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F G Witebsky - One of the best experts on this subject based on the ideXlab platform.
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susceptibility testing of mycobacterium avium complex in clinical laboratories results of a questionnaire and proficiency test performance by participants in the college of american pathologists Mycobacteriology e survey
Archives of Pathology & Laboratory Medicine, 1996Co-Authors: Gail L Woods, F G WitebskyAbstract:. Objectives.-To obtain information regarding the frequency and methodology of susceptibility testing of Mycobacterium avium complex (MAC) in clinical microbiology laboratories, and to assess interlaboratory reproducibility of MAC susceptibility testing. Design.-Questions addressing MAC susceptibility testing were added to the College of American Pathologists' 1994 Mycobacteriology E Proficiency Testing Survey, and participants were asked to complete the questionnaire. In addition, participants in the 1994 E Survey were asked to test susceptibility of a MAC isolate recovered from a proficiency testing specimen as an ungraded exercise if they offered such testing for patients. Results.-of the 1003 participants enrolled in the 1994 Mycobacteriology E-A Survey, 806 responded to one or more supplemental questions. In regard to the demand for MAC susceptibility testing, 606 participants indicated that the test is requested by physicians in their institutions, and 188 said that they do the test routinely on at least one MAC isolate per patient. Eighty-two percent (630/765) of participants refer the test to an outside laboratory, most commonly a commercial reference laboratory or state health laboratory. Of the 70 participants who perform MAC susceptibility testing in-house and indicated the method on the questionnaire, 54 (77%) used a solid medium, whereas only 14 (20%) used BACTEC TB, which currently is the recommended method. The most frequently tested drugs were ethambutol, rifampin, isoniazid, and streptomycin ; other commonly evaluated agents were ciprofloxacin, amikacin, and clarithromycin. Only eight participants modify the pH of the medium when testing a macrolide. In regard to reporting test results, 56% (45/80) report a qualitative result only, 35% (28/80) report a quantitative result with a qualitative interpretation, and 9% (7/80) report only a quantitative result. Participant performance on the MAC proficiency testing specimen showed lack of interlaboratory reproducibility ; 80% or fewer participants reported the correct result for all drugs except amikacin, for which 92% (11/17) of laboratories responded correctly. Conclusions.-Given the obvious interest in MAC susceptibility testing, standardized methodology that demonstrates interlaboratory reproducibility and, optimally, shows some correlation with clinical outcome is needed. Moreover, recommendations concerning indications for performing the test would be useful.
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mycobacterial testing in clinical laboratories that participate in the college of american pathologists Mycobacteriology e survey results of a 1993 questionnaire
Journal of Clinical Microbiology, 1995Co-Authors: Gail L Woods, F G WitebskyAbstract:Participants in the College of American Pathologists' Mycobacteriology E proficiency testing survey in 1993 were asked to complete a questionnaire addressing mycobacterial test methods, test volume, and frequency of detection of drug-resistant Mycobacterium tuberculosis (MTB). A similar questionnaire had been distributed in 1992. The population responding to the 1993 questionnaire changed, because of a shift of small hospitals to the limited Mycobacteriology E1 survey, and the format of some questions was altered, so a direct comparison of 1992 and 1993 responses was not always possible. Among participants who answered the questions in both years, there was a significant increase in the use of the fluorochrome stain (57% in 1992, 61% in 1993), BACTEC TB for culture (34% in 1992, 38% in 1993) and susceptibility testing (51% in 1992, 61% in 1993), and DNA probes for identification (30% in 1992, 51% in 1993). The percentage of participants who processed respiratory specimens at least seven times per week increased from 9% in 1992 to 13% in 1993, and the percentage processing five times per week increased from 68 to 72%. The percentage of respondents who reported an identification of MTB within 21 days of specimen receipts and susceptibility test results within 28 days in 1992 and 1993 increased from 30 to 41% and from 12 to 19%, respectively. In regard to resistant MTB, 177 institutions in 1991 and 291 in 1992 reported resistance to isoniazid, and 114 in 1991 and 187 in 1992 reported resistance to both isoniazid and rifampin. Laboratorians are to be applauded for using the more rapid mycobacterial testing methods; however, given that tuberculosis remains a problem, this trend must continue.
