Research Article

Workflow Modifications and Addition of MALDI-TOF-MS Technology Improved Turn-Around-Time to Identification of Common Urine Pathogens

Author: Amity L. Roberts

Objective: To modify both workflow and culture reading schedules to improve Turn-Around-Time (TAT) to a final urine culture report. Methods: We incorporated Matrix Assisted Laser Desorption/Ionization-Time of Flight-Mass Spectrometry Technology (MALDI-TOF-MS) into the workflow of the culture workups for rapid identification (ID). We also modified our culture reading schedules to include a split shift reading in addition to our conventional first shift culture reading schedule. Results: Retrospective pre-workflow (September-November 2013) and post-workflow (April, May, October 2014) modification turn-around-times were compared for sixteen different species of commonly isolated urine pathogens. A statistically significant (p-value <0.05) improvement in average TAT was noted for all species examined. Furthermore, Antimicrobial Susceptibility Testing (AST) TAT, and release of no growth culture TAT, improved significantly. The average pre-algorithm Length of Stay (LOS) was 5.345 days while the average post-algorithm LOS was 4.761 days (P=0.0005), when >10 days LOS cases were excluded. Conclusion: Converting from conventional identification methods to MALDI-TOF-MS, in conjunction with workflow modifications such as a second culture reading time, notably improved urine culture TAT for ID and AST, as well as for release of no-growth cultures. The improved TAT in the laboratory translated to a statistically significant improvement in inpatient LOS.