WHAT IS IT YOUR WHAT IS IT YOUR TRYING TO TELL ME!!!!TRYING TO TELL ME!!!!

ororHow to Decipher a Microbiology ReportHow to Decipher a Microbiology Report

By Beverley L. Orr, MT(ASCP)By Beverley L. Orr, MT(ASCP)

Boston Medical CenterBoston Medical Center

600+ Bed Hospital600+ Bed Hospital Safety Net HospitalSafety Net Hospital Level 1 Trauma CenterLevel 1 Trauma Center Boston University Medical Center and Boston Boston University Medical Center and Boston

City Hospital combinedCity Hospital combined Medical SchoolMedical School Dental SchoolDental School School of Public HealthSchool of Public Health

ObjectivesObjectives

Interpret /assess the quality of a specimen by Interpret /assess the quality of a specimen by gram stain interpretationgram stain interpretation

Correlate results from gram stain to final resultCorrelate results from gram stain to final result Distinguish between different susceptibility Distinguish between different susceptibility

methodsmethods Identify Resistant Organisms from Identify Resistant Organisms from

susceptibility reportsusceptibility report Identify “suspect” susceptibility resultsIdentify “suspect” susceptibility results

Boston Medical Center-Exceptional Care. Without Exception.

Dissecting a Culture ReportDissecting a Culture Report

Gram StainGram Stain Preliminary ReportPreliminary Report Final ReportFinal Report Susceptibility ReportSusceptibility Report

Gram StainGram Stain

WBCWBC SEC’sSEC’s BacteriaBacteria NotesNotes

Gram Stain InfoGram Stain Info

Preliminary resultPreliminary result Gram positive cocciGram positive cocci

ClustersClusters Gram positive cocci suggestive of Staphylococcus-like organismGram positive cocci suggestive of Staphylococcus-like organism

PairsPairs Gram positive cocci, lancet forms observedGram positive cocci, lancet forms observed

ChainsChains Gram positive cocci, suggestive of a Streptococcus-like organismGram positive cocci, suggestive of a Streptococcus-like organism

Pairs, chains and clustersPairs, chains and clusters

Gram Stain infoGram Stain info

Gram Negative Rods Gram Negative Rods Tiny,pleomorphic = Haemophilus, Bacteroides, Tiny,pleomorphic = Haemophilus, Bacteroides,

etc.etc. Coccobacillary – Haemophilus, Francisella, Coccobacillary – Haemophilus, Francisella,

Brucella, HACEK organismBrucella, HACEK organism Large = Enterobacteriacae (E coli, Kleb, etc.)Large = Enterobacteriacae (E coli, Kleb, etc.) Large, sausage shaped = PseudomonasLarge, sausage shaped = Pseudomonas Let’s talk Acinetobacter…..Let’s talk Acinetobacter…..

Gram Stain InfoGram Stain Info

Gram Positive RodsGram Positive Rods Diptheroid –likeDiptheroid –like Large, boxcarLarge, boxcar Non-spore formingNon-spore forming BranchingBranching Branching, modified afb stain negative/positiveBranching, modified afb stain negative/positive

Gram Stain InfoGram Stain Info

YeastYeast BuddingBudding Budding with pseudohyphaeBudding with pseudohyphae EncapsulatedEncapsulated

Gram Stain Q scoresGram Stain Q scores

Exporated SputumExporated Sputum How is it calculated?How is it calculated? What does it mean?What does it mean? What do we do with the score?What do we do with the score?

Gram Stain Q ScoresGram Stain Q Scores

WoundsWounds How is it calculated?How is it calculated? What does it mean?What does it mean? What do we do with the score?What do we do with the score?

Wound Q ScoreWound Q Score

Gram Stain Q scores, contGram Stain Q scores, cont

Bacterial vaginosisBacterial vaginosis How is it calculated?How is it calculated?

Lactobacillus presentLactobacillus present Gram negative rods (Gardnerella or Mobiluncus)Gram negative rods (Gardnerella or Mobiluncus) Altered floraAltered flora

What does it mean?What does it mean? What do we do with the score?What do we do with the score?