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college of american pathologists Mycobacteriology e proficiency testing survey summary of participant performance 1979 1992
Archives of Pathology & Laboratory Medicine, 1995Co-Authors: Gail L Woods, F G WitebskyAbstract:The College of American Pathologists first offered a program of proficiency testing in Mycobacteriology in 1969 to laboratories that offered any extent of diagnostic service. This program was intended to provide a mechanism for evaluation of methods of staining, culture, identification, and susceptibility testing. From 1979 to 1992, the period covered by this review, participation in the Mycobacteriology E Survey increased almost sixfold. On graded smears to be stained for detection of acid-fast bacilli, more than 85% of Extent 4 and Extent 3 laboratories and more than 80% of Extent 2 laboratories responded correctly to all specimens except one. Performance on specimens that contained Mycobacterium tuberculosis was similar for Extent 4 and Extent 3 laboratories. For all specimens containing M tuberculosis, a mean of more than 90% of Extent 4 and Extent 3 laboratories provided a correct identification each year except 1979, when a mean of 83% of Extent 3 laboratories responded correctly. Only Extent 4 laboratories were required to identify isolates other than M tuberculosis to the species level. For specimens that contained nontuberculous mycobacteria, the means of the yearly averages of correct responses for Extent 4 laboratories were 90% or greater for M kansasii, M marinum, M avium complex, and M fortuitum-chelonae complex and less than 85% for M bovis, M simiae, M scrofulaceum, M szulgai, M flavescens, M xenopi, M terrae complex, and M gastri. In general, on these same specimens, a slightly higher percentage of Extent 3 laboratories (which were required to identify only M tuberculosis to the species or complex level) gave correct or acceptable responses, and the performance of Extent 2 laboratories (which were only required to report whether or not a mycobacterium was present) was the best of all extents. The data suggest that laboratory performance improved somewhat after initial experience with uncommonly encountered organisms. For the most part, however, performance with a given species changed minimally from year to year.
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current status of mycobacterial testing in clinical laboratories results of a questionnaire completed by participants in the college of american pathologists Mycobacteriology e survey
Archives of Pathology & Laboratory Medicine, 1993Co-Authors: G L Woods, F G WitebskyAbstract:To learn what methods are used in clinical microbiology laboratories for detection, identification, and susceptibility testing of mycobacteria, questions addressing these issues were added to the College of American Pathologists' Mycobacteriology E proficiency testing survey, and participants in the survey were asked to complete the questionnaire. Other questions related to numbers of Mycobacteriology tests performed and the frequency with which drug-resistant Mycobacterium tuberculosis is isolated. Just over half of the respondents stained smears for acid-fast bacilli with the fluorochrome stain. Only 26% of respondents processed respiratory specimens daily, potentially providing results within 24 hours of receiving the specimen. The most rapid methods currently available for detection of mycobacteria and for identification of M tuberculosis, respectively, were used by 30% and 35% of the respondents. Half of the respondents who performed susceptibility testing on isolates of M tuberculosis used rapid methods. Approximately 26% of the respondents indicated that they usually provided a final identification of M tuberculosis within 21 days of receiving a specimen, and 11% indicated that identification and susceptibility test results were reported within 28 days. Participants' responses indicated that the mean number of specimens received for mycobacterial culture per month was higher during the first 5 months of 1992 than it had been in 1991. Moreover, the number of drug-resistant M tuberculosis isolated per month from January through May 1992 was about double the number isolated per month in 1991.(ABSTRACT TRUNCATED AT 250 WORDS)
Gail L Woods - One of the best experts on this subject based on the ideXlab platform.
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the Mycobacteriology laboratory and new diagnostic techniques
Infectious Disease Clinics of North America, 2002Co-Authors: Gail L WoodsAbstract:Use of the most rapid and reliable laboratory tests for mycobacterial detection, identification, and susceptibility testing is important for TB control. In 1993, CDC experts made recommendations regarding optimal methods of mycobacterial testing (i.e., stains for AFB, culture, identification, and susceptibility testing of M. tuberculosis) and turnaround times for reporting results. Various technical advances have enhanced the diagnostic capability of the laboratory and/or improved laboratory efficiency since then. The commercial NAA tests for direct detection of MTBC have the greatest potential to impact patient care. To assist physicians, CDC experts have published recommendations concerning use of the NAA tests for management of patients with suspected TB, with emphasis on the MTD assay, which is approved for both AFB smear-positive and smear-negative specimens. With regard to mycobacterial culture, totally automated, nonradiometric systems are commercially available. For mycobacterial identification, various molecular techniques have been developed, but at present, they are used predominantly in research or large reference laboratories. Molecular tests also have proved useful for better understanding the epidemiology of TB and investigating episodes of suspected laboratory cross-contamination. With regard to mycobacterial susceptibility testing, use of the new automated culture systems for testing MTBC is under evaluation, but only one such system has been approved for this purpose. In addition, laboratory guidelines for susceptibility testing of MTBC and certain NTM have recently been published by the NCCLS.
