We have been playing around for a while now, looking for the “best” way to rapidly identify isolates from positive blood cultures.
First of all we had a look at FISH (Fluorescent In-Situ Hybridisation). This was accurate, and pretty quick, but for the volumes of positive blood cultures that we process, even in a fairly big lab, it was somewhat on the expensive side.
We then had a look at MALDI-ToF based “centrifugation” methods. We dabbled with the Bruker sepsityper, or at least “home brew” versions thereof… This was quickish, but quite labour intensive, and to be honest a bit tedious. Nevertheless pick-up rates were good, particularly for Gram negative organisms.
However now that we have the Kiestra TLA in place, I think we are going to settle for the “Hot Chocolate” method. This involves inoculating an aliquot from a positive blood culture on to a pre-warmed chocolate agar, incubating for a pre-programmed 6 hours on the Kiestra system, and then performing an immediate MALDI-ToF on the plate colonies.
OK, so it is not quite as quick as FISH or Sepsityper, but it is cost-effective, does not require a lot of manual input, and it is a service that we can provide 24 hours a day.
Realistic solutions always involve some degree of compromise…
The excitement levels have been cranking up in our lab with the recent installation of the Kiestra Total Lab Automation system. Although we are not yet putting “live” samples through it I have been very impressed with what I have seen so far. It has exceeded my expectations and it clearly offers huge potential in terms of quality and efficiency improvements.
And I am not just saying that. If it was terrible I would say so….
I have just finished my initial basic training on the system and there are a few take home messages I have picked up from the course.
- It is a sophisticated product already, but there is clearly more to come…. See this article
- The more you know about the system and how it works, the more you will be able to configure it to maximise efficiency. Even though as a clinical microbiologist I won’t have too much day to day hands on involvement with the system, I fully intend to know it “inside out”
- The better you maintain and look after it, the better it will perform, and the less likely it is to break down.
Sure it is nice to be the first microbiology lab in New Zealand to have such a system in place, but I am aware of the fact that such systems will be commonplace throughout the country in a few years time.
I feel that if as a microbiologist, you are not excited by such a system and the potential it provides, you are probably in the wrong profession.
If you have any specific questions on installing a Kiestra, just let me know and I will try and answer.
More to come on this topic!