Screening tests and "rapid" identification. Is anybody out there listening?

The responses by 55 of 300 physicians queried at the University Hospital, Cincinnati, to an extensive questionnaire, form the basis for this comment on the clinical impact of screening tests and rapid identification. Examination and interpretation of smears of fluids and tissue were felt to provide useful data within a short time of specimen collection and the majority of physician respondents were willing to sacrifice some degree of accuracy in results in return for an answer delivered shortly after specimen submission. Screening for bacteriuria was felt to be useful if the test was sensitive enough to rule out infection as suggested by the presence of approximately 10,000 CFU/ml of urine, if results could be had within 1 hr of specimen collection for outpatients, 2 hr for inpatients, and if test results for pyuria accompanied the screen results. The value of taxonomy, in general, was directly related to how much knowing the taxon would direct antibiotic therapy. The time required for a taxonomic result seemed to matter only when susceptibility test results were either delayed or not forthcoming. Interest in the taxonomy of anaerobic bacteria appeared to be limited to a small group of physician respondents (infectious disease specialists) and also was relative to the ability of the taxonomic designation to evoke a specific therapeutic regimen. In summary, the impact of microbiologic data on the practice of medicine appears to depend on the ability of the laboratory to complete the entire test process, from order to transmission of answer, within a time frame perceived to be useful by the clinician.(ABSTRACT TRUNCATED AT 250 WORDS)