The importance of laboratory results

As the scenario video shows it is vital to recruit all frontline health workers into responsible stewardship of antibiotics.

Guidelines on how to collect good quality specimens should be made available by clinical laboratories and should be adhered to.

1. Microbiology tests must be done to confirm and to determine microbial cause, when there are clinical indications of infections.
2. Every prescriber should follow institutional policy on laboratory testing, as a requirement for stewardship.
3. Clinicians should ensure that good quality specimens (fluid/tissue/wound samples) are collected before commencement of antibiotics wherever possible.
4. Patients and their families need to be told about the importance of getting microbial profiles early and the benefit of giving targeted antimicrobial treatment based on laboratory results (such as optimal and correct antibiotic therapy, improved patient outcome, reduced cost, reduced hospital stay, reduced morbidity and mortality).
5. Prescribers should always review antibiotics in line with culture and sensitivity results.

The video also shows that it is important to counsel patients too.

Firstly, it is important to establish their level of understanding of disease causation and the role of laboratory investigations in treatment.

Secondly, patients need to be educated and informed about the role of the laboratories in management of common endemic illnesses, fevers, diarrhoea and vomiting, upper respiratory tract infections and sexually transmitted infections.

Thirdly, it is important to help them understand that antimicrobials used too many times and inappropriately make them useless. Therefore, the physician who prescribes an antibiotic must have established there is a good reason to do so by getting evidence very often from the laboratory. He also knows what tests are relevant and how to interpret them in view of the clinical situation after a physical examination.

Points to pass on:

• Antibiotics are useless against viral infections such as colds, catarrh, cough, flu and infantile diarrhoea, so appropriate examination, laboratory and radiological investigations are required to differentiate microbial causes of infections.

• Varieties of tests (including rapid tests) are also available to detect pathogens other than bacteria that cause common infections.

• Before an antibiotic is consumed, evidence of an infection must be obtained by a doctor.

• It is not right for a patient to go to the laboratory to order a test without being advised by a doctor. It may result in antibiotic abuse, adverse effects and unnecessary costs.

The fight to maintain the efficacy of antibiotics is global and universal. ‘All hands need to be on deck.’

Do you have a policy for laboratory testing in your hospital? Is it adhered to?

What are the challenges to optimal laboratory use in your hospital?

Post your thoughts in the comments below.