What Are the Differences Between a Research Lab and a Hospital Lab?

Barry Kreiswirth, PhD, founding director, Public Health Research Institute Tuberculosis Center, professor of medicine at Rutgers University, explains the differences between a research lab and a hospital lab.

Interview Transcript (slightly modified for readability)

“We talked about the need for surveillance. Now, if you think about it, what is the job of the hospital laboratory? As patients, people go into a hospital and invariably someone draws their blood. That’s what we do in hospitals when people come in with [a] fever and we’re trying to figure out what type of infections they may or may not have. What happens to that blood?

That blood gets sent to a laboratory, most commonly in the hospital (sometimes they outsource it, but usually [it's] in the hospital) and that hospital’s job, that laboratory, is to take that blood and ask whether any bacteria is there, because in general your blood should be sterile. So, they grow it and they ask: is something going to grow? [If] something does grow, then the question is: what is it? Then they identify it and [if it is a bacterium] then the next question is: what can I treat it with? Those are the jobs of a hospital lab and the faster they can identify the bacteria and tell the treating physician what drugs [he/she] can use to treat the patient, the better job they do. It normally takes, on average, 48 to 72 hours before the physician has that information in [his/her] hands.

What are you doing during the first 72 hours when a patient’s in a hospital? Well, most of the time, a doctor is treating empirically, from the seat of their pants; it’s based on experience; it’s based on presentation, but they’re basically giving broad spectrum antibiotics to try to think that they’re covering whatever this infection is, if it is an infection, and [he/she] will know soundly within 72 hours. That’s what happens in a hospital laboratory; that’s their job.

Research laboratories, like mine, can ask the next question. Once [we] have a bacteri[um] that is drug-resistant, we can analyze it further and ask questions [on] surveillance: do they have the mcr-1 gene? Do they have other resistance mechanisms? In our case, we’re not trying to impact the patient’s treatment; we’re trying to understand from a societal point of view and a public health point of view [the question of whether there are] lots of these strains not only in hospital A, but since I can work with multiple hospitals, we have a sense of what’s going on in a city, in a community, in a state, by comparing isolates from different sources. When we recognize that ‘these three hospitals seem to have a similar problem,’ then we’re starting to understand [what] that surveillance has been telling us; that 'yes, they’re spreading, and there’s bacteria now that are growing in numbers, and this is the type of data that we can generate with the thought that we potentially could have a problem.' That’s exactly what we need to do with the mcr-1 gene. As other resistance genes become identified, we can at least start doing the surveillance studies and work with hospitals to provide the information that they can use, not necessarily to treat patients, but more infection control and trying to control the number of these bad bugs in their hospital.”