Transformation From a Conventional Clinical Microbiology Laboratory to Full Automation

Background: To validate the performance, reproducibility, and reliability of BD automated instruments in order to establish a fully automated clinical microbiology laboratory. Methods: We used control strains and clinical samples to assess the accuracy, reproducibility, and reliability of the BD Kiestra WCA, the BD Phoenix, and BD Bruker MALDI-Biotyper instruments and compared them to previously established conventional methods. The following processes were evaluated: sample inoculation and spreading, colony counts, sorting of cultures, antibiotic susceptibility test, and microbial identification. Results: The BD Kiestra recovered single colonies in less time than conventional methods (e.g. E. coli, 7h vs 10h, respectively) and agreement between both methodologies was excellent for colony counts (kappa=0.824) and sorting cultures (kappa=0.821). Antibiotic susceptibility tests performed with BD Phoenix and disk diffusion demonstrated 96.3% agreement with both methods. Finally, we compared microbial identification in BD Phoenix and Bruker MALDI-Biotyper and observed perfect agreement (kappa=1) and identification at a species level for control strains. Together these instruments allow us to process clinical urine samples in 36h (effective time). Conclusion: The BD automated technologies have improved performance compared with conventional methods, and are suitable for its implementation in very busy microbiology laboratories.