This session will review stool specimen ordering, collection, processing, testing, and reporting including the new Universal Fixative, the routine O & P examination, fecal immunoassays, and the newer molecular procedures. Topics include organism identifications, specific recommendations for test orders and reporting, and clinical relevance of test results.  Risk management aspects of STAT procedures, and potential errors will also be reviewed. Specific parasites that will be discussed include:  Protozoa, helminths, and blood parasites. There will also be information related to changes in worldwide endemicity and pathogenesis. There will be time for questions.

Learning Objectives

The program will provide participants with information that will allow them to:

• describe the role of the laboratory and clinician regarding stool testing orders for routine, immunoassay, and molecular procedures  
• discuss the pros and cons of diagnostic methods for the recovery and identification of protozoa, helminths, and blood parasites
• describe the pros and cons of STAT testing for malaria and the free-living amebae, including risk management issues
• describe important result comments as an adjunct to reporting of results and clinical relevance

Presenter

Lynne S. Garcia, MS, CLS, FAAM
Director
LSG & Associates
Santa Monica, California

In this presentation, the history of gonococcal antimicrobial resistance will be reviewed and the appearance, unfolding epidemiology, and genetic basis of developing cephalosporin resistance will be described. Threats to the clinical efficacy of recommended single-dose oral and parenteral treatment regimens for gonorrhea have prompted clinical trials to evaluate new or alternative therapeutic approaches, and these will be briefly described. Lastly, the clinical, laboratory, and public health responses to the emergence of cephalosporin-resistant N. gonorrhoeae will be addressed, including the implications for public health, for physicians caring for patients, and for laboratories performing diagnostic testing for gonorrhea.

Learning Objectives

At the conclusion of this presentation, participants will be able to:

• Describe the evolution of antimicrobial resistance in Neisseria gonorrhoeae (NG);
• List the mechanisms responsible for the emergence of gonococcal resistance to  cephalosporins; 
• Learn the current  treatment approaches and new treatment regimens that are being investigated and/or proposed; and
• Describe the public health and laboratory challenges posed by emergence of cephalosporin resistance in N. gonorrhoeae.

Presenter

William M. Janda, Ph.D., D(ABMM)
Division Chair, Microbiology and Virology, Department of Pathology
John H. Stroger, Jr. Hospital/Cook County Health and Hospitals System
Professor Emeritus of Pathology, the College of Medicine
University of Illinois at Chicago
Chicago, Illinois

This presentation will review the stories of duodenoscopes contaminated with carbapenemase-resistant Enterobacteriaceae and heater-cooler units contaminated with Mycobacterium chimaera.  Each incident led to an FDA recall and shed light on instrument cleaning procedures.  The duodenoscope incident actually was the subject of a U.S. Senate investigation.  This presentation will: describe why cleaning of instruments is a critical hospital procedure; define how the microbiology laboratory can assist in preventing nosocomial infections; and also define the manufacturers’ responsibility to report problems to the FDA.

Learning Objectives

At the conclusion of this presentation, participants will be able to:

• Describe why cleaning of instruments is a critical hospital procedure.
• Define how the microbiology laboratory can assist in preventing nosocomial     infections.
• Describe the manufacturers’ responsibility to report problems to the FDA.

Presenter

Alice S. Weissfeld, PhD, D(ABMM), F(AAM)
Microbiology Specialists Incorporated
Houston, Texas

Each year, the CLSI updates the M100S document with recommendations for agents to test/report, interpretive criteria, and QC ranges. It is important for clinical microbiologists to implement the new recommendations into their procedures, as appropriate, to optimize detection and reporting of antimicrobial resistance. This session will highlight some of the newest CLSI recommendations by using specific cases and examples. Focus on laboratory testing methods and strategies to implement these changes will be made.

Learning Objectives

At the conclusion of this presentation, participants will be able to:

• List the new recommendations for antimicrobial susceptibility testing and reporting published in the CLSI M100S 27th edition.
• Discuss strategies to approaching testing of difficult organisms, such as atypical S. aureus, and difficult antimicrobials, such as colistin.

Presenter

Romney M. Humphries, Ph.D., D(ABMM), M(ASCP)CM
Section Chief of Clinical Microbiology, UCLA Health System 
Assistant Professor, Department of Pathology and Laboratory Medicine, 
David Geffen School of Medicine 

The prompt initiation of antibiotics to treat infections has been proven to reduce morbidity and save lives.  However, 20-50% of all antibiotics prescribed in US acute care hospitals are either unnecessary or inappropriate.  Antibiotics have potential serious side effects, including adverse drug reactions and Clostridium difficile infection.  In addition antimicrobial resistance has been known to emerge from the inappropriate use of antibiotics leading to increased morbidity, mortality, and costs of health care. Prevention of the emergence of resistance and the dissemination of resistant microorganisms has the potential to reduce these adverse effects and their associated costs.

The appropriate use of antimicrobials is an essential part of patient safety.  An effective antimicrobial stewardship program can limit the emergence and transmission of antimicrobial-resistant bacteria.  In addition antimicrobial stewardship can reduce health care costs without adversely impacting quality of care.  This session will discuss the importance, logistics, necessary elements and development of an antimicrobial stewardship team as well as the role of the microbiology laboratory in antimicrobial stewardship.  Practical examples of the impact of microbiology on antimicrobial stewardship will be provided.

