ODX: A Fitness Tracker-Based Device for Continuous Bacterial Growth Monitoring.

Continuous monitoring of bacterial growth in aqueous media is a crucial process in academic research as well as in the biotechnology industry. Bacterial growth is usually monitored by measuring the optical density of bacteria in liquid media, using benchtop spectrophotometers. Due to the large form factor of the existing spectrophotometers, they cannot be used for live monitoring of the bacteria inside bacterial incubation chambers. Additionally, the use of benchtop spectrometers for continuous monitoring requires multiple samplings and is labor intensive. To overcome these challenges, we have developed an optical density measuring device (ODX) by modifying a generic fitness tracker. The resulting ODX device is an ultraportable and low-cost device that can be used inside bacterial incubators for real-time monitoring even while shaking is in progress. We evaluated the performance of ODX with different bacterial types and growth conditions and compared it with a commercial benchtop spectrophotometer. In all cases, ODX showed comparable performance to that of the standard benchtop spectrophotometer. Finally, we demonstrate a simple and useful smartphone application whereby the user is notified when the bacterial concentration reaches the targeted value. Due to its potential for automation and mass production, we believe that the ODX has a wide range of applications in biotechnology research and industry.

An innovative pay-for-performance (P4P) strategy for improving malaria management in rural Kenya: protocol for a cluster randomized controlled trial.

BACKGROUND: In high-resource settings, 'pay-for-performance' (P4P) programs have generated interest as a potential mechanism to improve health service delivery and accountability. However, there has been little or no experimental evidence to guide the development or assess the effectiveness of P4P incentive programs in developing countries. In the developing world, P4P programs are likely to rely, at least initially, on external funding from donors. Under these circumstances, the sustainability of such programs is in doubt and needs assessment. METHODS/DESIGN: We describe a cluster-randomized controlled trial underway in 18 health centers in western Kenya that is testing an innovative incentive strategy to improve management of an epidemiologically and economically important problem--diagnosis and treatment of malaria. The incentive scheme in this trial promotes adherence to Ministry of Health guidelines for laboratory confirmation of malaria before treatment, a priority area for the Ministry of Health. There are three important innovations that are unique to this study among those from other resource-constrained settings: the behavior being incentivized is quality of care rather than volume of service delivery; the incentives are applied at the facility-level rather than the individual level, thus benefiting facility infrastructure and performance overall; and the incentives are designed to be budget-neutral if effective. DISCUSSION: Linking appropriate case management for malaria to financial incentives has the potential to improve patient care and reduce wastage of expensive antimalarials. In our study facilities, on average only 25% of reported malaria cases were confirmed by laboratory diagnosis prior to the intervention, and the total treatment courses of antimalarials dispensed did not correspond to the number of cases reported. This study will demonstrate whether facility rather than individual incentives are compelling enough to improve case management, and whether these incentives lead to offsetting cost-savings as a result of reduced drug consumption. TRIAL REGISTRATION: ClinicalTrials.gov Registration Number NCT01809873.

Transforming clinical microbiology with bacterial genome sequencing.

Whole-genome sequencing of bacteria has recently emerged as a cost-effective and convenient approach for addressing many microbiological questions. Here, we review the current status of clinical microbiology and how it has already begun to be transformed by using next-generation sequencing. We focus on three essential tasks: identifying the species of an isolate, testing its properties, such as resistance to antibiotics and virulence, and monitoring the emergence and spread of bacterial pathogens. We predict that the application of next-generation sequencing will soon be sufficiently fast, accurate and cheap to be used in routine clinical microbiology practice, where it could replace many complex current techniques with a single, more efficient workflow.

Improved, low-cost selective culture medium for Actinobacillus actinomycetemcomitans.

Actinobacillus actinomycetemcomitans is considered to be one of the major oral putative pathogens, especially in cases of juvenile periodontitis. This microorganism requires nutritionally complex media for growth, and therefore the media for its primary isolation usually include blood agar or serum in their base. In this study we present a new medium, Dentaid-1, which improves the detection of A. actinomycetemcomitans in periodontal samples. In its composition, blood and serum have been omitted, hence reducing its cost and making it a more restrictive medium against the growth of other microorganisms with high nutritional requirements. The growth yields of pure cultures of the bacteria on Dentaid-1 were comparable to those on nonselective blood agar. Moreover, clinical efficacy was evaluated in subgingival samples from 77 subjects with adult periodontitis. Dentaid-1 detected A. actinomycetemcomitans in 24 subjects, while a previously described tryptic soy-serum-bacitracin-vancomycin agar detected the microorganism in only 19 subjects (79.1%). Dentaid-1 is a low-cost, noninhibitory formula for the improved diagnosis and monitoring of patients subgingivally infected by this important oral putative pathogen.

