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The advantages of moving from stool culture to a molecular platform are many: faster time to results, more accurate pathogen identification, a savings of space and staff time. For Jose Alexander, MD, D(ABMM), SM, MB(ASCP), and colleagues at Florida Hospital Orlando, another plus is being able to adhere to the Infectious Diseases Society of America guideline suggestion that labs use a diagnostic approach that can distinguish O157 from non-O157 E. coli and Shiga toxin 1 from Shiga toxin 2 E. coli.
Dr. Alexander, a medical and public health microbiologist and the hospital's director of clinical microbiology, shared the story, in a webinar this spring and in a recent interview, of how his laboratory made the decision to switch to PCR.
"Moving from stool culture to a molecular platform seems to be the next big step for many laboratories, not only for the improvement of the technique for detection of pathogens and the benefits to the patient but also for the benefits to the laboratory itself," he said in the webinar, which was hosted by CAP TODAY and made possible by a special educational grant from Luminex.
One of the first things Dr. Alexander and his colleagues at Florida Hospital Orlando considered when weighing a switch was the department's stool culture volume and the cost implications. The Florida Hospital system has a 24/7 central microbiology department staffed by 42 full-time medical technologists and technicians for its 2,400 beds across seven hospitals and multiple longterm and nursing home facilities. By 2017, when the department made its case for molecular testing in place of culture, 780,000 tests were performed in the department, of which 7,200 were stool cultures.
"One of the most important steps in making the case for a switch to PCR and selecting the right panel for us was to document the types of organisms we had been screening for through stool cultures," Dr. Alexander said.
In 2016, the microbiology department cultured 6,800 stool samples, two-thirds of which were for outpatients, and found the most prevalent pathogen was Salmonella spp., with 163 cases, followed by 82 cases of Campylobacter spp. and 28 cases of Shigella spp. Other less common pathogens isolated included four cases of Escherichia coli O157, two cases of Yersinia enterocolitica, four cases of...