%0 Journal Article
%9 ACL : Articles dans des revues avec comité de lecture répertoriées par l'AERES
%A Cohen-Bacrie, S.
%A Ninove, L.
%A Nougairede, A.
%A Charrel, R.
%A Richet, H.
%A Minodier, P.
%A Badiaga, S.
%A Noel, G.
%A La Scola, B.
%A de Lamballerie, Xavier
%A Drancourt, M.
%A Raoult, Didier
%T Revolutionizing clinical microbiology laboratory organization in hospitals with in situ point-of-care
%D 2011
%L PAR00007814
%G ENG
%J Plos One
%@ 1932-6203
%M ISI:000292929500058
%N 7
%P e22403
%R 10.1371/journal.pone.0022403
%U https://www.documentation.ird.fr/hor/PAR00007814
%V 6
%W Horizon (IRD)
%X Background: Clinical microbiology may direct decisions regarding hospitalization, isolation and anti-infective therapy, but it is not effective at the time of early care. Point-of-care (POC) tests have been developed for this purpose. Methods and Findings: One pilot POC-lab was located close to the core laboratory and emergency ward to test the proof of concept. A second POC-lab was located inside the emergency ward of a distant hospital without a microbiology laboratory. Twenty-three molecular and immuno-detection tests, which were technically undemanding, were progressively implemented, with results obtained in less than four hours. From 2008 to 2010, 51,179 tests yielded 6,244 diagnoses. The second POC-lab detected contagious pathogens in 982 patients who benefited from targeted isolation measures, including those undertaken during the influenza outbreak. POC tests prevented unnecessary treatment of patients with non-streptococcal tonsillitis (n = 1,844) and pregnant women negative for Streptococcus agalactiae carriage (n = 763). The cerebrospinal fluid culture remained sterile in 50% of the 49 patients with bacterial meningitis, therefore antibiotic treatment was guided by the molecular tests performed in the POC-labs. With regard to enterovirus meningitis, the mean length-of-stay of infected patients over 15 years old significantly decreased from 2008 to 2010 compared with 2005 when the POC was not in place (1.43 +/- 1.09 versus 2.91 +/- 2.31 days; p = 0.0009). Altogether, patients who received POC tests were immediately discharged nearly thrice as often as patients who underwent a conventional diagnostic procedure. Conclusions: The on-site POC-lab met physicians' needs and influenced the management of 8% of the patients that presented to emergency wards. This strategy might represent a major evolution of decision-making regarding the management of infectious diseases and patient care.
%$ 052