FROM MICROBIOLOGY TO CLINICAL MICROBIOLOGY CAN WE MAKE IT? Dr.T.V.Rao MD

FROM MICROBIOLOGY TO CLINICAL MICROBIOLOGY

CAN WE MAKE IT?

Dr.T.V.Rao MD

The Curriculum in Microbiology in the Indian contest remained static for several

decades; the training in MD (Microbiology) under Medical Faculty remained without clinical

approaches in Diagnosis and treatment. Much of Medical Microbiology remained to the Laboratory

with little interest in the Hospital practice. Every Medically qualified Microbiologist spends Major

years of life in a speciality without much productivity and newer innovations. Thanks to several

curricular changes in efforts to make subject, as par with a Clinical Speciality. Fewer allocations from

both Government and Private Institutions in funding and shortage of qualified technicians have

brought the speciality to brink of deterioration. The Pandemic of AIDS awakened the Society and

Doctors that spread of AIDS cannot be controlled with Laboratories, but our continuous

understanding of the Society, and greater understanding of the disease with clinical knowledge. I

think it is time that we should become active to make Microbiology as Clinical Microbiology with our

united efforts. At present we all study in-depth Microbiological aspects dealing particularly with

theoretical and little practical knowledge of medical diagnostics. It also focuses on molecular and

conventional techniques for isolating, identifying and characterizing bacterial, viral, fungal and

parasitic pathogens, as well as prevention and control of infectious diseases, epidemiology, and

details of specimen collection, handling, examination and interpretation of results. However a little

interactions with our knowledge of Medicine make greater contributions. At present curriculum is

elaborate and wide without much specificities, creates greater confusion. My little experience as

qualified in MD from reputed Government Institution make me to realize that I do not practice even

10% of the knowledge gained in my post-graduation, and Post graduate degrees make you a

undergraduate teachers at the most a postgraduate examiner after years of our service. It is

questionable how much we are productive to the society. The reasons are many clinicians go on

their own way thinking antibiotics can solve all problems, which has led to growing concerns on

Antibiotic multidrug, pan drug resistant strains. We can make a change in thinking with practice of

few good ideals as ………

1 Make use of suitable range of diagnostic, investigative and/or monitoring procedures when

undertaking investigations, which can give optimal, care of the patients.

2 Communicate complex and technical information to patient’s, colleagues and those with limited

technical knowledge in terms that facilitate understanding of issues.

3 Accept the responsibilities of the role of the scientist-trained person in relation to other health

care professionals and with empathy and sensitivity to patients, and families.

4 Ensure validations of data, through use of appropriate sources of information including relevant

databases and consultation with senior colleagues.

5 Use laboratory Information Technology, WHONET systems for handling, processing and storage of

patient data.

CLINICAL EXPERIENTIAL LEARNING

The recommended examples of clinical microbiology learning are

? Prepare a portfolio of significant clinical cases reported in your hospital and be able to list clinical

outcomes and main learning points.

? Participate in multidisciplinary review meetings at which bacteriology and other diagnostic results

are presented as part of the clinical record.

? Critically appraise the internal quality control and external quality assessment of different routine

bacteriology methods and draw conclusions about method performance and quality.

Our Postgraduate Students should be, familiar with

? The clinical impact of important bacterial and viral infections and of the appropriate clinical

and laboratory investigations.

? The interpretation and reporting of laboratory results in the context of important bacterial

and other Microbial infections.

? The partnership between the clinical microbiology laboratory and other clinical specialties in

the investigation of common bacterial infections. As we are aware many specimens sent to

Microbiology are sent for Histopathological and biochemical examination too, our constant touch

with our colleagues makes our reports acceptable and causes no confusion among the Clinicians.

? Perform and critically evaluate the results from a range of assays used to investigate viral

infection including: immunoassay; agglutination; immunofluorescence; neutralization;

Immmunoblotting, electrophoresis and gel diffusion. Many rapid tests we do in the laboratory are

inconclusive, and may not be specific, and Microbiologists should accept the limitations and try for

better and newer generation of tests, or else we become static in progress of the patients care.

? Clinical practice guidelines if followed by Clinical microbiologists, have several potential

benefits, including better patient care at lower costs and, when applied properly, the potential to

protect health care providers from legal claims. There are several potential reasons we are failing to

follow, many standard guidelines, due lack of coordination at many levels of administration,

resources and funding crunch as in most of the Developing countries. Still we can do better being

aware of clinical practice guidelines. It is not surprising that clinical microbiologists might not be

aware of a specific aspect of clinical practice guidelines.

Many of us are confused with different conflicting interpretative criteria; there are over 1,000

clinical practice guidelines in the National Guidelines Clearinghouse database, all of which make

recommendations that directly affect laboratory practice.

? Overcoming the challenges, remains a challenge to all upcoming Microbiologists, until the

Medical fraternity realizes, Microbiology is not an armchair job as in the past but active Life Saving

Clinical Specialty.

Changing role of Microbiologists – Simple Measures to Improve our Laboratories - Now the Society

realises that Antibiotic Resistance is a concern to everybody’s health and a future concern for even a

Healthy person, We should be proactive and prove that we are leaders to handle the situation, with

even little developments in our Laboratories, will prove useful to the Medical profession. Hospital

Microbiology laboratories should follow standard protocols for susceptibility testing, possible with

following with CLSI guidelines and reporting on WHONET software 5.6 which also can be changed

from default to the currently accepted zone sizes in reporting, Must generate and distribute

Antibiograms at regular intervals (Quarterly) to the Clinicians so they can be made aware how

ineffective some antibiotics have become. Hospitals to send antimicrobial susceptibility testing (AST)

to standardized labs to avoid erroneous reporting of organisms and their susceptibility pattern. Pandrug-resistant Gram-negatives, carbapenem-resistant Gram-Negatives, Vancomycin- resistant

Enterococcus and MRSA should be made notifiable. We can create collaborating laboratories around

us and strive to improve the quality control of isolates for identification emerging trends in antibiotic

resistance.

Note – The above published articles are contributed to various WEB resources for benefit of Young

Generation of Microbiologists

Dr.T.V.Rao MD, Former Professor of Microbiology.

At present Member associate and adviser to Elsevier research Netherlands