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Form HAIC.400.12 2024 LABORATORY TESTING PRACTICES FOR CANDIDEMIA QUESTIO
ICR 202410-0920-009 · OMB 0920-0978 · Object 147565701.
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Lab ID No. [][][][][][] 2024 LABORATORY TESTING PRACTICES FOR CANDIDEMIA QUESTIONNAIRE 1) What kind of laboratory is this? (select one) Hospital laboratory Commercial laboratory (Quest, etc.) Other (specify) ______________________ Unknown 2) Does this laboratory ever receive blood cultures from nursing homes or other long term care facilities? Yes No Unknown 3) Does the clinical microbiology laboratory at your institution have a separate mycology section or laboratory? Yes No Unknown 4) What kind of blood culture system does your laboratory use? (check all that apply) BacT/Alert Bactec FX BacT/Alert 3D Isolator tubes VersaTREK Other (specify) ______________________ Bactec 9240 5) What is the approximate volume of fungal cultures ordered and performed annually in your laboratory for any specimen type? Specify number: ______________ Unknown 6) What is the approximate volume of fungal blood cultures ordered and performed annually in your laboratory? Specify number: ______________ Unknown YEAST IDENTIFICATION 7) Does this laboratory offer yeast identification (either onsite or sent to another laboratory)? Yes No (-------- If No, SKIP TO QUESTION 18 --------) Unknown (is there another laboratory staff member who can assist with the questionnaire?) 8) Where is yeast identification done? (check the most applicable) On-site, in the laboratory Sent to commercial lab Sent to affiliated hospital lab Sent to other local/regional, non-affiliated reference or public health laboratory Other ______________________________ Unknown Answer the following questions for the lab selected in question 8. 9) How does this lab identify yeast? (check all that apply) MALDI-TOF Bruker (Biotyper) MALDI-TOF bioMerieux (VITEK MS) VITEK 2 API 20C DNA sequencing PNA-FISH BactiCard Candida BD Phoenix MicroScan RapID Plus Other (specify) ______________________ Unknown 10) Does this laboratory routinely use chromogenic agar for the identification or differentiation of Candida isolates? Yes No Unknown 11) Species-level identification is performed for Candida spp. isolated from which of the following? a. Blood isolates Yes, always 2024 Yes, with clinician order No Unknown Page 1 of 4 Lab ID No. [][][][][][] b. Other normally sterile body site isolates Yes, always Yes, with clinician order c. Abdominal isolates Yes, always Yes, with clinician order No Unknown No Unknown d. Respiratory isolates Yes, always Yes, with clinician order No Unknown e. Urine isolates Yes, always Yes, with clinician order No Unknown Other (specify) ____________________ Yes, always Yes, with clinician order No Unknown f. 12) How does this laboratory meet proficiency testing requirements for yeast identification? Commercial provider (specify) _________________ Internal alternate assessments (specify) __________________ 13) Does this laboratory employ PCR molecular tests to identify Candida from blood specimens? Yes (go to Q14) No (go to Q17) Unknown 14) Does this laboratory employ the T2Candida Panel to identify Candida from blood specimens? Yes (go to Q14a) No (go to Q15) Unknown a. If Yes, when did this lab first start using T2Candida Panel? Date (mm/dd/yyyy): ____/____/________ b. If Yes and you get a positive result on T2Candida Panel, does this lab culture the blood to obtain an isolate? Yes, always No Yes, with a clinical order Unknown 15) Does this laboratory employ the BioFire (FilmArray) to identify Candida from blood culture? Yes (go to Q15a) No (go to Q16) Unknown a. If Yes, when did this lab first start using BioFire? Date (mm/dd/yyyy): ____/____/________ b. If Yes and you get a positive result on BioFire, does this lab culture the blood to obtain an isolate? Yes, always No Yes, with a clinical order Unknown 16) Does this laboratory employ any other PCR molecular tests to identify Candida from blood specimens? Yes (specify) ______________________ No Unknown 17) If No for Question 13, does this laboratory have plans to employ PCR molecular tests for Candida identification in the near future (e.g., T2Candida Panel, BioFire)? Yes (specify) ___________________ Unknown No Not applicable ANTIFUNGAL SUSCEPTIBILITY TESTING 18) Does this laboratory offer any antifungal susceptibility testing for Candida (either onsite or sent to another laboratory)? Yes No (-------- If No, QUESTIONNAIRE COMPLETE --------) Unknown (is there another laboratory staff member who can assist with the questionnaire?) 