Learning Objectives

At the conclusion of this presentation, participants will be able to:

• Describe antimicrobial stewardship and why an antimicrobial stewardship program is beneficial
• List the suggested members of a well-developed antimicrobial stewardship program
• Describe the role of the clinical microbiology laboratory in an antimicrobial stewardship program
• List one thing that could be done in the clinical microbiology laboratory that would positively impact antimicrobial stewardship

Presenters

Susan E. Sharp, PhD, D(ABMM), FAAM
Director, Regional Microbiology and Infectious Diseases Molecular Laboratories
Associate Professor of Pathology, Oregon Health and Sciences University
Kaiser Permanente - NW
Portland, Oregon

Yvette S. McCarter, PhD, D(ABMM)
Professor of Pathology
UF College of Medicine-Jacksonville
Director, Clinical Microbiology
UF Health Jacksonville
Jacksonville, Florida

This session will focus on new disease associations for pathogens that are increasingly being isolated in every day clinical microbiology laboratories.  In contrast to other emerging pathogen discussions, this presentation will focus on bringing to light those pathogens that we have known about for some time but the expanding bodies of evidence have solidified their clinical significance.  The goal of this talk is to provide some practical guidance for the clinical scenarios in which these organisms will be encountered and to assist laboratories with the identification of these organisms, whether or not they are using MALDI-TOF MS.

Presenter

Christopher D. Doern, PhD, D(ABMM)
Associate Professor, Pathology
Associate Director of Clinical Microbiology
Virginia Commonwealth University Medical
Medical College of Virginia Campus

Rapid, on-demand molecular tests for infectious diseases are now available in a variety of platforms that can be used at or near the point-of-care.  Although these tests are often considered to be lower complexity, there are a number of factors that can contribute to suboptimal performance and/or inaccurate results.  In addition, interpretation and correlation of results from some highly multiplexed assays can be challenging.  This presentation will discuss a number of the pre-analytic, analytic, and post-analytic issues surrounding the use of rapid molecular testing and how some of these difficulties can be avoided.

Learning Objectives

At the conclusion of this presentation, participants will be able to:

• Recognize the importance of pre-analytical factors in the performance of rapid molecular tests.
• Discuss examples of the difficulties in interpretation and correlation of results from rapid molecular testing.
• Understand the limitations of rapid molecular testing and what measures can be instituted to ensure accurate result reporting.

Presenter

Jim Dunn, PhD, D(ABMM)
Associate Professor, Dept. of Pathology and Immunology
Baylor College of Medicine
Director, Medical Microbiology and Virology
Texas Children’s Hospital
Houston, Texas

The offering of diagnostic solutions for the clinical microbiology laboratory has grown significantly over the past several years. Today’s clinical microbiology diagnostic offerings can range from very automated high through put instruments to highly multiplexed panels to molecular point of care devices for sensitive rapid testing nearer the patient. Deciding on which solution or platform is right for one’s laboratory and how to utilize the test to best fit the needs of the clinical need can be challenging, particularly when the evidence based studies around outcomes and economics is still evolving. This teleconference will provide an overview of the various solutions and approaches to evaluating technology for routine clinical microbiology practice.

Learning Objectives

At the end of this Session the attendees will be able to:

• Discuss the role of diagnostics in the age of consumer driven healthcare
• Understand the key elements for evaluating technology and developing a business case for rapid diagnostics
• Recognize the need for algorithms and stewardship for optimal test utilization.

Presenters

Beth Marlowe, PhD, D(ABMM)
Roche Molecular Solutions, Inc

Eszter Deak, PhD, D(ABMM)
The Permanente Medical Group, Regional Reference Laboratory

Challenging infectious disease cases will be presented for participants to solve using patient history, microbiology findings and in some situations antibiotic susceptibility results. These case studies will focus on three bacteria that are emerging as significant human pathogens. We will examine the process of identifying these pathogens based on patient history and clinical laboratory findings as well as the phenotypic and molecular assays that were used to identify mechanisms of antibiotic resistance. Participant will be asked to answer questions pertaining to each case in a preconference questionnaire.

Learning Objectives

At the conclusion of this presentation, participants will be able to:

• Identify new or emerging microbial pathogens based on patient history and clinical laboratory findings
• List phenotypic and molecular assays that can be used to identify mechanisms of antibiotic resistance
• Name three bacteria that are emerging as significant human pathogens

Presenter

Gary Procop, MD, MS
Medical Director, Enterprise Test Utilization and Consultative Services
Director, Molecular Microbiology, Virology, Mycology and Parasitology
Professor of Pathology, Cleveland Clinic Lerner College of Medicine
Robert J. Tomsich Pathology & Laboratory Medicine Institute
Cleveland Clinic

"Ask the Experts" was first introduced for the 2010 Micro Teleconference Series, and due to an overwhelmingly enthusiastic response, it is returning again in 2017.  For those unfamiliar with this format, throughout the year webinar participants are asked to submit questions or problems they have encountered in their laboratories.  Question can be related to any area that is of concern to the participant.  This session will address these questions/problems. Receipt of questions well in advance of the webinar will facilitate the process of obtaining a response from the panel.

Learning Objectives

At the conclusion of this presentation, participants will be able to:

• Receive answers to your most problematic concerns in the microbiology laboratory.
• Recognize the most up to date protocols, opinions, best practices in microbiology.
• Identify methods to incorporate these solutions into your own laboratory.  

Panelist

Yvette S. McCarter, PhD, D(ABMM)
Director, Clinical Microbiology
UF Health Jacksonville