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Changes in Access to Comprehensive Clinical Microbiology Laboratory Testing in Tennessee From 2019-2024.

Kaleb Wolfe¹, Stephanie A Hart², Stacy Curry-Johnson³

¹Division of Infectious Diseases, University of Kansas Medical Center, Kansas City, Kansas, USA.

Open Forum Infectious Diseases

|March 2, 2026

Summary

Clinical microbiology laboratory access in Tennessee declined significantly, with a 38% decrease in comprehensive testing sites. This reduction impacts patient care, especially in vulnerable populations, necessitating further investigation into consequences.

Keywords:

clinical microbiology geographic access health equity laboratory consolidation social determinants of health

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Area of Science:

Clinical Microbiology
Public Health
Health Services Research

Background:

Timely clinical microbiology laboratory testing is vital for infectious disease management, influencing antibiotic choice, patient outcomes, and healthcare expenses.
Geographic access to comprehensive (Tier 1) clinical microbiology laboratories in Tennessee was assessed between 2019 and 2024.

Purpose of the Study:

To evaluate changes in geographic access to comprehensive clinical microbiology laboratories in Tennessee from 2019 to 2024.
To identify factors associated with the closure of these essential laboratories.

Main Methods:

Tier 1 microbiology laboratories in Tennessee were identified for 2019 and 2024 with assistance from the Tennessee Department of Health.
Catchment areas were determined using a 25-mile drive-time radius around each laboratory.
Changes in laboratory numbers and locations were quantified, and demographic data for closed vs. open laboratories were compared.

Main Results:

The number of Tier 1 microbiology laboratories in Tennessee decreased by 38% over five years.
This reduction led to a 35% decrease in statewide square-mile coverage.
Laboratory closures were linked to rurality, lower income, higher poverty, race, increased disability, and lower educational attainment.

Conclusions:

A significant decrease in Tier 1 clinical microbiology laboratories in Tennessee between 2019 and 2024 has reduced local access to comprehensive testing.
This decline disproportionately affects areas with at-risk patient populations, potentially impacting timely diagnosis and appropriate antimicrobial therapy.
Further research is required to understand the clinical and economic implications of these changes in laboratory access.