2024 Page 2 of 4 Lab ID No. [][][][][][] 19) Where is antifungal susceptibility testing (AFST) done? (check the most applicable) On-site, in the laboratory (go to Q20) Sent to commercial lab (-------- If not an on-site laboratory, QUESTIONNAIRE COMPLETE --------) Sent to affiliated hospital lab Sent to other local/regional, non-affiliated reference or public health laboratory Other ______________________________ Unknown Answer the following questions for the lab selected in question 19. 20) Is antifungal susceptibility testing available for any of the following antifungal drugs (check all that apply): Fluconazole Caspofungin Voriconazole Amphotericin B Itraconazole Flucytosine Posaconazole Other (specify) __________________ Micafungin Unknown Anidulafungin 21) What methods are used for AFST, excluding Amphotericin B? (check all that apply) Broth microdilution with laboratory Vitek (bioMerieux) developed plates Other ______________________________ YeastOne (Thermo Scientific™ Sensititre™) Unknown Gradient diffusion (E test) 22) What methods are used for AFST of Amphotericin B? (check all that apply) Broth microdilution with Vitek (bioMerieux) laboratory developed plates Other ______________________________ YeastOne (Thermo Scientific™ Sensititre™) Unknown Gradient diffusion (E test) 23) How does this laboratory meet proficiency testing requirements for antifungal susceptibility testing, if performed? Commercial provider (specify) _________________ Internal alternate assessments (specify) __________________ 24) How are results of AFST reported when breakpoints are available? (select one) Categorical interpretation only (susceptible, Both--categorical interpretation PLUS MIC resistant, etc.) Unknown MIC only 25) How are results of AFST reported when breakpoints aren’t available? (select one) MIC only Epidemiological cutoff values (ECVs) Unknown 26) For what type of Candida isolates is antifungal susceptibility testing (AFST) performed automatically? (check all that apply) Blood isolates No AFST performed automatically (requires Other normally sterile body site isolates order from a clinician) Other (specify) ______________________ Unknown 2024 Page 3 of 4 Lab ID No. [][][][][][] 27) When is AFST performed for the following Candida spp.? a. C. albicans Performed automatically (Go to 27ai) Performed with a clinician’s order (Go to 27ai) Not performed i. Drugs for which AFST is performed on C. albicans (check all that apply): Micafungin Fluconazole Other Anidulafungin Voriconazole Unknown Caspofungin Amphotericin B b. C. glabrata Performed automatically (Go to 27bi) Performed with a clinician’s order (Go to 27bi) Not performed i. Drugs for which AFST is performed on C. glabrata (check all that apply): Micafungin Fluconazole Other Anidulafungin Voriconazole Unknown Caspofungin Amphotericin B c. C. parapsilosis Performed automatically (Go to 27ci) Performed with a clinician’s order (Go to 27ci) Not performed i. Drugs for which AFST is performed on C. parapsilosis (check all that apply): Micafungin Fluconazole Other Anidulafungin Voriconazole Unknown Caspofungin Amphotericin B d. Other Candida spp. Performed automatically (Go to 27di) Performed with a clinician’s order (Go to 27di) Not performed i. Drugs for which AFST is performed on other Candida spp. (check all that apply): Micafungin Fluconazole Other Anidulafungin Voriconazole Unknown Caspofungin Amphotericin B 28) Is this laboratory tracking susceptibility trends for Candida spp. isolates tested in your lab? Yes No Unknown ------------------------------------------------ END OF QUESTIONNAIRE ------------------------------------------------ 2024 Page 4 of 4
| File Type | application/pdf |
| File Title | Form HAIC.400.12 2024 LABORATORY TESTING PRACTICES FOR CANDIDEMIA QUESTIO |
| Author | Angela Ahlquist |
| File Modified | 2023-08-10 |
| File Created | 2023-08-10 |