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quality assurance in the Mycobacteriology laboratory quality control quality improvement and proficiency testing
Clinics in Laboratory Medicine, 1996Co-Authors: Gail L Woods, John C RidderhofAbstract:In conclusion, the components of QA (QC, QI, and PT) in the Mycobacteriology laboratory address not only the accuracy of testing but also provide a measure for the laboratory practices that are necessary to effectively diagnose and control tuberculosis in the community. Given the extremely important role of laboratory testing in the control of tuberculosis, providing rapid diagnosis and determination of susceptibility test results, laboratories should use the recommendations concerning turnaround times as either achievable goals or a measure of whether the laboratory should be performing Mycobacteriology tests. We strongly urge laboratories to include their turnaround times for test results and the timeliness of reporting those results in their annual QA program.
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susceptibility testing of mycobacterium avium complex in clinical laboratories results of a questionnaire and proficiency test performance by participants in the college of american pathologists Mycobacteriology e survey
Archives of Pathology & Laboratory Medicine, 1996Co-Authors: Gail L Woods, F G WitebskyAbstract:. Objectives.-To obtain information regarding the frequency and methodology of susceptibility testing of Mycobacterium avium complex (MAC) in clinical microbiology laboratories, and to assess interlaboratory reproducibility of MAC susceptibility testing. Design.-Questions addressing MAC susceptibility testing were added to the College of American Pathologists' 1994 Mycobacteriology E Proficiency Testing Survey, and participants were asked to complete the questionnaire. In addition, participants in the 1994 E Survey were asked to test susceptibility of a MAC isolate recovered from a proficiency testing specimen as an ungraded exercise if they offered such testing for patients. Results.-of the 1003 participants enrolled in the 1994 Mycobacteriology E-A Survey, 806 responded to one or more supplemental questions. In regard to the demand for MAC susceptibility testing, 606 participants indicated that the test is requested by physicians in their institutions, and 188 said that they do the test routinely on at least one MAC isolate per patient. Eighty-two percent (630/765) of participants refer the test to an outside laboratory, most commonly a commercial reference laboratory or state health laboratory. Of the 70 participants who perform MAC susceptibility testing in-house and indicated the method on the questionnaire, 54 (77%) used a solid medium, whereas only 14 (20%) used BACTEC TB, which currently is the recommended method. The most frequently tested drugs were ethambutol, rifampin, isoniazid, and streptomycin ; other commonly evaluated agents were ciprofloxacin, amikacin, and clarithromycin. Only eight participants modify the pH of the medium when testing a macrolide. In regard to reporting test results, 56% (45/80) report a qualitative result only, 35% (28/80) report a quantitative result with a qualitative interpretation, and 9% (7/80) report only a quantitative result. Participant performance on the MAC proficiency testing specimen showed lack of interlaboratory reproducibility ; 80% or fewer participants reported the correct result for all drugs except amikacin, for which 92% (11/17) of laboratories responded correctly. Conclusions.-Given the obvious interest in MAC susceptibility testing, standardized methodology that demonstrates interlaboratory reproducibility and, optimally, shows some correlation with clinical outcome is needed. Moreover, recommendations concerning indications for performing the test would be useful.