Culture Report - PreliminaryCulture Report - Preliminary

Presumptive vs DefinitivePresumptive vs Definitive Presumptive (not on sterile body fluids)Presumptive (not on sterile body fluids)

E coliE coli ProteusProteus PseudomonasPseudomonas EnterococcusEnterococcus Candida albicans or notCandida albicans or not Bacillus sp, not anthracisBacillus sp, not anthracis

Culture report - preliminaryCulture report - preliminary

Lactose fermenterLactose fermenter Non-lactose fermenterNon-lactose fermenter Gram positive cocciGram positive cocci Gram positive rodGram positive rod Staph speciesStaph species Strep speciesStrep species Normal floraNormal flora No Salmonella, Shigella, Campylobacter…No Salmonella, Shigella, Campylobacter…

Blood Culture report – PNA FishBlood Culture report – PNA Fish

Peptide nucleic acid detection by Fluorescent Peptide nucleic acid detection by Fluorescent in situ hybridization- positive blood culturesin situ hybridization- positive blood cultures Staph aureus (Oxoid PBP 2a for mrsa)Staph aureus (Oxoid PBP 2a for mrsa) Candida albicans (use fluconazole, etc)Candida albicans (use fluconazole, etc) Enterococcus faecalis or Enterococcus Enterococcus faecalis or Enterococcus

faecium/duranfaecium/duran Future – dual probe Coag Neg Staph & Staph Future – dual probe Coag Neg Staph & Staph

aureus, E coli and Pseudomonas aeruginosaaureus, E coli and Pseudomonas aeruginosa

Culture report - FinalCulture report - Final

Pathogen listed, most numerous firstPathogen listed, most numerous first Normal FloraNormal Flora No SSCEYVNo SSCEYV No Strep A, C or GNo Strep A, C or G No Group B beta strep isolated – (broth No Group B beta strep isolated – (broth

enhanced)enhanced)

Susceptibility ReportsSusceptibility Reports

Where is the methicillin result Where is the methicillin result OxacillinOxacillin CefoxitinCefoxitin

What about inducible clindamycin resistanceWhat about inducible clindamycin resistance D testD test

What about Vanco resistance –What about Vanco resistance – Staphs with MIC >= 4, retest by alternate methodStaphs with MIC >= 4, retest by alternate method

Phoenix has FDA approved mic to detect vrsaPhoenix has FDA approved mic to detect vrsa

Enterococcus – BHI with vanco, E test, motilityEnterococcus – BHI with vanco, E test, motility E faecium vs E faecalis (penicillin/ampicillin susceptibility)E faecium vs E faecalis (penicillin/ampicillin susceptibility)

Susceptibility problems-GNRSusceptibility problems-GNR

Gentamicin susceptible/Tobra or Amikacin resistantGentamicin susceptible/Tobra or Amikacin resistant Ceftriaxone susceptible/Cefepime resistantCeftriaxone susceptible/Cefepime resistant Cefazolin susceptible/Ceftriaxone resistantCefazolin susceptible/Ceftriaxone resistant Aztreonam resistant or Ceftriaxone resistantAztreonam resistant or Ceftriaxone resistant Imipenem resistant Pseudomonas aeruginosaImipenem resistant Pseudomonas aeruginosa Pip/tazo resistancePip/tazo resistance Aminoglycoside report on salmonella, shigella-NOT!Aminoglycoside report on salmonella, shigella-NOT! Antibiotic reporting on E coli O157:h7 –NOT!!!!Antibiotic reporting on E coli O157:h7 –NOT!!!!

Culture Reports – Corrected ReportCulture Reports – Corrected Report

Any time there is a change to the report there Any time there is a change to the report there should be a corrected report generated and a should be a corrected report generated and a call made to unit/physician.call made to unit/physician.

ExamplesExamples Supplemental reports happen – additional Supplemental reports happen – additional

comment, additional organism, additional comment, additional organism, additional antibiotic requested, etc.antibiotic requested, etc.