Clinical Tools

Fungemia Detection using MDRA (Multi-Disease Risk Assessment)

• A computerized algorithm that uses 34 pre-selected, weighted clinical and laboratory values (5,3,1) to optimize laboratory microbiology blood cultures for detecting Fungemia
• Multi-Disease Risk Assessment (MDRA) Fungal Infection Action Form
  [ Excel Version | PDF Version ]
  
  

Antibiotic Selection using Pharmaco-Economics Form: Linking X, Y, and Z

• A check sheet based on selected MICs that integrates pharmaco-kinetics (X), pharmaco-dynamics (Y) and pharmaco-economics (Z) for anti-infective comparison based on E-Test (AB Biodisc)
• Includes cost comparison of biofilms
• Pharmacoeconomics Form [ PDF Version ]
  
  

Blood Culture Signature: Time to Detection

• Distribution of frequent Bloodstream Isolates by Time to Detection, segregated by 6-Hospital Service Areas (corresponding to 6 Antibiograms), which allows for comparison of 50%, 75%, and 90% detection time or time organism will not be recovered. [ Click Here ]
  
  

Biofilm Susceptibility, Minimal Biofilm Eradication Concentration (MBEC) by Calgary Biofilm Device

• Susceptibility method utilizing Calgary Biofilm Device (CBD) to determine effective inhibition of biofilms, mono or multiple species aerobic or anaerobic.
  
  
• These clinical profiles with predetermined anti-infective dilutions are established for organisms associated with 3 symptoms: respiratory, urinary, and sepsis.
  
  
• Also includes an Anti-Fungal MBEC and Dental MBEC using hydroxyapatite to duplicate the tooth enamel surface. The Ratio of MBEC:MIC, may be a clinical indicator or outcomes. [ Click Here ]
  

Biofilm Susceptibility by Biofilm Elimination Concentration (BEC) using 30% F-127 Poloxamer (reverse-gel) and E-Strips with interpretation for clinical significance

• The 30% F-127 Poloxamer (liquid at 4°C) converts planktonic to biofilm phenotype formation at 37°C (solid) and allows for the utilization of E-Strips to measure anti-biofilm phenotype susceptibility simulating a Kirby Bauer Technique.
  
  
• By measuring both the planktonic (MH) and biofilm (Poloxamer) MIC and calculating a ratio (BEC/MIC), clinical significance can be evaluated.
  
  
• Four antibiotic templates (A-D) list potential antibiotics to evaluate by isolate site of infection (Respiratory, Urinary, Wound, Blood) [ Click Here ]
  

Selected Antibiograms

• Unique selection of antibiotic profiles, sorted by 1) mechanism of resistance, 2) relative resistance, and 3) clinical diseases: respiratory, wound, and indwelling medical devices (IMDs). Uses the TSN USA electronic database with daily data contributions by >500 hospitals
  [ Blood ] [ Urine ] [ All Specimens for All Locations ]
  

Biotumor: Tumors are Eucaryotic Biofilms

• There has been a long association between planktonic bacteria and tumors (Fig 2).
  
  I have also long felt that biofilms (their architecture, physical properties, chemical properties [hydrated polymer-like] and biological properties) (Fig 12) shared more properties with eucaryotic tumors (7) than procaryotic, planktonic bacteria (Fig 17).
  
  And it has been my goal to link these similarities in a practical outcome: Common Cancer Therapy (Fig 1), focused on the “Universal Biofilm Co-aggregate,” Candida albicans (Fig 10, 11). Hence, over time I have developed a number of Hypotheses, Concepts, and Aims in our Translational Biofilm Research Laboratory (Fig 3-9).
  
  All focus on the original observation that biofilms have four tumor-like stages that mimic the universal growth cycle of tumors and microbes: Lag, Log, Stationary, and Death (metastasis) (Fig 13-15). Other investigators share this concept (Fig 18).
  
  Methods to expand “Proof of Concept” have resulted in three testing strategies that evaluate anti-tumor and anti-biofilm activity of antibiotics, anti-fungal, anti-tumor (chemotherapy agents), and “others” in a unique Poloxamer assay (Fig 19) with Interpretation via a unique BioType, integrating Mechanism of Action.
  
  
• Our design strategy has focused on three options:
  
  
  • Therapeutic pharmacology discovery (Drug Discovery)
    (Variable = Drug, Concentration, and Constant = 3 organism mixed biofilm matrix)
    
    
  • Synergy Testing
    (Variable = Drug Combinations and Constant = 3 organism mixed biofilm matrix)
    
    
  • Point of Care Testing
    (Variable is cancer patient isolate and Constant is 17 drug battery template divided into A) Anti-tumor, B) Antibacterial, C) Anti-fungal, and D) Unique)
    
    
• Ultimately, the Poloxamer high through-put model could screen for new anti-tumor, antibiofilm drugs, resulting in targeting of a tumor drug and destruction via procaryotic biofilm architecture within the eucaryotic tumor biofilm (BioTumor) (Fig 20, 21). Our postulated biofilm links are shown in Figure 21.
  
  
• Poster presentations to date include:
  
  
  1. Location: IAOO (International Association of Oral Oncology). Toronto, Canada. July 8-11, 2009 Title: EXTRAPOLATING TUMOR THERAPY TO MANAGE ORAL BIOFILMS SIMULTANEOUSLY: A COMPARATIVE MODEL.
     
     
  2. Location: ASM (American Association of Microbiology) Annual Meeting. Philadelphia, PA. May 17-21, 2009. Title: EFFECTS OF ANTI-CANCER DRUGS ON BIOFILMS: BENIGN, PROCARYOTIC TUMORS
     
     
  3. Location: 5th International Biofilms Symposium (ASM) Cancun, Mexico. Nov 11-15, 2009. Title: A MODEL AND STRATEGY TO COMPARE ANTI-TUMOR AND ANTI-BIOFILM EFFICACY UTILIZING A DISTINCTIVE BIOTYPING CLASSIFICATION SYSTEM.
     
     
  4. Location: Biofilms 4 International Conference. September 1-3, 2010. Winchester, UK. Title: BIOFILM (PROCARYOTE) COMMUNITIES PREDICTING TUMOR (EUCARYOTE) THERAPY.
  
  

Bug-Drug Calculator

• Patented program to match WVUH isolates, by service and source, and stratify by sensitivity and cost, at time of physician order entry.
• Computerized Antimicrobial Decision Support: An Offline Evaluation of a Database-Driven Empiric Antimicrobial Guidance Program in Hospitalized Patients with a Bloodstream Infection. CJ Mullett, JG Thomas, et al. Int J Med Inf 2004 Jun 15:73(5):455-460.
• Database-Driven Computerized Antibiotic Decision Support: Novel use of Expert Antibiotic Susceptibility Rules Embedded in a Pathogen-Antibiotic Logic Matrix. CJ Mullett and JG Thomas. Proc AMIA Symp. 2003:480-483.
• Under Reconstruction
  
  

Mountain State Oral-Facial Microbiology Laboratory

• The importance of oral infections is emerging, given the concern about links with 3 systemic diseases: heart, lung, and adverse pregnancy outcomes.
• The Oral Facial Microbiology Laboratory is situated within the WVUH diagnostic laboratory in Ruby Memorial Hospital, combining strengths of both sections into one unique diagnostic unit (www.wvuhlab.com).
• The laboratory results are reviewed weekly by TEAM BIOFILM, a composite of Periodontists, Pharmacists, and Clinical Microbiologists, utilizing a unique report form. This includes the use of the Dental Antibiogram
  (www.wvuhlab.com)
• Under Reconstruction