Clinical microbiology testing involves lengthy turnaround times, from sample collection to report issuance—typically 2–3 days for most tests, with blood cultures requiring up to 7 days to yield a negative result. Moreover, the antimicrobial susceptibility test (AST) reports sometimes recommend drug regimens that do not align with clinicians’ prescribing practices, and treatment outcomes based on laboratory results are often suboptimal. These issues frequently give rise to dissatisfaction among clinical departments toward the laboratory. Conversely, the laboratory often faces criticism from clinical teams due to the inability to obtain high‑quality specimens, which directly compromises test accuracy. The absence of effective communication further exacerbates tensions between the two departments. This paper seeks to analyze these interdepartmental conflicts and propose strategies for resolution.

1. Causes of the conflict

1.1 Clinical Departments

1.1.1. Incorrect timing and methods of specimen collection: Blood culture specimens should ideally be collected before the administration of antimicrobial agents, following aseptic technique. Two to three samples must be obtained within 24 hours, with two to three bottles drawn simultaneously each time. However, clinical nurses often collect only a single bottle; some do so regardless of whether the patient has a fever, while others even obtain specimens from the intravenous infusion site. For specimens related to specific infections, collection must adhere to designated times—for example, in cases of intermittent bacteremia, sampling should occur 0.5 to 1.0 hour before the peak of fever or 1 hour after the onset of chills or fever—yet many nurses are unaware of these requirements and collect at random. Urine culture specimens require a clean midstream sample, preferably obtained via catheterization; yet nurses typically distribute collection containers to patients, instructing them to collect the sample themselves, which frequently leads to contamination. The greatest challenges arise with sputum cultures: laboratories commonly receive saliva samples contaminated with oral flora rather than properly collected sputum produced by forceful coughing from deep within the respiratory tract after repeated rinsing with plain water. Requiring patients to recollect specimens not only delays treatment but also risks obtaining substandard samples, thereby creating significant inconsistencies.

1.1.2. Non‑standard specimen collection containers: When collecting specimens for bacterial culture, it is essential to use clean, sterile, capped, sealed, and leak‑proof containers. However, in clinical practice, some specimens are collected without sterile containers, others lack airtight seals, and still others are mixed with routine specimens during submission—particularly sputum and stool samples—greatly increasing the risk of cross‑contamination.

1.1.3. Untimely specimen transport and improper storage: Specimens should be sent for testing immediately after collection, and stored at room temperature for no more than 2 hours (with the storage time appropriately shortened during summer). Prolonged standing leads to three issues: first, specimens may dry out, rendering them untestable; second, contaminating microorganisms can proliferate, interfering with testing; third, bacterial viability may decline, affecting test results—for example, in sputum samples containing Streptococcus pneumoniae or Haemophilus influenzae. For specimens that are highly susceptible to drying or can only be collected in small quantities, cotton swabs should be used to collect the sample, which should then be placed directly into a liquid culture medium for immediate submission. As for specimens that cannot be tested promptly, they should be stored refrigerated at 4°C (except for urine samples intended for Neisseria gonorrhoeae testing and cerebrospinal fluid samples). Unfortunately, these guidelines are often overlooked in the fast‑paced clinical setting.

1.2. Laboratory Department

1.2.1. Non-standard technical procedures: Due to the meager economic returns of clinical laboratory testing—particularly in hospitals with low specimen volumes—insufficient attention is paid to the development of laboratory departments, resulting in a lack of essential instruments, equipment, and qualified personnel. Consequently, the culture, isolation, identification, and antimicrobial susceptibility testing of pathogenic microorganisms are often performed improperly (e.g., delayed specimen inoculation, failure to meet required temperature, humidity, and gas‑level conditions for bacterial cultivation), thereby directly compromising the accuracy of test results.

1.2.2. Prioritizing Antimicrobial Susceptibility Testing over Pathogen Identification: Historically, most clinicians have performed bacterial cultures solely to identify antimicrobial agents to which the causative pathogen is susceptible, without specifying the exact identity of the pathogen. Meanwhile, the laboratory, due to the complexity and time‑consuming nature of bacterial identification and the lack of experience among some staff members, has often issued test reports immediately upon receiving susceptibility results, omitting further characterization of the pathogen. Consequently, when clinicians receive susceptibility results that do not include commonly used agents—particularly when a drug to which the bacterium is sensitive fails to produce the expected clinical outcome—they tend to express skepticism and dissatisfaction toward the laboratory.