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mycobacterial testing in clinical laboratories that participate in the college of american pathologists Mycobacteriology e survey results of a 1993 questionnaire
Journal of Clinical Microbiology, 1995Co-Authors: Gail L Woods, F G WitebskyAbstract:Participants in the College of American Pathologists' Mycobacteriology E proficiency testing survey in 1993 were asked to complete a questionnaire addressing mycobacterial test methods, test volume, and frequency of detection of drug-resistant Mycobacterium tuberculosis (MTB). A similar questionnaire had been distributed in 1992. The population responding to the 1993 questionnaire changed, because of a shift of small hospitals to the limited Mycobacteriology E1 survey, and the format of some questions was altered, so a direct comparison of 1992 and 1993 responses was not always possible. Among participants who answered the questions in both years, there was a significant increase in the use of the fluorochrome stain (57% in 1992, 61% in 1993), BACTEC TB for culture (34% in 1992, 38% in 1993) and susceptibility testing (51% in 1992, 61% in 1993), and DNA probes for identification (30% in 1992, 51% in 1993). The percentage of participants who processed respiratory specimens at least seven times per week increased from 9% in 1992 to 13% in 1993, and the percentage processing five times per week increased from 68 to 72%. The percentage of respondents who reported an identification of MTB within 21 days of specimen receipts and susceptibility test results within 28 days in 1992 and 1993 increased from 30 to 41% and from 12 to 19%, respectively. In regard to resistant MTB, 177 institutions in 1991 and 291 in 1992 reported resistance to isoniazid, and 114 in 1991 and 187 in 1992 reported resistance to both isoniazid and rifampin. Laboratorians are to be applauded for using the more rapid mycobacterial testing methods; however, given that tuberculosis remains a problem, this trend must continue.
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college of american pathologists Mycobacteriology e proficiency testing survey summary of participant performance 1979 1992
Archives of Pathology & Laboratory Medicine, 1995Co-Authors: Gail L Woods, F G WitebskyAbstract:The College of American Pathologists first offered a program of proficiency testing in Mycobacteriology in 1969 to laboratories that offered any extent of diagnostic service. This program was intended to provide a mechanism for evaluation of methods of staining, culture, identification, and susceptibility testing. From 1979 to 1992, the period covered by this review, participation in the Mycobacteriology E Survey increased almost sixfold. On graded smears to be stained for detection of acid-fast bacilli, more than 85% of Extent 4 and Extent 3 laboratories and more than 80% of Extent 2 laboratories responded correctly to all specimens except one. Performance on specimens that contained Mycobacterium tuberculosis was similar for Extent 4 and Extent 3 laboratories. For all specimens containing M tuberculosis, a mean of more than 90% of Extent 4 and Extent 3 laboratories provided a correct identification each year except 1979, when a mean of 83% of Extent 3 laboratories responded correctly. Only Extent 4 laboratories were required to identify isolates other than M tuberculosis to the species level. For specimens that contained nontuberculous mycobacteria, the means of the yearly averages of correct responses for Extent 4 laboratories were 90% or greater for M kansasii, M marinum, M avium complex, and M fortuitum-chelonae complex and less than 85% for M bovis, M simiae, M scrofulaceum, M szulgai, M flavescens, M xenopi, M terrae complex, and M gastri. In general, on these same specimens, a slightly higher percentage of Extent 3 laboratories (which were required to identify only M tuberculosis to the species or complex level) gave correct or acceptable responses, and the performance of Extent 2 laboratories (which were only required to report whether or not a mycobacterium was present) was the best of all extents. The data suggest that laboratory performance improved somewhat after initial experience with uncommonly encountered organisms. For the most part, however, performance with a given species changed minimally from year to year.
Robert C Good - One of the best experts on this subject based on the ideXlab platform.
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biosafety in the clinical Mycobacteriology laboratory
Clinics in Laboratory Medicine, 1996Co-Authors: Jonathan Y Richmond, Richard C Knudsen, Robert C GoodAbstract:This article presents an expanded agent summary statement for laboratorians working with Mycobacterium tuberculosis. It focuses on reducing the serious risk of infection in clinical laboratories that process specimens from tuberculosis patients or that work with purified cultures of tubercle bacilli. Administrative and engineering controls, practices and procedures, and personal protective equipment are discussed. Guidelines for packaging specimens for transfer to another laboratory also are presented.
