The scope of the Clinical Microbiology services under the direction of Dr. Preeti Pancholi is to provide timely, accurate medically necessary tests to aid in the evaluation, diagnosis and treatment of infectious diseases. The specific goals are multifaceted and focus on the following 1) practice evidence based laboratory medicine 2) expand rapid non-growth dependent technology that detects pathogens in a clinically-relevant time frame to impact optimal patient management 3) actively participate in surveillance team efforts to plan and execute microbiological and epidemiological investigations 4) participate in antimicrobial restriction and control programs within the medical center to employ proactive, multifaceted strategies to minimize the spread of antibiotic resistant pathogens within the hospital. The clinical Microbiology service has become a highly complex discipline that plays a pivotal role as essential members of multidisciplinary teams. The laboratory experienced another productive year. Over 236,000 specimens were received for testing. This represents a 7.2% increase over the previous year with the most marked increased in specimen numbers in the area of diagnostic molecular microbiology and AFB/mycology. The new Molecular Microbiology section was officially inaugurated in December of 2007. Molecular techniques have revolutionized the diagnosis of infectious diseases providing highly accurate, rapid, and more sensitive diagnosis. The integration of molecular techniques with the traditional discipline of clinical microbiology enables robust diagnosis and provides accurate descriptions of new and emerging pathogens. Since its inauguration, several new molecular tests have been implemented including quantitative CMV and EBV viral load assays and HCV genotyping. To support the Ohio network for organs donors, NAT testing of plasma for HIV and HCV was implemented in the Special Functions laboratory on a STAT basis. MRSA is a growing public health concern, and is cited as the leading cause of Hospital Acquired Infections. In conjunction with culture that routinely takes >48h to result, we now offer the rapid detection of MRSA using the GeneXpert™ MRSA assay automated real time PCR diagnostic system to detect presence of MRSA DNA from nasal swabs in patients at risk for nasal colonization. This test is currently being performed on patients in the ICU and BMT services. Utilization of real-time PCR for detection of MRSA has the potential to dramatically affect infection control practice by rapidly identifying MRSA colonized patients. Concomitant cultures are necessary only to recover organisms for typing or for further susceptibility testing. The Division also prepared and published on line and pocket card annual antimicrobial drug susceptibility reports (antibiograms) of the most common pathogens recovered from our patient population for the 3 hospitals (OSU main and Ross Heart, James, and OSU East). ICU-specific antibiograms were also generated to guide the selection of appropriate, cost effective empiric antibiotic use, which becomes especially important in light of our increase in multi drug resistant microorganisms. In response to the observation of strains of K. pneumoniae that were resistant to carbapenems, the laboratory instituted a phenotypic KPC confirmatory Hodge test to enable the detection of cabapenemase in Enterobacteriaceae organisms. Furthermore, a new gram-positive Microscan panel was validated to expand the susceptibility range testing for vancomycin to guide treatment. In-house testing of these antibiotics resulted in more rapid reporting and increased efficiencies in work flow. Microbroth dilution TREK panels incorporating an expanded panel of drugs (amikacin, ciprofloxacin, clarithromycin, imipenem, tobramycin, cefoxitin, linezolid, ceftriaxone, minocycline, gatifloxacin, trimethoprim sulfamethoxazole, amoxicillin-clavulanic acid) were validated and implemented for rapidly growing Mycobacterium species in order to meet the needs of ordering physicians and to perform expanded susceptibility testing in house, resulting in more timely susceptibility reporting and cost savings. The Inoculab Automated Urine Plater was purchased in order to increase plating efficiency and uniformity of streaking. The Division successfully concluded a clinical trial on the rapid detection of MRSA from nasal swabs. This assay was implemented at OSUMC to aid in the prevention and control of MRSA infections in healthcare settings. A new clinical trial on the rapid detection of MRSA and methicillin susceptible S.aureus (MSSA) was initiated for screening blood cultures and wounds, data for which was submitted by Cepheid to obtain FDA approval. The plan is to implement this assay for assessing MRSA/MSSA in blood cultures in 2009. The multiple benefits of this rapid identification method will improve patient treatment and reduce the overutilization of vancomycin. The Division welcomes Dr. Joan-Miquel Balada-Llasat who joined The Ohio State University Medical Center as Assistant Professor and Associate Director in Clinical Microbiology in October, 2008. Dr. Balada-Llasat got his PhD in Molecular Microbiology from Tufts Medical School, his PharmD from University of Barcelona, and the D(ABMM) certification after completing a rigorous fellowship at The University of Washington in Seattle. As part of his education he trained at The University of Washington Medical Center, the Seattle Children’s Hospital, Harbor View Medical Center, Seattle VA Hospital, and Brigham and Women Hospital in Boston.