Mycobacterium tuberculosis and whole genome sequencing: a practical guide and online tools available for the clinical microbiologist.

Whole genome sequencing (WGS) has the potential to revolutionize the diagnosis of Mycobacterium tuberculosis infection but the lack of bioinformatic expertise among clinical microbiologists is a barrier for adoption. Software products for analysis should be simple, free of charge, able to accept data directly from the sequencer (FASTQ files) and to provide the basic functionalities all-in-one. The main aim of this narrative review is to provide a practical guide for the clinical microbiologist, with little or no practical experience of WGS analysis, with a specific focus on software products tailor-made for M. tuberculosis analysis. With sequencing performed by an external provider, it is now feasible to implement WGS analysis in the routine clinical practice of any microbiology laboratory, with the potential to detect resistance weeks before traditional phenotypic culture methods, but the clinical microbiologist should be aware of the limitations of this approach.

Erythropoiesis-stimulating agents: switch from intravenous to subcutaneous administration in hemodialyzed patients.

UNLABELLED: The aim of this study was to undertake a long-term comparison of hemodialyzed patients who had undergone IV administration of ESAs and subsequently switched to SC administration, focusing particularly on the numerous comorbidity factors and the possible savings implicated in the switch. A total of 75 patients were treated as follows: 12% epo-alpha 33.3% epo-beta 54.6% darbepoetin IV for a period of 12 months followed by a second 12-month SC. The following parameters were evaluated: Charlson Comorbidity Index (CCI), Geriatrics index of comorbidity, iron storage pool, CRP, iPTH, dry weight, eKt/V, total protidemia and albumin, dose and type of: ESAs used, iv iron, vitamin C, vitamin B12, folates, vitamin D and derivatives, calcimimetic and ACEi, /month, and finally the cost of iv vs. sc treatment. No clinical or blood chemistry variations were observed during the study, with the exception of a significant increase of Hb from 11.2 ± 1.1 to 11.6 ± 0.9 g/dl (p = 0 .001). The total yearly cost for all 75 patients treated with ESAs amounted to 191,278 € for IV administration compared to 154,016 € for SC administration, with an overall saving of 19.4%. CONCLUSION: The subcutaneous route of administration is considered the safest, and the significant cost savings incurred at minimum discomfort for patients should not be overlooked. No costs saving were obtained for darbepoetin with regard to subcutaneous administration. Furthermore, Epo-beta sc is frequently characterised by the potential effect of extending intervals between administrations maintaining constant levels of Hb.