Here are a few rules I use when signing out results that contain Staphylococcus aureus… Some are ridiculously obvious but you will see where I am going with this.

• If MRSA, don’t report flucloxacillin as susceptible (!).
• If MRSA isolate from the hospital, ensure it has been sent to the reference lab for typing.
• Check Staph aureus isolates from other samples on the same patient have the same antibiogram.
• On sterile site cultures, release flucloxacillin only if susceptible.
• Do not report quinolones or tetracyclines in children or pregnancy.
• If the isolate is erythromycin resistant, check for a D zone before reporting clindamycin as susceptible.
• If the isolate is erythromycin susceptible and clindamycin resistant, double check everything before releasing.
• If it is a nasal swab, check that mupirocin and fusidic acid have been tested.

and there will be more that I haven’t thought of…

If you work in a microbiology lab, you will have a similar set of rules for Staphylococcus aureus, allowing for the inevitable place to place variation.

I “follow” these rules, subconsciously a lot of the time, on a daily basis. It does not take up a lot of time, but it is time nevertheless, and trust me, it is not the most exciting work.

The point I am trying to make here is that there is nothing in the list above that could not be programmed into a good LIS (Laboratory Information System) rules engine. Unfortunately when it comes to rules engines for microbiology results, our LIS is still a bit on the primitive side…..

As LIS systems become more advanced, so will the rules engines that they contain. I suspect that they will also become customisable in terms of being able to input easily the particular rules that you want.

So instead of Clinical Microbiologists and Senior Scientists sitting there wasting time following rules in our head we will more and more be able to get our computers to do it for us. And you can be sure that computers will do it a lot better than us, well me anyway..

All that will remain for us is to deal with the outliers or the exceptionally important (that is the way it should be), and that this aspect of our jobs will become redundant (hopefully we will not become redundant). We will generally not be signing results out, but simply making up the rules to allow computers to do it for us.

Michael