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Year : 2016  |  Volume : 34  |  Issue : 2  |  Page : 260--261

Microbial identification systems: Making us tilt at windmills?

S Khan, A Kumar 
 Department of Microbiology, Amrita Institute of Medical Sciences, Ponekara, Kochi, Kerala, India

Correspondence Address:
S Khan
Department of Microbiology, Amrita Institute of Medical Sciences, Ponekara, Kochi, Kerala

How to cite this article:
Khan S, Kumar A. Microbial identification systems: Making us tilt at windmills?.Indian J Med Microbiol 2016;34:260-261

How to cite this URL:
Khan S, Kumar A. Microbial identification systems: Making us tilt at windmills?. Indian J Med Microbiol [serial online] 2016 [cited 2020 Jul 7 ];34:260-261
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Dear Editor,

We read with interest the article, "Isolation of Francisella tularensis from blood culture." [1] The authors have based their report of "the first ever isolation of F. tularensis from blood culture of a febrile patient from central India" on identification obtained from VITEK 2 Compact (bioMerieux) microbial identification system. That microbial identification systems have changed the face of microbial diagnostics, is a foregone conclusion. However, laboratories which have integrated these systems in their daily workflow should also be aware of the grey areas of diagnostics that one encounters with these systems. F. tularensis, unfortunately, represents this unresolved diagnostic dilemma. [2] 16S rRNA sequencing studies have shown that VITEK 2 colorimetric system has identified Oligella spp. as F. tularensis even when the system defined it as an excellent quality identification. [2] In this case, the growth within 48 h in blood culture system and good growth in cysteine-free media within 48 h raise several questions regarding the identity of the organism.

Second, this article also rekindles an old debate regarding bacterial identification for publication - how much is enough? [3] A general consensus exists that taxon identification should be a polyphasic approach. [4] Relying on a single identification system; whether genotypic or phenotypic increases the chances of misidentifying bacterial species. [4] The problem appears to be more profound when microbial identification systems are used to describe new infectious syndromes with previously unrecognised pathogens. Standards for such identification need to be implemented to ensure the scientific and medical accuracy of the association of pathogenic bacteria with infectious processes in the medical literature. [4]

Finally, the authors and the journal have the responsibility of protecting the privacy of the patient; as the International Committee of Medical Journal Editors (ICMJE) recommendations on roles and responsibilities of the journals following ICMJE prescribe. According to these recommendations, "Identifying information, including names, initials, or hospital numbers, should not be published in written descriptions, photographs, or pedigrees unless the information is essential for scientific purposes and the patient (or parent or guardian) gives written informed consent for publication. Informed consent for this purpose requires that an identifiable patient be shown the manuscript to be published." The authors have uploaded VITEK 2 identification prints and BacT/ALERT growth graphs which give us little scientific information but confirm the patient's identity. That such a vital component of maintaining patient anonymity escaped the attention of concerned authors, reviewers, proofreaders and copy editors; calls for serious introspection on our part as a scientific community about our stark disregard of publication ethics as far as the patient is concerned.

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1Nirkhiwale SD, Gehlot GS, Bandi AK, Jasani AN. Isolation of Francisella tularensis from blood culture. Indian J Med Microbiol 2015;33:329-31.
2Zbinden A, Böttger EC, Bosshard PP, Zbinden R. Evaluation of the colorimetric VITEK 2 card for identification of gram-negative nonfermentative rods: Comparison to 16S rRNA gene sequencing. J Clin Microbiol 2007;45:2270-3.
3Janda JM, Abbott SL. Bacterial identification for publication: When is enough enough? J Clin Microbiol 2002;40:1887-91.
4Vandamme P, Pot B, Gillis M, de Vos P, Kersters K, Swings J. Polyphasic taxonomy, a consensus approach to bacterial systematics. Microbiol Rev 1996;60:407-38.