Blog | Thursday, August 1, 2013

Swabs are evil (and other sage advice from your friendly clinical microbiologist)


The current state of infectious disease diagnostics is an Achilles' heel to effective treatment and prevention. Despite the strides we've made in many areas (molecular diagnostics for viral respiratory pathogens, for example), for many serious infections our turnaround times are too long to be clinically relevant. Our test performance characteristics are all over the map, and sample acquisition at the bedside, clinic or operating room is inconsistent. ("Whoa, not sure what this is. Let's stick a swab in it and send it to micro. Just check all the boxes on that requisition.")

One of the most important jobs of a clinical microbiologist is to communicate early and often with clinicians, to advise them on what samples to obtain, and what tests to order, to maximize the likelihood that the correct diagnosis will be made.

That's why I'm so happy that a bevy of clinical microbiologists decided to put as much good advice as they could into one helpful guidance document, found here: A Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2013 Recommendations by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM).

Whether you're an intern trying to decide what test to order on a patient you suspect of having filariasis, or a neurosurgeon wondering what to do when that focal brain lesion turns out to be filled with pus, this is your handy reference.

Daniel J. Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. This post originally appeared at the blog Controversies in Hospital Infection Prevention.