Ruolo ed organizzazione della microbiologia clinica di domani

Infectious diseases continue to represent an important preventive and clinical problem especially in the light of the emergence of new pathogens, of the return of infrequent pathogens and of the increased risk of infective pathologies associated with migratory flow. Another critical point is represented by the possible insurgence of infections due to agents used in bioterrorism. More than ever it is indispensable for our country to define a network of structures able to give an organized response to these relevant problems both in terms of prevention and assistance. It is therefore important to define a protocol for clinical microbiology on a national basis that responds to different levels of activity. Keeping in mind that the fundamental objectives of microbiology are: - diagnosis of infective diseases - determination of resistance to antimicrobic drugs as a valid instrument to allow the clinician to proceed with specific treatment - control of infection spreading in the sanitary structures (hospital infections) - to develop front line defence in new infections and bioterrorism, in collaboration with the department of prevention - to be a reference centre for specific training The principals on which one must base the reorganization are essentially three: 1. to configurate the microbiology service on the basis of real needs of the local population 2. to give qualitatively optimal results in real time 3. supporting “good clinical practice” to assure adequate patient results and acceptable costs for the regionale sanitary system (SSR) The organization of microbiology should therefore foresee a microbiology department, structured on a provincial basis or a vast area including a structured centralized complex with peripheral structures (even simplified). This must integrate actively with the department of prevention in regard to the dynamics of infectious diseases in the territory and with the Division of Infectious Diseases (where this exists). In parallel an active interaction with research structures (IRCCS and University) present in the territory to enable the coordinated implementation of the guidelines of research and its relapse on diagnostic exams. Keeping in mind that the quality of diagnostic performance is closely linked to the professional experience of the operators it is good practice centralizing some diagnostic procedures by identifying a reference centre. In a regional network organized in this way it is important to include a coordinating structure, since it is necessary to activate a complete level of communication, information exchange, activity planning, and complete problem solving.