1.2.3. Lack of Communication with Clinical Departments: Typically, bacterial identification takes 2–3 days, while blood cultures require more than 7 days; however, clinical treatment cannot wait for antimicrobial susceptibility results to be available. Meanwhile, the laboratory department often positions itself as a supporting unit, lacking timely and effective communication with clinicians. Before bacterial identification results are reported, it fails to promptly communicate smear microscopy findings and bacterial growth patterns to the clinical team, demonstrating insufficient awareness of the need for preliminary reporting. As a result, clinicians remain unaware of the source of the pathogen, leading to the indiscriminate use of new or expensive antibiotics or empiric therapy, which in turn increases the workload and challenges faced by the laboratory.

2. Strategies for Resolving Conflicts

2.1. Clinical Aspects

2.1.1. Conduct training on fundamental microbiological knowledge: As bacterial nomenclature evolves and new species emerge, physicians and nurses often struggle to keep abreast of their pathogenic significance and diagnostic criteria. The laboratory department should promptly communicate the latest advances in bacterial taxonomy and emerging technologies to all clinical specialties, thereby enhancing their theoretical understanding. In addition, it should collaborate with clinicians to establish appropriate protocols for specimen collection, transport, and storage, ensuring pre-analytical quality and meeting the needs of clinical diagnosis and treatment.

2.1.2. Establishing the critical role of pathogen‑specific microbiological testing: Performing bacterial cultures not only enables early identification of infectious agents but also facilitates the rational selection of antimicrobial agents based on the specific pathogen and its susceptibility profile, thereby preventing the emergence of resistant strains, reducing the incidence of nosocomial infections, and improving the success rate of treating severe infections. For both outpatients and inpatients, clinicians must obtain appropriate specimens for bacterial culture prior to initiating antimicrobial therapy, and then tailor antimicrobial treatment according to the results of susceptibility testing. In critically ill patients, when the causative pathogen and susceptibility data are unavailable, empirical therapy should be administered based on the clinical situation and local patterns of bacterial resistance; once susceptibility results are available, the treatment regimen should be adjusted to optimize antimicrobial efficacy, minimize adverse reactions, and mitigate or slow the development of bacterial resistance.

2.1.3. Standardizing Antimicrobial Management: Currently, the main issues in the clinical use of antimicrobial agents include an excessive variety of drugs, a high initial prescribing level (e.g., first- and second-generation cephalosporins are rarely used), prolonged treatment durations (typically exceeding one week, with widespread overuse of prophylactic regimens), inappropriate drug substitutions, and irrational combination therapies, all of which have contributed to the escalating problem of bacterial resistance [3]. Therefore, all healthcare institutions should strengthen oversight of antimicrobial use and strictly adhere to the “Clinical Guidelines for the Use of Antimicrobial Agents” to standardize their clinical application.

2.2. Laboratory Department

2.2.1. Ensuring Timely and Accurate Testing: Testing personnel should begin by strengthening their sense of professional responsibility, diligently study and master the latest technologies in this field, promptly summarize their experiences, continuously refine their methods, actively implement internal quality control, proactively undergo external quality assessment, and strive to provide clinicians with accurate and rapid etiological information.

2.2.2. Establishing a Scientific Reporting Model: Completely overhaul the traditional three-step workflow of specimen collection, culture, and report issuance. Greater emphasis should be placed on the credibility of the reports and their relevance to clinical diagnosis. By integrating patients’ clinical information, bacterial test results should be comprehensively analyzed, accompanied by appropriate commentary (e.g., certain Klebsiella or Escherichia coli strains harboring extended‑spectrum β‑lactamase–mediated resistance may show in vitro susceptibility to third‑generation cephalosporins yet exhibit poor clinical outcomes), thereby preventing contradictory findings that could lead to adverse consequences for clinical practice.

2.2.3. Strengthening Collaboration with Clinical Departments: With bacterial resistance continuing to rise, clinical treatment is facing significant challenges. The Laboratory Department should promptly obtain patients’ clinical information, actively participate in the development of treatment plans, and regularly provide feedback to clinicians on antimicrobial usage and local resistance surveillance. Furthermore, it should progressively refine the pre‑reporting system to ensure that clinicians have timely access to bacterial culture results, thereby facilitating the selection of the most appropriate therapeutic regimen.

Affiliation: Department of Emergency Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan — Shang Lixia, Li Bingqiang