Shea Shari, Kubota Kristy A, Maguire Hugh, Gladbach Stephen, Woron Amy, Atkinson-Dunn Robyn, Couturier Marc Roger, Miller Melissa B
Association of Public Health Laboratories, Silver Spring, Maryland, USA
Association of Public Health Laboratories, Silver Spring, Maryland, USA.
J Clin Microbiol. 2016 Dec 28;55(1):10-19. doi: 10.1128/JCM.01624-16. Print 2017 Jan.
INTRODUCTIONIn November 2015, the Centers for Disease Control and Prevention (CDC) sent a letter to state and territorial epidemiologists, state and territorial public health laboratory directors, and state and territorial health officials. In this letter, culture-independent diagnostic tests (CIDTs) for detection of enteric pathogens were characterized as "a serious and current threat to public health surveillance, particularly for Shiga toxin-producing Escherichia coli (STEC) and Salmonella" The document says CDC and its public health partners are approaching this issue, in part, by "reviewing regulatory authority in public health agencies to require culture isolates or specimen submission if CIDTs are used." Large-scale foodborne outbreaks are a continuing threat to public health, and tracking these outbreaks is an important tool in shortening them and developing strategies to prevent them. It is clear that the use of CIDTs for enteric pathogen detection, including both antigen detection and multiplex nucleic acid amplification techniques, is becoming more widespread. Furthermore, some clinical microbiology laboratories will resist the mandate to require submission of culture isolates, since it will likely not improve patient outcomes but may add significant costs. Specimen submission would be less expensive and time-consuming for clinical laboratories; however, this approach would be burdensome for public health laboratories, since those laboratories would need to perform culture isolation prior to typing. Shari Shea and Kristy Kubota from the Association of Public Health Laboratories, along with state public health laboratory officials from Colorado, Missouri, Tennessee, and Utah, will explain the public health laboratories' perspective on why having access to isolates of enteric pathogens is essential for public health surveillance, detection, and tracking of outbreaks and offer potential workable solutions which will allow them to do this. Marc Couturier of ARUP Laboratories and Melissa Miller of the University of North Carolina will explain the advantages of CIDTs for enteric pathogens and discuss practical solutions for clinical microbiology laboratories to address these public health needs.
引言
2015年11月，美国疾病控制与预防中心（CDC）致函各州及领地的流行病学家、各州及领地公共卫生实验室主任以及各州及领地卫生官员。在这封信中，用于检测肠道病原体的非培养诊断测试（CIDTs）被描述为“对公共卫生监测构成严重且当前的威胁，尤其是对产志贺毒素大肠杆菌（STEC）和沙门氏菌而言”。该文件称，CDC及其公共卫生合作伙伴在处理这个问题时，部分方式是“审查公共卫生机构的监管权限，要求在使用CIDTs时提交培养分离株或标本”。大规模食源性疾病暴发持续威胁着公共卫生，追踪这些暴发是缩短暴发时间和制定预防策略的重要工具。很明显，用于肠道病原体检测的CIDTs，包括抗原检测和多重核酸扩增技术，正变得越来越普遍。此外，一些临床微生物学实验室将抵制提交培养分离株的要求，因为这可能不会改善患者的治疗结果，但可能会增加大量成本。对临床实验室来说，提交标本成本更低且耗时更少；然而，这种方法对公共卫生实验室来说将是繁重的，因为这些实验室需要在分型之前进行培养分离。来自公共卫生实验室协会的莎莉·谢伊和克里斯蒂·久保田，以及来自科罗拉多州、密苏里州、田纳西州和犹他州的州公共卫生实验室官员，将解释公共卫生实验室对于获取肠道病原体分离株为何对公共卫生监测、暴发检测和追踪至关重要的观点，并提供使他们能够做到这一点的潜在可行解决方案。ARUP实验室的马克·库蒂里耶和北卡罗来纳大学的梅利莎·米勒将解释CIDTs对肠道病原体检测的优势，并讨论临床微生物学实验室满足这些公共卫生需求的实际解决方案。
