Deciding how extensively to work up and report respiratory cultures is the worst. There are useful guidelines on how to approach this. But, in my experience, very few laboratories strictly follow these guidelines. That can be because of concerns about under-reporting pathogens or about over-reporting microbiota, or it can be the result of pressure from clinical staff to report more organisms than the guidelines suggest. Today, we’ll be talking with two guests about their study on how...

Antimicrobial resistance is the ‘silent pandemic’ and to tackle this challenging public health problem we need to attract the best and brightest. Today we will discuss pathways to work on this field with trainees who will be the next generation of outstanding researchers in the field, currently as part of different T32 training programs in the United States. Welcome to Editors in Conversation Topics discussed: Different pathways to follow careers in antimicrobial research The challenges to...

The idea of applying machine learning and digital pathology platforms to everyday workflows in the clinical microbiology laboratory has become increasing intriguing and appealing, especially as labs continue to optimize efficiency in the midst of workforce shortages. The promise of this new digital frontier is multifold, including decreasing turnaround time and potentially cost, and freeing up technologist time to focus on higher yield activities in the lab. Many labs have now taken the...

There are a number of regulatory proposals under consideration which could have important effects on clinical microbiology labs, and clinical labs more generally. First, the VALID act would change how clinical tests are regulated with particularly important implications for laboratory-developed tests. Second, the Centers for Medicare and Medicaid Services has proposed changes to the educational requirements for lab directors under CLIA and additional changes that would increase the fees that...

Infections caused by Mycobacterium abscessus appear to be increasing in frequency among the immunocompromised population and are challenging to treat. Antibiotic options in these cases are scarce, prolonged therapy is required and new options are needed. We will discuss this important topic with experts in the field. Topics discussed: Define M. abscessus as an opportunistic pathoge The intrinsic phenotypic characteristics of M. abscessus, including resistance to common antimicrobials...

The inoculum effect of antibiotic susceptibility testing is often discussed at playgrounds and infectious diseases conferences, but many of us don’t really have a clear definition of what it is or a good understanding of its importance. We’ll be talking about the inoculum effect and susceptibility testing of Staphylococcus aureus with cefazolin. Some of the questions we’ll discuss are: • What exactly is the inoculum effect and how is it measured? • Does the inoculum effect have clinical...

As July 26, the world has documented 19,188 cases of monkeypox, with 3,591 cases in the US alone, making the US the country with the most known infections amid the global outbreak. The WHO has declared monkeypox a public health emergency. Although this disease has been known for years, certain features suggest that we are facing a unique outbreak of monkeypox with the potential for worldwide spreading. In this special podcast edition of Editors in Conversation we will discuss the diagnosis...

Dr. Bobbi Pritt aka @parasitegal, creator of the blog Creepy Dreadful Wonderful Parasites, is a pathologist and clinical microbiologist with specialty interests in parasitic and vector-borne infections, and the pathology of infectious diseases. Dr. Pritt discusses her career and how she became an expert in clinical parasitology, her work internationally and how others can participate in global health work and how technology (digital pathology, AI, automation, etc.) will affect the lab and...

Infections caused by Stenotrophomonas maltophilia appear to be increasing in frequency among the immunocompromised population and are challenging to treat. Moreover, resistance to traditional drugs used against these organisms is now becoming more common. Antibiotic options in these circumstances are scarce and new options are needed. We discuss this important topic with experts in the field. Recorded live in Washington DC at ASM Microbe 2022. Topics • Stenotrophomas maltophilia as an...

We are just back from the Molecular Virology Workshop in West Palm Beach. This is a terrific meeting that is organized by the Pan-American Society for Clinical Virology or PASCV. The workshop immediately precedes the Clinical Virology Symposium that ASM organizes and many of us like to attend both. Today we’ll be talking about some of the high points of the Molecular Virology Workshop, with two members of the organizing committee from PASCV. Guests: Dr. Erin Graf, Director, Clinical...

Infections caused by multidrug-resistant Pseudomonas aeruginosa are considered a major public health problem. Antibiotic options are scarce but new drugs are emerging and more maybe available in the near future. Topics discussed: Pseudomonas aeruginosa as an important pathogen capable of developing resistance to multiple antibiotics Common mechanisms of resistance in Pseudomonas aeruginosa The current and future approaches for these MDR organisms. Guests: Michael Satlin, MD, Associate...

It is estimated that anywhere from 575,000 to 677,000 bloodstream infections occur annually in North America, with approximately 40,000 of those directly linked to patient mortality in the United States, making bloodstream infections the 11th most common cause of death in the US according to the Centers for Disease Control and Prevention. The detection of bloodstream infections and subsequent identification of the etiologic agent or agents is an essential role played by all clinical...

This episode is dedicated to the memory of the late George A. Jacoby, who was a pillar in the B-lactamase research community and a leader in the field of antimicrobial resistance. Assigning names to b-lactamase variants has been inconsistent and has led to confusion in the published literature. The common availability of whole genome sequencing has resulted in an exponential growth in the number of new b-lactamase genes. In November 2021 an international group of b-lactamase experts met...