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changing practices in Mycobacteriology a follow up survey of state and territorial public health laboratories
Journal of Clinical Microbiology, 1996Co-Authors: B R Bird, M M Denniston, R E Huebner, Robert C GoodAbstract:The resurgence of tuberculosis, which includes an increase in the isolation of multidrug-resistant strains of Mycobacterium tuberculosis, emphasizes the need for more rapid laboratory testing for identification of the etiological agent of the disease. In December 1991, state and territorial public health laboratories were surveyed to determine the methods that they were using for testing and reporting of M. tuberculosis. A follow-up survey was conducted in June 1994 to measure changes in the testing and reporting practices that had occurred as a result of efforts focused on the disease and on laboratory improvement. Completed questionnaires were received from 51 of 55 laboratories. Comparative data indicate that the proportion of laboratories reporting testing results within the number of days recommended by the Centers for Disease Control and Prevention has increased. Starting from the time at which the laboratory receives the specimen, the proportion of laboratories reporting the results of microscopic smear examination within the recommended 24 h has increased from 52.1 to 77.6%; the proportion reporting isolation and identification within 21 days has increased from 22.1 to 72.9%; and the proportion reporting results of isolation, identification, and drug susceptibility testing within 28 days has increased from 16.7 to 48.9%. Use of the recommended rapid testing methods has also increased: the proportion of laboratories using fluorescence staining for acid-fast microscopy has increased from 71.4 to 85.7%, the proportion using BACTEC for primary culture has increased from 27.1 to 79.6%, the proportion using rapid methods for M. tuberculosis identification has increased from 74.5 to 100.0%, and the proportion using BACTEC for primary drug susceptibility testing has increased from 26.2 to 73.3%. By implementing the recommended methods for M. tuberculosis testing and reporting, state and territorial public health laboratories are now able to transmit results to physicians more rapidly.
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diagnostic Mycobacteriology laboratory practices
Clinical Infectious Diseases, 1995Co-Authors: Thomas M Shinnick, Robert C GoodAbstract:The resurgence of tuberculosis has forced clinical laboratories to improve the methods used for detection of M. tuberculosis. Current recommendations for diagnostic laboratory performance [7] include (1) daily processing of specimens (i.e., handling these specimens in the same way that all other specimens sent to the laboratory are handled); (2) inoculation of liquid media (e.g., BACTEC) for the primary culture; (3) use of nucleic acid probes or the NAP test for identifying isolates as M. tuberculosis as soon as possible; (4) determining drug susceptibility with use of liquid media; and (5) reporting results of each step to physicians in a timely manner. The immediate goals are to report identification of M. tuberculosis within 10-14 days of receipt of the specimen and to report drug susceptibilities within 15-30 days. This can be done if current technologies are fully utilized. The amplification-based systems for the identification of M. tuberculosis and the luciferase-based systems for rapid determination of drug susceptibilities should help further shorten turn-around times. The results to date demonstrate that these systems are feasible, although they must be reduced to formats that can be used routinely in clinical laboratories. The gene-amplification systems may be the most promising, and they are nearing commercial availability. If the assays function as well during routine use as they have during clinical trials, a clinical laboratory may soon be able to report confirmed M. tuberculosis infection to the physician within hours of receiving a specimen, instead of within the typical period of 2-4 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)
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current practices in Mycobacteriology results of a survey of state public health laboratories
Journal of Clinical Microbiology, 1993Co-Authors: R E Huebner, Robert C Good, Jerome I TokarsAbstract:Fifty-six state and territorial public health laboratories were surveyed to determine whether currently available rapid methods for the identification and drug susceptibility testing of Mycobacterium tuberculosis were being performed. Forty (71%) laboratories use fluorochrome rather than conventional basic fuchsin stains for screening clinical specimens for acid-fast bacilli. Of the 55 laboratories that routinely culture for mycobacteria, 16 (29%) use the more rapid radiometric methods. Species identification of isolates is done by biochemical tests in 13 (23%) laboratories; 40 (72%) use nucleic acid probes, high-performance liquid chromatography, or the BACTEC p-nitro-alpha-acetylamino-beta-hydroxypropiophenone (NAP) test (rapid tests); 3 laboratories do not perform species identification. Drug susceptibility testing is performed with solid media by 36 of 45 (80%) laboratories, while the more rapid radiometric methods are used by 9 (20%) laboratories. Compared with the laboratories that use conventional methods, laboratories that use rapid methods report results more quickly: for species identification, 43 days (conventional) versus 22 days (rapid); for drug susceptibility testing, 44 days (conventional) versus 31 days (rapid) from specimen processing. Rapid technologies for microscopy and species identification are being used by many, but not all, state and territorial public health laboratories; however, most laboratories do not use the more rapid radiometric methods for routine culture or drug susceptibility testing of mycobacteria. Implementation of such rapid technologies can shorten turnaround times for the laboratory diagnosis of tuberculosis and recognition of drug resistance.
M Salfinger - One of the best experts on this subject based on the ideXlab platform.
