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"Maldi-Tof (Bruker) with the Phoenix and move to 132 well card"

Tom Olma, SHS in-charge General Microbiology Unit, CIDMLS, icpmr Westmead, Pathology West Microbiology

Discipline Network Supervising Scientist

Identification linked to susceptibility interpretation

• Combination ID and Susceptibility cards

– Requires ID for interpretation

• Very general release of results

– With holds some/most/all

• Change ID can change interpretation

• ID can be done off line

– Staphylococci

– Maldi

integration

• Epicenter:

– Blood cultures –FX

– MGIT

– Phoenix

– Report management

• %susceptibility, Time To Detection/result, Custom formats for studies, blood volume, incidence reports etc

• Bruker Maldi TOF

EpiCare

• Creates rules that are organisational, and/or client specific

– HUB organisations

– Mixed practice-Hospital, GP, Rural

• Can also use Sentinel

– Blackberry, email, sms

Maldi – Epicentre Interface

• Through Bruker

– Accession and isolate No

– Goes to flex controller and runs.

– Sends result to epicentre

– If no order in LIS goes no where

Lis logged test • Through LIS

– Order PMID

– Lis ->epicentre->label and ready to go

• Use label to enter into Bruker

• Bruker ->epicentre with result

• Epicentre changes ID and isolate number based on Bruker accession

• If different creates conflict (combo panel) any ID with Bruker

• Epicentre sends to LIS as usual

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Interfacing to LIS: Epicentre Epicentre Client Server – bench based

Client server link to epicentre and LIS Workflow

• Order Maldi ID and Phoenix susceptibility (Combo or susceptibility only – pull down menu with default).

• Assign #Accession to Maldi template spot and label prints for phoenix panel prep

• Inoculate Maldi spot.

• Attach label to ID broth and make up #0.5 < #4.0 suspension -> AP

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• Bruker accurately identifies bacteria commonly encountered and translates to faster and cheaper processing workflows

• Bruker correlates with identification of commonly encountered bacteria with the Phoenix identification in the exception of known genus/species viz S. pneumoniae/ S.mitis & S. oralis; Shigella/E. coli; Listeria spp etc

Result of combo panel Bruker – Phoenix interfacing

Combined panel SA Pathology and ICPMR Principles and Issues

• EUCAST breakpoints where available (note exceptions, and source of alternative BPs)

• Lowest dilution in the range should be one dilution below the Susceptible (≤) breakpoint

• Highest dilution in the range should be one dilution above the Resistant (>) breakpoint

• "Yellow box" requirement for some agents can result in some ranges being longer than required

• For some agents, the lowest available concentration is not low enough to accommodate EUCAST ranges

• Fosfomycin needs 2 wells per concentration selected for Gram-negatives, but only one for Gram-positives. Reason unclear

• Streptococci panel: not required

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