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WHAT IS IT YOUR TRYING TO TELL ME!!!! or How to Decipher a Microbiology Report

WHAT IS IT YOUR TRYING TO TELL ME!!!! or How to Decipher a Microbiology Report. By Beverley L. Orr, MT(ASCP). Boston Medical Center. 600+ Bed Hospital Safety Net Hospital Level 1 Trauma Center Boston University Medical Center and Boston City Hospital combined Medical School Dental School

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WHAT IS IT YOUR TRYING TO TELL ME!!!! or How to Decipher a Microbiology Report

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  1. WHAT IS IT YOUR TRYING TO TELL ME!!!!orHow to Decipher a Microbiology Report By Beverley L. Orr, MT(ASCP)

  2. Boston Medical Center • 600+ Bed Hospital • Safety Net Hospital • Level 1 Trauma Center • Boston University Medical Center and Boston City Hospital combined • Medical School • Dental School • School of Public Health

  3. Objectives • Interpret /assess the quality of a specimen by gram stain interpretation • Correlate results from gram stain to final result • Distinguish between different susceptibility methods • Identify Resistant Organisms from susceptibility report • Identify “suspect” susceptibility results

  4. Boston Medical Center- Exceptional Care. Without Exception.

  5. Dissecting a Culture Report • Gram Stain • Preliminary Report • Final Report • Susceptibility Report

  6. Gram Stain • WBC • SEC’s • Bacteria • Notes

  7. Gram Stain Info • Preliminary result • Gram positive cocci • Clusters • Gram positive cocci suggestive of Staphylococcus-like organism • Pairs • Gram positive cocci, lancet forms observed • Chains • Gram positive cocci, suggestive of a Streptococcus-like organism • Pairs, chains and clusters

  8. Gram Stain info • Gram Negative Rods • Tiny,pleomorphic = Haemophilus, Bacteroides, etc. • Coccobacillary – Haemophilus, Francisella, Brucella, HACEK organism • Large = Enterobacteriacae (E coli, Kleb, etc.) • Large, sausage shaped = Pseudomonas • Let’s talk Acinetobacter…..

  9. Gram Stain Info • Gram Positive Rods • Diptheroid –like • Large, boxcar • Non-spore forming • Branching • Branching, modified afb stain negative/positive

  10. Gram Stain Info • Yeast • Budding • Budding with pseudohyphae • Encapsulated

  11. Gram Stain Q scores Exporated Sputum How is it calculated? What does it mean? What do we do with the score?

  12. Gram Stain Q Scores Wounds How is it calculated? What does it mean? What do we do with the score?

  13. Wound Q Score

  14. Gram Stain Q scores, cont • Bacterial vaginosis • How is it calculated? • Lactobacillus present • Gram negative rods (Gardnerella or Mobiluncus) • Altered flora • What does it mean? • What do we do with the score?

  15. Culture Report - Preliminary • Presumptive vs Definitive • Presumptive (not on sterile body fluids) • E coli • Proteus • Pseudomonas • Enterococcus • Candida albicans or not • Bacillus sp, not anthracis

  16. Culture report - preliminary • Lactose fermenter • Non-lactose fermenter • Gram positive cocci • Gram positive rod • Staph species • Strep species • Normal flora • No Salmonella, Shigella, Campylobacter…

  17. Blood Culture report – PNA Fish • Peptide nucleic acid detection by Fluorescent in situ hybridization- positive blood cultures • Staph aureus (Oxoid PBP 2a for mrsa) • Candida albicans (use fluconazole, etc) • Enterococcus faecalis or Enterococcus faecium/duran • Future – dual probe Coag Neg Staph & Staph aureus, E coli and Pseudomonas aeruginosa

  18. Culture report - Final • Pathogen listed, most numerous first • Normal Flora • No SSCEYV • No Strep A, C or G • No Group B beta strep isolated – (broth enhanced)

  19. Susceptibility Reports • Where is the methicillin result • Oxacillin • Cefoxitin • What about inducible clindamycin resistance • D test • What about Vanco resistance – • Staphs with MIC >= 4, retest by alternate method • Phoenix has FDA approved mic to detect vrsa • Enterococcus – BHI with vanco, E test, motility • E faecium vs E faecalis (penicillin/ampicillin susceptibility)

  20. Susceptibility problems-GNR • Gentamicin susceptible/Tobra or Amikacin resistant • Ceftriaxone susceptible/Cefepime resistant • Cefazolin susceptible/Ceftriaxone resistant • Aztreonam resistant or Ceftriaxone resistant • Imipenem resistant Pseudomonas aeruginosa • Pip/tazo resistance • Aminoglycoside report on salmonella, shigella-NOT! • Antibiotic reporting on E coli O157:h7 –NOT!!!!

  21. Culture Reports – Corrected Report • Any time there is a change to the report there should be a corrected report generated and a call made to unit/physician. • Examples • Supplemental reports happen – additional comment, additional organism, additional antibiotic requested, etc.

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