A national survey on laboratory practices for specimen processing, streptococcus pneumoniae identification and...

Standardized processing of respiratory specimens and accurate identification and antimicrobial susceptibility testing (AST) of Streptococcus pneumoniae are crucial for clinical management. This study investigated laboratory practices for specimen processing, S. pneumoniae identification, and AST of S. pneumoniaeamong CARSS hospitals. A nationwide online survey was conducted in 2023. After data cleaning, 3,297 valid questionnaires were analyzed. The survey assessed specimen distribution, sputum/BALF processing, identification and quality control (QC). Sputum was the most common specimen(39.92%), followed by "others" (20.83%), blood (20.47%), urine (14.16%), and BALF (4.58%). Most laboratories performed routine Gram staining on sputum (71.55%) and BALF (66.88%). For sputum smears, 75.80%  ~ 86.29% reported semi-quantitative cell/pathogen counts. The dominant acceptability criterion for sputum was > 25 WBCs/LPF and <10 SECs/LPF (98.88%). For unacceptable sputum specimens yielding S. pneumoniae 45.12% laboratories laboratories performed identification/AST only if the bacterial quantity was ≥ 2 + . Common identification methods were Optochin/bile solubility test (53.32%), Vitek GP card (42.74%) and MALDI-TOF MS (30.15%). AST methods included Vitek GP68 (38.76%), disk diffusion (32.91%), gradient diffusion (22.78%) and DL-96STREP cards (21.20%). Notably, 44.10% perform no routine AST QC and 44.62% lacked QC strain ATCC 49619. Only 49.65% used ATCC 49619 for QC.Significant variations exist in laboratory practices for respiratory specimen processing and S. pneumoniae workup across CARSS hospitals. While conventional methods remain prevalent, MALDI-TOF MS adoption is growing.The high proportion of laboratories lacking routine AST QC underscores the need for standardized protocols and enhanced quality assurance nationwide.