Mixed mould species in laboratory cultures of respiratory specimens: how should they be reported, and what are the indications for susceptibility testing?

AIMS: To investigate how clinical microbiology laboratories should report and interpret mixed mould isolates including Aspergillus species from clinical samples and the criteria for susceptibility testing of the isolates. METHODS: Retrospectively collected data from our laboratory information system of moulds isolated between January 2005 and December 2007. Patient case notes were also reviewed. RESULTS: A total of 502 isolates (from 273 patients) were found. 20 patients with clinical diagnosis of a probable fungal infection had mixed Aspergillus species. CONCLUSIONS: In most instances, the isolation of Aspergillus species from non-sterile sites does not represent clinical disease, but only colonisation/contamination. However, for high-risk patients including transplant recipients, a positive culture is associated with invasive disease. Our tertiary centre routinely reports single fungal isolates and mixed cultures with appropriate comments, and those considered significant will also have susceptibility testing carried out. The correlation of culture results with clinical features can differentiate between invasive disease and contamination.

Audit of laboratory mycology services for the management of patients with fungal infections in the northwest of England.

BACKGROUND: Fungal infection is increasingly recognised as an important cause of morbidity and mortality, especially in immunocompromised patients. Little information exists on laboratory services available and the methods used by general microbiology laboratories to diagnose these important infections. AIM: To investigate the services microbiology laboratories in northwest England provide towards the diagnosis and management of superficial and deep fungal infections. METHODS: A questionnaire was sent to laboratories to get a holistic view of the support given to clinicians looking after patients with fungal infections. The aim was not to investigate details of each laboratory's standard operating procedures. The completed questionnaires, which formed the basis of this report, were returned by all 21 laboratories which were recruited. This study was conducted between March 2004 and September 2004. RESULTS: Services were provided to District General Hospitals and to six tertiary centres, including eight teaching hospitals by 16 laboratories. Their bed capacity was 250-1300 beds. Total specimens (including bacterial and viral) processed annually were 42 000-500,000 whereas fungal ones were 560-5400. CONCLUSION: In most microbiology laboratories of northwest England, clinicians were aware of the potential of fungal pathogens to cause infections especially in immunocompromised patients. Additional measures such as prolonged incubation of samples were introduced to improve fungal yield from patients at high risk. It is necessary to train and educate laboratory and medical staff about the role of serology and molecular methods in diagnosis and management of patients with fungal infection.

Chaos and complexity--the future for health care HRM.

The need to understand chaos and complexity in organisations has particular importance for health which is bedevilled by the complexity of organisations and the sometimes chaotic nature of its core activities. This article seeks to explore these issues in the context of one of the key functions which is expected to hold together this diversity: Human Resource Management (HRM). An exploration of the nature of HRM in health care as it has evolved indicates that in order for it to have a pivotal role for the future it will need to rethink this role in the changing paradigm which is now emerging; in so doing it could develop as the organisational intelligence for health care in the future facilitating organisational learning and creativity.