Anaerobes under assault: from cottage industry to industrialization of medicine and microbiology.

More than 100 years have elapsed since the initial discovery of anaerobiosis, the first anaerobic microbiological isolation, and the first clinical descriptions of human anaerobic infection. New species are still being discovered, the important role of anaerobes as normal flora and in the maintenance of health is becoming increasingly appreciated, and the development of resistance by anaerobes to virtually all antimicrobials has recently accelerated. Anaerobes and their products have been employed widely and at times have been associated with political evolution, such as the establishment of the state of Israel. Despite all this, the current era of recession and health care economizing threatens the field of anaerobic bacteriology with funding cutbacks and diminished recognition. In order to prevent stagnation in the field and its decline, anaerobists must remain committed and vigilant and must take an increasingly active stance in education, publication, and research.

How far should a clinical laboratory go in identifying anaerobic isolates, and who should pay?

Identification of anaerobic bacteria in specimens from sites of infection due to mixed organisms can be time-consuming and expensive. Laboratories should limit anaerobic workups by testing only those specimens that have been properly collected and transported to the laboratory. Use of selective and differential media for initial processing can provide rapid and relevant information to the clinician. Anaerobes isolated from normally sterile sites and sites of serious infection should always be completely identified. Group- or genus-level identifications may suffice in other instances. The Bacteroides fragilis group of organisms should always be identified because of their virulence and resistance to many antimicrobial agents. Some of the other organisms that warrant identification include Clostridium septicum (associated with gastrointestinal malignancy); Clostridium ramosum, Clostridium innocuum, and Clostridium clostridioforme (which are resistant to antibiotics); Clostridium perfringens (a cause of potentially serious infection); anaerobic cocci (which may be resistant to metronidazole and clindamycin); and fusobacteria (which may be virulent and resistant to clindamycin and penicillin).

Determining productivity and unit costs in a bacteriology laboratory.

This paper describes in detail the process of identification of the "products" of a department of clinical microbiology, the determination of resource requirements, the identification of total resource costs and the calculation of unit costs in order to identify the items which can be regarded as profitable in relation to the OHIP fee scale, as well as those services whose true cost is not met by that scale. The process permits an assessment of the overall profitability of the entire division and provides data for judging the probable gains from contracting out services.

[The bacteriology laboratory of tomorrow]. / Le laboratoire de bactériologie de demain.

The development of needs and the conditions for performing examinations in clinical bacteriology leads us to consider that bacteriological analysis should eventually: be closer to clinical requirements. This results in an accelerated bacteriology (whose response-times approach those of other biological specialties) and in a consideration of the diagnostic and therapeutic importance of the response; be less costly. This leads to an increase in productivity, and involves an introduction of computers, automatic systems for antibiograms and identification, and appropriate and inexpensive bioreagents; consider the requirements of the technicians in order to avoid diminishing the interest of the work. This development demands a recognition of needs, whether expressed or not, and a rejection of olds habits that are not adapted to the requirements of a bacteriology which is closer to the patient, quicker, and finally, less costly.

Cost effectiveness of quality control in bacteriology.

The cost effectiveness of quality control in bacteriology stipulated by regulators is not established. The authors evaluated 111 surveillance procedures applied to 54 different operations; 100 had been performed in the authors' lab between 1965 and 1980, 91 of which had been performed 50 times. Forty-six conformed to CLIA requirements (CLIA-P). Thirty-seven others were CLIA-P, which had been modified (CLIA-PM) by reducing frequency and extent because few or no deficiencies had been observed. Eight others were devised by the authors (HH-P). The number detecting deficiencies, the per cent, and the mean per cent of deficiencies detected were: CLIA-P, 31, 67%, 3.5%; CLIA-PM, 8, 22%, 2.1%; HH-P, 8, 100%, 8.8%. Compliance with CLIA would cost HH $20,700/year (3.4% of total bacteriology laboratory cost). HH-P would cost an additional $9000/year. Discontinuation of CLIA-P not detecting deficiencies would reduce HH costs by $2900/year. Application of other low yield CLIA-P only to new lots of selected dehydrated media and fresh batches of selected reagents would reduce cost further by $2000/year.