Teleclinical Microbiology: An Innovative Approach to Providing Web-Enabled Diagnostic Laboratory Services in Syria

Abstract

Objectives: Telemedicine can compensate for the lack of health care specialists in response to protracted humanitarian crises. We sought to assess the usability of a teleclinical microbiology (TCM) program to provide diagnostic services in a hard-to-reach region of Syria.

Methods: A semimobile station was equipped with conventional micrograph and macrograph digital imaging systems. An electronic platform (Telemicrobiology in Humanitarian Crises, TmHC) was created to facilitate sharing, interpreting, and storing the results. A pilot study was conducted to identify the bacterial species and antimicrobial susceptibility pattern of 74 urinary clinical isolates. An experience survey was conducted to capture the feedback of 8 participants in the program.

Results: The TmHC platform (https://sdh.ngo/tmhc/) enabled systematic transmission of the laboratory records and co-interpretation of the results. The isolates were identified as Escherichia coli (n = 61), Klebsiella pneumoniae (n = 12), and Proteus mirabilis(n = 1). All the isolates were multidrug resistant. The performance of our TCM module was rated 4 (satisfying) and 5 (very satisfying) by 6 and 2 users, respectively. Data security of and cost-effectiveness were the main perceived concerns.

Conclusions: Although we encountered several context-related obstacles, our TCM program managed to reach a highly vulnerable population of 4 million people confined in the northwest region of Syria.

Keywords: Antimicrobial resistance; Conflict medicine; Telemedicine; Telepathology; Urinalysis.

FIGURE 1

Photos of the movable caravan used in our teleclinical microbiology project (A); the light microscope mounted with an eyepiece digital camera (B); the microscopic field of a Gram-stained smear (C); the BIOMIC V3 device (Giles Scientific) (D); and the antimicrobial susceptibility agar plate of 1 of the clinical isolates included in the pilot study (E).

FIGURE 2

Antimicrobial susceptibility rates for 74 urinary clinical isolates included in the pilot study. AMK, amikacin (30 μg); AMP, ampicillin (10 μg); ATM, aztreonam (30 µg); CAZ, ceftazidime (30 μg); CIP, ciprofloxacin (5 μg); CRO, ceftriaxone (30 μg); FEP, cefepime (30 μg); FOS, fosfomycin (200 μg); GEN, gentamicin (10 µg); IMI, imipenem (10 μg); MEM, meropenem (10 μg); NIF, nitrofurantoin (100 μg); SXT, trimethoprim/sulfamethoxazole (1.25/23.75 μg); TGC, tigecycline (15 μg); TOB, tobramycin (10 μg); TPZ, piperacillin/tazobactam (30/6 μg).