When it comes to lab automation, microbiology used to lag behind other laboratory disciplines – at least up to now. U.S. medical company Becton Dickinson has developed the fully automated sample processing system BD Kiestra TLA. This new technology, which is currently being tested at the Heidelberg University Hospital, is highly promising, particularly when dealing with the global challenge posed by microorganisms with multiple drug resistance.
If done manually, growing and identifying infecting agents in artificial culture media, such as agar plates, is a tedious job: From preparing the specimen, to streaking it across the culture medium with a wire loop, to providing it with the correct atmospheric conditions in an incubator, to labeling the plates and checking on them following a certain schedule, the necessary working steps can not only be time-consuming, but also prone to error. Although automated lab procedures would help improve the speed as well as the quality of such tasks, they are still somewhat of a novelty in medical microbiology.
“In contrast to for example clinical chemistry or hematology, where patient specimens have been processed in fully automated ways for several years, medical microbiology is one of the last areas of in vitro diagnostics, where manual procedures are still the rule—to a large part using the same techniques that were already established by Robert Koch,” a celebrated German physician and pioneering microbiologist, Dr. Detlef Storm, marketing manager for central Europe at BD Diagnostics Heidelberg, Germany, told us.
To him, the main reason for this situation is that the methods of medical microbiology are relatively hard to standardize. After all, the microbial world is both tiny and vast.
BD Acquired Kiestra for a Total Lab Automation
While at least semi-automated systems have been available for almost 10 years, fully automated microbiology lab systems are still taking baby steps. Along with companies like bioMérieux and Copan, Becton Dickinson was one of the first companies to work on a fully automated solution. To that end, four years ago BD acquired Netherlands-based company Kiestra—a pioneer in automated microbial water analytics that developed a semi-automated medical microbiology lab.
The result of this cooperation is the new BD Kiestra Total Lab Automation (TLA), which fully automatizes and digitalizes all major working steps necessary to generate a microbiological test result from a patient specimen.
Here’s how it works:
When a barcoded test tube is inserted in BD Kiestra TLA, the system automatically recognizes the type of material, retrieves and labels the appropriate culture plates from integrated petri dish storage containers, opens the test tube to pick up an aliquot with a pipet, and is able to inoculate up to five plates at the same time, using a patented streaking technology.
“Properly streaking the specimen across the plate is critical to separating the different microbial colonies from one another. Therefore we developed the magnetic rolling bead technology: A small metallic blob rolls over the culture medium and can generate streak lengths of up to four meters,” said Storm about this feature, which has been shown to produce up to three to five times more single colonies compared with manual methods.
The system then automatically transports the inoculated plates to the appropriate incubators, where each plate can be photographed up to every two hours. The lab technicians can then digitally review the plates on high-resolution monitors.
In April 2016, a BD Kiestra TLA was officially inaugurated at the microbiological laboratory of the Heidelberg University Hospital, led by Professor Dr. Klaus Heeg.
“We had two main reasons for implementing the system in our laboratory: The strong increase of test volumes as a quantitative aspect, and the fact that automated plate inoculation provides a significantly higher test resolution for microbic samples than manual methods as a qualitative aspect,” explained Dr. Stefan Zimmermann, Head of Division Bacteriology in Heeg’s laboratory. Zimmermann estimates that the test volumes at the laboratory have doubled in the last seven to eight years, mostly due to a surge in screenings for microorganisms with multiple drug resistances (MDR).
“Currently we receive about 700 samples every day from the different clinics. About 300 of those are nasal or rectal swabs for MDR screenings. These screenings have already been validated for routine testing on our BD Kiestra TLA along with all urine samples, which add up to approximately 100 samples per day,” said Zimmermann. Within the few months since the opening of BD Kiestra TLA, the lab was already able to reduce the time for most MRSA (Methicillin-resistant Staphylococcus aureus) screening results from about two days to 25 hours, thanks to the system’s ability to accurately manage inoculation times for every single culture plate.
According to Zimmermann another advantage of using the fully automated system is that lab technicians and physicians now have more time for clinically relevant tasks, such as interpreting findings or counseling clinicians about antimicrobial treatment. To better understand the effects of using BD Kiestra TLA on clinical outcomes, the lab will start conducting a crossover trial with two intensive care units, starting this fall.
The lab is also looking into training BD Kiestra TLA to become more intelligent.
“We hope that using a fully automated system will lead to quantifiable benefits for our patients, and eventually possibly even bigger scale effects such as reducing the incidence of antimicrobial resistance,” Zimmermann, who expects first preliminary results of the study in mid-2017, told us.
Together with Becton Dickinson, the lab is also looking into training BD Kiestra TLA to become more intelligent. In a first step, the system is supposed to learn to automatically identify Methicillin-resistant Staphylococcus aureus (MRSA) bacteria by recognizing the unique red hue they generate on chromogenic culture plates.