Laboratory survey and literature review of anaerobic bacteriology: foundations of a clinically orientated and evidence-based workup for anaerobic cultures

• Results of a survey revealed a huge diversity in all analytical stages of clinical anaerobic microbiology.
• Existing workup and reporting procedures regarding anaerobes are expert-based and have not been extensively clinically validated.
• A pragmatic, clinically orientated and feasible procedure for the workup of anaerobic cultures, using MALDI-TOF MS identification, based upon literature data and existing guidelines is proposed in this paper.

Since the introduction of matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) in routine microbiology laboratories, identification of anaerobic bacteria has become easier. These increased possibilities provide new challenges concerning analytical workup and reporting of anaerobes. In February 2015, an extensive web-based survey on pre-analytical, analytical and post-analytical procedures of anaerobic microbiology was sent to 53 Belgian, university and non-university hospital laboratories. Answers of 34 participating laboratories revealed a huge diversity in all analytical stages of anaerobic microbiology. Whether or not colony types were identified was mainly based on anatomical origin of the sample, colony morphology, and total number of different anaerobic isolates in the sample, while reporting of isolate results and performing anti-microbial susceptibility testing was mainly based on anatomical origin of the sample, number of different anaerobic isolates, and the identification of the anaerobic bacteria. These variety of workup procedures were mainly expert-based and have not been extensively clinically validated. For this reason, a standardized, clinically orientated, and feasible procedure for the workup of anaerobic cultures was developed, using MALDI-TOF MS identification, based upon literature data and existing guidelines.