The Mini-Lab: The next step towards integrated antimicrobial resistance surveillance from a global health perspective
Introduction: Access to diagnostics in low- and middle-income countries (LMICs), in particular to clinical microbiology is crucial at district level to provide effective and timely patient treatment. Furthermore, data related to antimicrobial resistance (AMR) are often inconsistently collected in LM...
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| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-03-01
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| Series: | International Journal of Infectious Diseases |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1201971224008130 |
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| Summary: | Introduction: Access to diagnostics in low- and middle-income countries (LMICs), in particular to clinical microbiology is crucial at district level to provide effective and timely patient treatment. Furthermore, data related to antimicrobial resistance (AMR) are often inconsistently collected in LMICs. To address this problem, the non-governmental medical organization (NGO) Médecins Sans Frontières developed the Mini-Lab, a self-contained, easily installed, quality-assured, stand-alone clinical bacteriology laboratory to facilitate sepsis diagnosis in its fields of intervention. In addition to the diagnostic management of patients, the Mini-Lab can also contribute to AMR surveillance in rural settings and, ultimately, in the elaboration of antibiotic guidelines based on local epidemiological data. Because the Mini-Lab could make bacteriological diagnosis affordable and accessible for patients living in the most remote areas, we evaluated the different stages of Mini-Lab implementation in two different health facilities located outside MSF's field of intervention. The integration of the Mini-Lab into the local epidemiological surveillance system and its contribution to the adaptation of local antimicrobial guidelines was also assessed. Methods: All stages of the deployment process (started in June 2023) of two Mini-Lab in Ha Hoa province in Vietnam and South Kivu province in the Democratic Republic of Congo (DRC) respectively were examined in this study. This includes analysis of the diagnostic mapping carried out prior to implementation, evaluation of laboratory technician training, ease-of-use analysis of the entire laboratory workflow, advice on antimicrobial stewardship as well as contribution to antimicrobial resistance surveillance. Results: Preliminary field results show that diagnostic mapping is crucial before deployment to meet the local needs and avoid any unnecessary waste of resource. Given the dependence on local human skills, laboratory staff training and remote assistance via tele microbiology after the field training module are essential to the successful implementation of MSF out-of-field. In addition, close collaboration with infectious diseases specialists (IDS) and infection prevention and control (IPC) teams is crucial to leverage the added-value of the laboratory results provided by the Mini-Lab, whether in the diagnosis of sepsis, meningitis or urinary tract infections. Beside its clinical usefulness, the Mini-Lab has proved capable of contributing to the monitoring of AMR at the district level in both areas, thanks to its connection to WHONET. Conclusion: Simple enough to be implemented in remote locations in all countries, including LMIC ones, the Mini-Lab can be seen as an important step towards strengthening clinical bacteriology at the district hospital level and establishing a sustainable national AMR surveillance system, including in rural and/or remote areas. In addition to its contribution to individual care, the use of the Mini-Lab will provide public health authorities with crucial, timely and invaluable information to improve global health. |
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| ISSN: | 1201-9712 |