Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
J Public Health Manag Pract. 2012 Jul-Aug;18(4):E4-E10. doi: 10.1097/PHH.0b013e3182368c74.
Although clinical microbiology testing facilitates both public health surveillance of infectious diseases and patient care, research on testing patterns is scant. We surveyed hospital laboratories in Georgia to assess their diagnostic testing practices.
Using e-mail, all directors of hospital laboratories in Georgia were invited to participate. The survey focused on timing and location of diagnostic testing in 2006 for 6 reportable diseases: giardiasis, legionellosis, meningococcal disease, pertussis, Rocky Mountain spotted fever, and West Nile virus disease.
Of 141 laboratories, 62 (44%) responded to the survey. Hospitals varied widely in their use of diagnostic testing in 2006, with 95.1% testing for meningococcal disease, but only 66.1% and 63.3% testing for legionellosis and West Nile virus disease, respectively. Most laboratories (91%) performed gram stain/culture to diagnose meningococcal disease in-house and 23% performed ova and parasite panels for giardiasis were conducted in-house. Fewer than 11% of laboratories performed in-house testing for the remaining diseases. Laboratories affiliated with small hospitals (≤100 beds) were more likely to send specimens for outside testing compared with laboratories associated with large hospitals (>250 beds). Median turnaround time for ova and parasite panel testing for giardiasis was significantly shorter for in-house testing (1.0 days) than within-system (2.25 days) or outside laboratory (3.0 days) testing (P = .0003). No laboratories reported in-house testing for meningococcal disease, pertussis, or Rocky Mountain spotted fever using polymerase chain reaction.
Many hospitals did not order diagnostic tests for important infectious diseases during 2006, even for relatively common diseases. In addition, hospital laboratories were unlikely to perform diagnostic testing in-house; sending specimens to an outside laboratory may result in substantial delays in receiving results. These unsettling findings have adverse implications for both patient care and public health surveillance; they indicate an immediate need to study nationally the use and timeliness of clinical microbiologic testing.
临床微生物学检测有助于传染病的公共卫生监测和患者治疗，但有关检测模式的研究却很少。我们对佐治亚州的医院实验室进行了调查，以评估其诊断检测实践。
通过电子邮件向佐治亚州所有医院实验室主任发出邀请，参与此项调查。该调查侧重于 2006 年 6 种报告疾病（贾第虫病、军团病、脑膜炎球菌病、百日咳、落基山斑点热和西尼罗河病毒病）的诊断检测时间和地点。
在 141 个实验室中，有 62 个（44%）对调查做出了回应。2006 年，各医院的诊断检测使用情况差异很大，脑膜炎球菌病的检测率为 95.1%，但军团病和西尼罗河病毒病的检测率分别仅为 66.1%和 63.3%。大多数实验室（91%）自行进行革兰氏染色/培养以诊断脑膜炎球菌病，23%自行进行贾第虫病的粪便检查。不到 11%的实验室进行其余疾病的内部检测。与大型医院（>250 张病床）相比，附属小型医院（≤100 张病床）的实验室更有可能将标本送检进行外部检测。贾第虫病粪便检查的寄生虫卵和粪便检查的中位周转时间，内部检测（1.0 天）明显短于系统内检测（2.25 天）或外部实验室检测（3.0 天）（P =.0003）。没有实验室报告使用聚合酶链反应进行内部脑膜炎球菌病、百日咳或落基山斑点热检测。
许多医院在 2006 年并未对重要传染病进行诊断检测，即使是针对相对常见的疾病。此外，医院实验室也不太可能进行内部诊断检测；将标本送到外部实验室可能会导致结果的延迟。这些令人不安的发现对患者治疗和公共卫生监测都有不利影响；它们表明，需要立即在全国范围内研究临床微生物学检测的使用和及时性。
