive blood culture bottles (BCBs) has not been rigorously assessed. We performed a prospective randomized controlled trial evaluating outcomes associated with rapid multiplex PCR (rmPCR) detection of bacteria, fungi, and resistance genes directly from positive BCBs.

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The 2023 Duke-ISCVID Criteria for Infective Endocarditis: Updating the Modified Duke Criteria

Vance G Fowler, David T Durack, Christine Selton-Suty … (2023)

The microbiology, epidemiology, diagnostics, and treatment of infective endocarditis (IE) have changed significantly since the Duke Criteria were published in 1994 and modified in 2000. The International Society for Cardiovascular Infectious Diseases (ISCVID) convened a multidisciplinary Working Group to update the diagnostic criteria for IE. The resulting 2023 Duke-ISCVID IE Criteria propose significant changes, including new microbiology diagnostics (enzyme immunoassay for Bartonella species, PCR, amplicon/metagenomic sequencing, in situ hybridization), imaging ([18F]FDG PET/CT, Cardiac Computed Tomography), and inclusion of intraoperative inspection as a new Major Clinical Criterion. The list of “typical” microorganisms causing IE was expanded and includes pathogens to be considered as typical only in the presence of intracardiac prostheses. The requirements for timing and separate venipunctures for blood cultures were removed. Last, additional predisposing conditions (transcatheter valve implants, endovascular cardiac implantable electronic devices, prior IE) were clarified. These diagnostic criteria should be updated periodically by making the ISCVID-Duke Criteria available online as a “Living Document”.

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Author and article information

Contributors

Priya Nori:

ORCID: https://orcid.org/0000-0002-1472-4611

Role: ConceptualizationRole: Project administrationRole: SupervisionRole: Writing – original draftRole: Writing – review & editing

Phyu Thwe: Role: ConceptualizationRole: Data curationRole: ResourcesRole: SupervisionRole: Writing – original draftRole: Writing – review & editing

Jaime Mogollon: Role: Writing – original draftRole: Writing – review & editing

Rachel Bartash: Role: ConceptualizationRole: Writing – original draftRole: Writing – review & editing

Wendy Szymczak: Role: ConceptualizationRole: Writing – original draftRole: Writing – review & editing

Erika Orner: Role: Writing – original draft

Musa Bolkent: Role: Writing – original draft

Robin Patel: Role: ConceptualizationRole: Formal analysisRole: SupervisionRole: Writing – original draftRole: Writing – review & editing

Journal

Journal ID (nlm-ta): Ther Adv Infect Dis

Journal ID (iso-abbrev): Ther Adv Infect Dis

Journal ID (publisher-id): TAI

Journal ID (hwp): sptai

Title: Therapeutic Advances in Infectious Disease

Publisher: SAGE Publications (Sage UK: London, England )

ISSN (Print): 2049-9361

ISSN (Electronic): 2049-937X

Publication date (Electronic): 12 October 2023

Publication date Collection: Jan-Dec 2023

Volume: 10

Electronic Location Identifier: 20499361231205092

Affiliations

[1-20499361231205092]Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA

[2-20499361231205092]Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA

[3-20499361231205092]Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA

[4-20499361231205092]Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA

[5-20499361231205092]Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA

[6-20499361231205092]Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA

[7-20499361231205092]Division of Pediatric Infectious Diseases, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA

[8-20499361231205092]Division of Clinical Microbiology, and Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, MN, USA

Author notes

[*] pnori@ 123456montefiore.org

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Priya Nori https://orcid.org/0000-0002-1472-4611

Article

Publisher ID: 10.1177_20499361231205092

DOI: 10.1177/20499361231205092

PMC ID: 10571669

PubMed ID: 37842169

SO-VID: 1892df91-c2c3-4396-bcd5-b2918f8d2591

License:

This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

History

Date received : 18 May 2023

Date accepted : 15 September 2023

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cover-date January-December 2023

typesetter ts1

Keywords: clinical microbiology,genetic sequencing,maldi-tof ms,outpatient parenteral antibiotic therapy

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Keywords: clinical microbiology, genetic sequencing, maldi-tof ms, outpatient parenteral antibiotic therapy

What is the role of the clinical microbiology laboratory in the care of diagnostically challenging OPAT patients? Illustrative cases and literature review

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Most cited references 14

Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of america.

Randomized Trial of Rapid Multiplex Polymerase Chain Reaction-Based Blood Culture Identification and Susceptibility Testing.

The 2023 Duke-ISCVID Criteria for Infective Endocarditis: Updating the Modified Duke Criteria

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