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Laboratory Diagnosis of Mycobacterial Infections: New Tools and Lessons Learned
Clinical Infectious Diseases, 2002Co-Authors: Yvonne m. Hale, Gaby e. Pfyffer, M SalfingerAbstract:Even in the 21st century, tuberculosis continues to be a problem. Although the number of cases continues gradually to decrease in the United States, cases get more difficult to treat, specifically those that are multiple-drug resistant. Infection of one-third of the world's population ensures that tuberculosis will not disappear in the near future. In light of this, it will be useful to know the goals for the health care system and how these goals may be accomplished. Laboratory testing in the Mycobacteriology field is experiencing more changes today than ever before. Determining what assays will be most useful to the clinician is a challenge, and acceptance of the new technology by the medical community an even greater one. Clinicians must use the best available resources to determine the most appropriate care for their patients and work together with the laboratory to ensure that the communication channels are open. This review focuses on current state-of-the-art resources useful for accurate and rapid laboratory diagnosis of mycobacterial infections.
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The new diagnostic Mycobacteriology laboratory
European Journal of Clinical Microbiology and Infectious Diseases, 1994Co-Authors: M Salfinger, Gaby e. PfyfferAbstract:Recent surveys in the USA show that many Mycobacteriology laboratories continue to use less-than-optimum culture and susceptibility testing methods. This seems to be true for European countries as well. The past few years have brought significant changes to the clinical tuberculosis laboratory. High-performance liquid chromatography and direct detection of acid-fast bacilli in clinical specimens aim at the same goal: increased sensitivity and specificity of the diagnostic approach and reduction of turnaround time. This review outlines a brief comparison between contemporary traditional methods and the latest developments in the direct detection of acid-fast bacilli. If patient care and public health are always considered paramount, regardless of admission time, hospital type, etc., the current concept of services has several shortcomings. One way to manage this situation is to sort and allocate specimens according to a system of priorities. There is a growing realization that no single method by itself is the best. To streamline the best choice for laboratory diagnosis, an additional dynamic acid-fast network is presented: ‘Point-of-Care,’ ‘Fast Track,’ and ‘Specialty’ laboratories. The physician interacts with all three types of laboratories, so ongoing communication between the physician and the laboratory is essential. Laboratorians must work together in the formation of this dynamic acid-fast network to improve service rendered for our patients.
Gaby e. Pfyffer - One of the best experts on this subject based on the ideXlab platform.
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Laboratory Diagnosis of Mycobacterial Infections: New Tools and Lessons Learned
Clinical Infectious Diseases, 2002Co-Authors: Yvonne m. Hale, Gaby e. Pfyffer, M SalfingerAbstract:Even in the 21st century, tuberculosis continues to be a problem. Although the number of cases continues gradually to decrease in the United States, cases get more difficult to treat, specifically those that are multiple-drug resistant. Infection of one-third of the world's population ensures that tuberculosis will not disappear in the near future. In light of this, it will be useful to know the goals for the health care system and how these goals may be accomplished. Laboratory testing in the Mycobacteriology field is experiencing more changes today than ever before. Determining what assays will be most useful to the clinician is a challenge, and acceptance of the new technology by the medical community an even greater one. Clinicians must use the best available resources to determine the most appropriate care for their patients and work together with the laboratory to ensure that the communication channels are open. This review focuses on current state-of-the-art resources useful for accurate and rapid laboratory diagnosis of mycobacterial infections.
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The new diagnostic Mycobacteriology laboratory
European Journal of Clinical Microbiology and Infectious Diseases, 1994Co-Authors: M Salfinger, Gaby e. PfyfferAbstract:Recent surveys in the USA show that many Mycobacteriology laboratories continue to use less-than-optimum culture and susceptibility testing methods. This seems to be true for European countries as well. The past few years have brought significant changes to the clinical tuberculosis laboratory. High-performance liquid chromatography and direct detection of acid-fast bacilli in clinical specimens aim at the same goal: increased sensitivity and specificity of the diagnostic approach and reduction of turnaround time. This review outlines a brief comparison between contemporary traditional methods and the latest developments in the direct detection of acid-fast bacilli. If patient care and public health are always considered paramount, regardless of admission time, hospital type, etc., the current concept of services has several shortcomings. One way to manage this situation is to sort and allocate specimens according to a system of priorities. There is a growing realization that no single method by itself is the best. To streamline the best choice for laboratory diagnosis, an additional dynamic acid-fast network is presented: ‘Point-of-Care,’ ‘Fast Track,’ and ‘Specialty’ laboratories. The physician interacts with all three types of laboratories, so ongoing communication between the physician and the laboratory is essential. Laboratorians must work together in the formation of this dynamic acid-fast network to improve service rendered for our patients.
