Performance evaluation of the Mini-Lab, an all-in-one clinical bacteriology laboratory adapted to low-resource settings, in a district hospital in Central African Republic: A prospective descriptive study

Abstract

Objectives: Médecins sans Frontières designed an all-in-one microbiology laboratory (the "Mini-Lab") to improve bacterial infections diagnosis in low-resource settings by nonexpert laboratory staff. We assessed the diagnostic performance of the Mini-Lab in its final intended use.

Methods: This was a prospective descriptive study at a District Hospital in Central African Republic. We included hospitalised patients who had a blood culture prescription. Bacteria isolated in the Mini-Lab were sent to a reference laboratory for confirmation. Ease of use was assessed using a self-administered questionnaire after training and up to 8 months after.

Results: Isolated from 960 blood cultures between Sept 2021 and Feb 2022, 76 pathogens were sent for confirmation. The concordance of bacterial identification between the Mini-Lab and the reference method was 97% (74/76) at genus level and 90% (68/76) at species level. Antibiogram showed very good category concordances (≥90%) between the Mini-Lab and the reference methods for most antibiotics. The Mini-Lab was perceived as easy to use by the laboratory technicians.

Conclusion: The Mini-Lab, routinely implemented in a district hospital in combination with an antimicrobial stewardship programme showed good performances and usability by nonexpert laboratory staff. It is a promising solution to improve access to microbiological diagnostics in remote areas.

Keywords: Antimicrobial resistance; Blood culture; Low-resource settings; Microbiology laboratory; Sepsis.