Urinalysis represents a large proportion of testing performed in clinical microbiology and laboratories continue to explore automation as part of quality and efficiency initiatives. Several options are now available in the areas of specimen processing, incubation, and imaging, but only recently have advances have been made in the use of sophisticated software and algorithms to effectively interpret images in a clinical context, much like a microbiologist would. This represents a significant step forward as artificial intelligence encroaches into the tightly guarded sanctity of microbiology plate reading professionals.
APAS® Independence is a medical device that images and interprets microbiological culture plates. Interpretation of cultures is based on the ability to distinguish specific organism groups and morphologies that input into an expert rule system based on international reporting guidelines. The device is able to then designate those plates that are “positive’’ or ‘’review’’ which have a high probability of being significant which require microbiologist intervention, and those that are "no growth" or "no significant growth" which can be triaged out of the workflow. Given that up to 70% of urine cultures are negative, skilled microbiologists can appropriately use their time on those samples that require further work only.
We present here data to support its use in a clinical laboratory and provide examples of how the technology is able to analyse and interpret bacterial growth on chromogenic media in the context of the expert rule system. The incorporation of laboratory-specific flags such as a high leucocyte count, physician specialty, or ward, is useful as it provides an override mechanism for those samples that laboratories determine must go to a microbiologist for assessment, irrespective of growth status. This is especially important in complicated cases of UTI where further incubation or culturing for fastidious organisms may be required.