Antibiotic susceptibility testing is too slow. Faster identification of microorganisms is now common, as many laboratories use MALDI-TOF or molecular technologies for quick and definitive identification of bacteria. Improvements in susceptibility testing have lagged, as we continue to use tests that take a day for results, and which have not significantly changed in decades. Rapid phenotypic testing has can only be done on limited sample types, using a dedicated platform, and it has not been...

Bacteriophages are interesting viruses that target bacteria and have been used for therapeutic purposes. Recently, the emergence of antibiotic resistance has spurred a renewed interest in using these viruses or their products as therapeutic tools against recalcitrant human pathogens. AAC has also published a recent manuscript from ARLG to guide the use of phages in clinical practice. We will discuss with experts in the field the state-of-the-art in phage therapy. Objectives: • Understand...

When most of us hear the word ‘CAPA’, these days we more than likely immediately start thinking about SARS-CoV-2 variants, trying to remember how important this particular one was in the grand scheme of the COVID-19 pandemic. But, that is not the ‘kappa’ we will be talking about today. Instead, we’ll be discussing the other CAPA, or COVID-19 Associated Pulmonary Aspergillosis, and we will cover a few areas on this topic, including: - Defining what CAPA is and how prevalent it is among ICU...

AAC just published a review from the WHO advisory panel on the antibacterial pipeline analyzing ‘traditional’ and ‘non-traditional’ antibacterial agents and modulators in clinical development current on 30 June 2021 with activity against the WHO priority pathogens, mycobacteria and Clostridioides difficile. Today, we will dissect this important publication Objectives: • Understand the role of the WHO in antimicrobial resistance • Discuss the analysis of the antibacterial pipeline •...

In less than two months since it was discovered, the omicron variant of SARS-CoV-2 has become the dominant variant of the virus, causing an unprecedented rise in the number of cases of COVID-19 in the U.S. and elsewhere. The emergence of this variant has quickly led to some surprising claims about diagnostic testing for omicron and a renewed appreciation of the importance of sequencing the viral genome for typing purposes. We will address several questions about testing for omicron,...

As we round out yet another year of this pandemic, clinical microbiologists have not slowed down. We have not slowed down in our response to the pandemic or other day-to-day testing needs, despite the constant reagent backorders and personnel shortages, and equally as important, we have not slowed down in publishing high quality, informative and clinically relevant papers, which have really spanned the gamut of clinical microbiology - from antimicrobial susceptibility testing, to next...

Infections caused by carbapenem-resistant Acinetobacter spp. are considered an urgent public health problem. Antibiotic options are scarce but new drugs may be available in the near future. We discuss this important topic with experts in the field. Topics discussed: Acinetobacter as an opportunistic pathogen Therapeutic approaches for Acinetobacter infections The future approach for this MDR organisms. Guests: Dr. Yohei Doi, Professor and Director, Center for Innovative Antimicrobial...

Is sequencing the SARS-CoV-2 genome useful for patient care? What about institutional infection control? And if clinical labs decide to perform SARS-CoV-2 sequencing, how should they do it? How should they report the results? And will they get paid? Until recently, sequencing of SARS-CoV-2 genomes has mainly been done in public health or research laboratories. Now, there is increasing interest in sequencing the viral genome in healthcare settings for uses in patient care and infection...

Candida auris is an urgent and high-priority antimicrobial resistant organisms. COVID-19 appears to have increased the identification of this pathogen in vulnerable patients. We discuss with experts the emergence of Candida auris and its relationship with COVID-19. Guests: Dr. Sevtap Arikan-Akdagli, Director, Department of Medical Microbiology, Head of Mycology Laboratory, Hacettepe University Medical School, Ankara, Turkey Dr. Bhavarth Shukla. Assistant Professor of Medicine, University of...

Today we’re talking about testing in schools for COVID-19, and about recalls of SARS-CoV-2 tests due to false positive results, and, about whether we are ready to go to in-person scientific and medical meetings. Joining me for this roundtable discussion are two frequent guests on the podcast, Dr. Melissa Miller, from UNC School of Medicine, and Dr. Elli Theel, from Mayo Clinic. Links: School Testing for COVID-19....

How can we determine whether someone who has COVID-19 can transmit the virus to other people? Tests in routine clinical use, such as reverse-transcription polymerase chain reaction and antigen tests, are designed to determine whether SARS-CoV-2 is present or not, but many people have proposed that these tests be used to determine whether a patient is infectious. Furthermore, tests for SARS-CoV-2 that are not routinely used in clinical laboratories, such as viral culture and detection of...

Enterococci, particularly vancomycin-resistant isolates tend to affect the most vulnerable and immunocompromised patients and are one of the most difficult bacteria to treat. In absence of robust clinical data, we will discuss therapeutic approaches for these recalcitrant organism.