NHS GG&C Vitek MS Experience

Jane NormanJanet Young

Dr Aleksandra MarekSMVN - 27th May 2013

Overview Microbiology Service across GG&C (Nov 2011-Nov 2013)

• Abbott Managed Service Contract • Number of labs = 8• Number of IT systems = 5• New equipment/systems to be commissioned

and installed = 25• Laboratory Commissioning = 4• Laboratory Migrations = 7• MSC Equipment to be moved to nSGH

Laboratory May 2012 = 95

Where we are now – May 2014

• Number of labs = 3 (250-350K specimens/annum)

• Virology/Ref Labs co-located in NLB, GRI• State of the art laboratory accommodation• Each with VitekMS• LIMS migration 1 unified LIS – Telepath• Standardised

equipment/Processes/SOPs/LEAN• Future – Smart Incubators

Lessons Identified/Lessons Learned

• Too ambitious with Implementation Plan

• Too much change at once

• Complex IT systems

• Training

Case Study

A Rare Pathogen

57 year old female

Pus breast abscess

Microscopy

Numerous white cell, GPC

CO2 blood agar

Gram film

•Vitek MS ID

•Actinomyces neuii (API Coryne)

•First described 1985 patients postcataract endophthalmitis

•Round, smooth, convex, white colonies in CO2

•Atypical non-branching – short rods or cocci

•Frequent interpretation as skin contaminant

•Presentation not typical actinomycosis

•Journal of Clinical Microbiology, Apr. 2010, p. 1506 – 1509

•50% cases abscesses

•Cyst and breast lump

•Diabetic foot osteomyelitis, blood, native valve endocarditis

•Treatment surgical debridement. Antibiotics patients with fever

•Further cases

•Pus thigh abscess – insect bite

•Cyst

•Pilonidal abscess pus

Blood Cultures•Received and being process

•2 day negatives

•Positive bottle

•Positive bottle, gram film released -available on portal

•MS ID transferred, released – portal

•Vitek 2 sensitivity transferred, released -portal

Using the VITEK MS from a clinical perspective

• Coming to the end of a period of getting to know the instrument

• Areas of greatest impact clinically, blood cultures, CF microbiology, anaerobic microbiology

• Impact on antimicrobial prescribing likely if we combine the technique with principles of good antimicrobial stewardship

• Direct processing of blood cultures using MALDI-TOF

• Plan to compare turn-around-time and laboratory feasibility locally of direct processing of blood culture isolates using the biomerieux protocol vs short incubation protocol

• Aim once systems are validated to show that we can improve time to correct antibiotic therapy and hopefully LOS

• AST using MALDI initially using Hrabak et al method of detection of hydrolysis and decarboxylation of carbapenems.

• Couple of systems described for detection of rRNA methyltransferase activity but these are not yet at a stage where it can be used in a routine diagnostic laboratory.

Further plans…. Antibiotic sensitivity testing

• MRSA• Outbreak typing

….crude typing

Thank you

Acknowledgements

• GRI: Stuart KerrPat Millar

• SGH: Jim Guthrie