Clinical medicineNational hospital survey of anaerobic culture and susceptibility methods: III
Introduction
While anaerobic bacteria are important clinical pathogens, clinical laboratories vary in their capabilities and interest in the isolation and identification of anaerobes and in their performance of anaerobic susceptibility testing [1], [2]. Recently, the controversy about the importance of obtaining anaerobic cultures has reemerged when Lassmann et al. [3] noted a 74% rise in anaerobic bacteremias at the Mayo Clinic and that in today's complex medical patients “the clinical context for anaerobic infections [is] less predictable than it once was.” This highlights the need for practice improvement [4]. Numerous studies have demonstrated that appropriate early therapy results in a better clinical outcome with lower mortality and morbidity and shortened length of stay for diverse conditions including bacteremia [5], [6]. With the rising resistance to a variety of commonly employed anti-anaerobe agents, including several case reports of clinical metronidazole resistance, also suggests that the availability of susceptibility testing is clinically relevant [7]. However, laboratorians that are often concerned about the cost of testing [2] often treat anaerobic bacteriology as the poor stepsister and as a consequence even guideline committees have suggested that anaerobic culture of community-acquired intraabdominal infections need not be performed [8]. In order to assess the current status of anaerobic culture and susceptibility methods, we performed a new national survey in randomly selected, large nonteaching hospitals across the United States.
Section snippets
Methods
In the fall of 2006 a sample of 150 hospitals was randomly selected from the American Hospital Association's Guide to the Health Care Field, 2006 edition [9]. The sample was limited to general medicine and surgical hospitals with bed capacities of 200–1000. For each selected hospital, the microbiology laboratory was contacted by telephone to identify the appropriate person to discuss anaerobic bacteriology and whether anaerobic cultures were processed in-house or sent to reference laboratories.
Results
Of the 150 hospital laboratories contacted, 128 (85%) responded to the screening question by saying that they processed anaerobic cultures in-house, and 22 (15%) said that they send selected specimens to reference laboratories, of which 8 were within their hospital system and 12 were to independent laboratories and two did not answer. Of the 128 hospital labs sent the survey instrument, 76 (59%) were returned, and 15 of the 22 reference labs (68%) returned their surveys.
Questions and answers:
- 1.
Discussion
The typical clinical presentation of patients with anaerobic bacteremia is less predictable then it was a decade ago [3]. In addition, anaerobes have exhibited new antimicrobial resistance patterns [13], [14], [15]. Despite technical improvements and increased standardization, our prior two surveys had noted a dramatic decline in the availability of anaerobic bacteriology and susceptibility data available to clinicians [1], [2]. Consequently, they often must use surveys and small studies
Acknowledgments
This survey was supported in part by a grant form Merck & Co, Inc. We thank C. Vreni Merriam, Judee Knight and Alice E. Goldstein for various forms of support.
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