Jim Poggi
By Jim Poggi
Everybody wants to prevent infection; what about detecting infections?
What’s all the fuss about infection prevention? We had a record flu kit season, so we did our part in the physician office lab. Besides, most infections are diagnosed and treated in the hospital, not the physician office, right? Nope, not even if you sold a few strep and RSV kits along the way and placed some of the new, exciting molecular testing platforms that are out there.
Physician practices, with or without labs, are bombarded with concerns about infection prevention, antibiotic stewardship and sepsis every day. From peer reviewed journals, internet blogs, consumer magazines and newspapers to questions being raised by patients themselves, concerns about preventing, diagnosing and treating infections are becoming top of mind. The very realistic concerns about emerging strains of antibiotic resistant bacteria make the prospect of living in a world without effective antibiotics a frightening prospect and one that just might be on the horizon. In addition, sepsis, which can quickly turn an infection into a deadly situation, is gaining a lot of attention. It progresses rapidly, and urgent diagnosis and treatment are critical to save lives and prevent organ damage and other complications. Urgent care centers and free-standing emergency rooms face a higher percentage of acutely ill patients and deal with these challenges to an even greater degree.
The distributor rep and infection prevention
So what’s the role of the distributor account manager? You have a lot of responsibility to know the issues, stay well informed, and help your customers understand available solutions for the entire continuum of infection management, from prevention to diagnosis to treatment and management in the post-acute stages including wound care. This article will focus on diagnosis, since that is clearly the role of lab for our physician customer base. There is a LOT to know, and this article will provide some useful facts and suggestions, but is by no means a comprehensive resource.
Since many acute infections (rapid onset, high fever, muscle aches and even delirium) end up in the emergency room, what is the role of infection diagnosis in primary care, urgent care centers and free-standing emergency rooms? Ten years ago, the answer would have been that CLIA waived practices should test for flu and strep. CLIA moderate complexity practices should consider CBCs to help differentiate between viral and bacterial infections. Few physician practices were testing for RSV, and there were no simple-to-perform tests for Clostridium difficile and MRSA. STD testing was largely confined to hospitals and community health clinics and HIV and hepatitis C (HCV) testing was clustered in a few communities with a concentration of high risk individuals and concerned clinicians. Since plated microbiology media are CLIA high complexity, take highly trained personnel and results require one day or more, they had very little acceptance or applicability in primary care practices.
The need for early detection
With the advent of new reader-based rapid tests and molecular technologies broadening the range of available infectious disease tests, increased awareness of the need for early detection and accurate identification of the cause of infection and new effective treatments for hepatitis C, the picture has changed dramatically in recent years. Every practice will need to make an informed decision about the range of tests appropriate to perform, from patient, personnel, equipment and risk tolerance considerations.
But the range of options has expanded dramatically. Some thoughts on applicable tests for a variety of infections is provided below to give you some food for thought as you approach your customers and help them to deliver appropriate solutions to the challenges of infection diagnosis. Your category or marketing team, lab suppliers and specialists are also in an excellent position to guide you in delivering solutions for your customers and prospects. Be sure to use all the resources at your disposal.
Some diagnostic tests for common infections
| Type of infection | Available tests | Formats | CLIA waived? |
| Respiratory | Flu, strep, RSV, adenovirus | Visual rapid, reader rapids, molecular | Most are |
| Enteric | C. difficile, H. pylori (antigen), E. coli, many others | Visual rapids, molecular | Some |
| STD | Syphilis, gonorrhea, chlamydia, HIV, others | Visual rapid, latex agglutination, plated media, molecular | Some |
| Hepatitis | HAV, HBV, HCV | Visual rapid (HCV), molecular | HCV rapid |
| Skin wound | Specific pathogens including strep | Plated media, molecular | No |
| Urinary tract | Urinalysis, specific pathogen tests | Urinalysis, plated media, molecular | Urinalysis |
| Eye | Conjunctivitis (adenovirus) | Visual rapid | Yes |
| Bacterial v Viral | CBC, specific pathogen tests | CBC, molecular | New CBC |
| Sepsis detection | Lactate, procalcitonin | Chemistry and immunoassay systems | No |
The literature and available tests for infections are undergoing rapid and exciting changes. The range of choices of tests and test methods you have available today suits many more physician practice needs than ever before and continues to improve. We have faster, more accurate and easier to use tests for more sources of infection than ever before. While antibiotic resistance and sepsis are daunting prospects, you, your manufacturers and the laboratory community are better armed than ever before to combat these challenges.
Infections and diagnosis facts
- Organ panel tests (ALT, AST, CMP and BMP) are important follow up tests after an acute sepsis episode to understand the extent of organ damage caused by sepsis
- There are more than 30 different pathogens (viral or bacterial) that can cause respiratory infections; differential diagnosis is critical to treatment plans
- Only about 20 percent of all the flu tests performed in the past flu season were positive
- Sepsis is NOT an infection; it is the body’s reaction to an infection
- Urinary tract infections, E. coli, influenza, strep and MRSA are leading causes of sepsis
- Cure rates for hepatitis C in the United States are now over 95 percent using newer medications
- The CDC recommends HIV and HCV screening in healthcare settings for specific patient populations
- HCV for baby boomers – adults born from 1945 through 1965
- HIV: The CDC recommends HIV screening for patients aged 13-64 years in all health-care settings