The SARS-CoV-2 pandemic has highlighted the need for dedicated leadership in clinical microbiology laboratories, according to a report in the Journal of Clinical Microbiology, a journal of the American Society for Microbiology.
"When the virus invaded the U.S., there were no commercially available assays for detection of COVID-19," said coauthor Linoj P. Samuel, Ph.D., D(ABMM), Division Head, Clinical Microbiology, Henry Ford Health System, Detroit. "Reference laboratories and public health departments were overwhelmed, and it often took a week or more to get COVID-19 PCR results back to the providers."
"It was left to medical microbiologists to develop assays on their own using information available in the published literature that enabled many hospitals to perform testing in house and get critical results in a timely manner," said Dr. Samuel.
Medical microbiologists played a central role in developing and increasing COVID-19 testing capacity, especially when shortages of essential supplies hampered testing efforts, said the authors.
Unfortunately, clinical microbiology laboratories at many institutions lacked onsite medical microbiologists, and many "struggled to provide the required rapid test development and oversight to be able to implement testing quickly," said the authors.
Doctoral level medical microbiologists are needed to run clinical microbiology laboratories on a full time basis, the report emphasizes. But laboratory leaders frequently lack the appropriate specialized training, and/or "have other duties," said Dr. Samuel.
Their current level of training and commitment is insufficient for "a rapidly evolving field that is constantly dealing with novel pathogens," explained Dr. Samuel. One such challenge for microbiology lab directors is that the rates of antimicrobial resistance continue to rise, and new resistance mechanisms evolve, complicating efforts to identify specific therapeutics that can treat a patient's infection. Further challenges faced by laboratories "include rapidly developing technologies, healthcare-acquired infections, and diverse patient populations," said the authors.
The benefits from relying on medical microbiologists have been well-documented in the literature, said the authors. These include improved use of antimicrobial therapies, cost effective incorporation of novel technologies, faster determination of appropriate antimicrobial therapy, less use of unnecessary therapies, reduced expenditures on antibiotics and reduced time spent by patients in the intensive care unit.
Guidance from medical microbiologists is particularly important when antimicrobial susceptibility test results fail to meet expected patterns, said the authors. "For example, some Enterobacterales can express a combination of porin mutations, efflux pumps and other resistance mechanisms that mimic carbapenemase expression, which could lead to the use of less effective, and potentially toxic antibiotics."
"Medical microbiologists with the appropriate knowledge and tools can correctly evaluate the [antimicrobial susceptibility test] results and communicate their interpretation to the clinical teams to facilitate effective therapy… this expertise is not possessed by most medical laboratory scientists, laboratory supervisory staff and physicians," said the authors.
Medical microbiologists are also needed to recognize how best to integrate novel diagnostic technologies, or change ordering practices, said Dr. Samuel.
"In one example, the medical microbiologist was able to use data on test utilization to change ordering practices by demonstrating that test orders for H. pylori serology were driving misdiagnosis and inappropriate treatment," said Dr. Samuel. "In another example, the medical microbiologist collaborated with clinical colleagues to evaluate patient data to show that use of a multiplex molecular respiratory viral platform did not have the expected impact on outcomes and required additional decision support."
With doctoral level medical microbiologists running clinical microbiology laboratories, these kinds of advances would happen more quickly and reliably. "The commitment to ensure that medical microbiologists are part the standard of care serves to improve healthcare and encourage continued development of the field at this time," said Dr. Samuel.
