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Safety
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I am about to start work with MRSA/VRE. What safety precautions are required in the lab and for staff. Are there definite guidelines. Thank You
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(answered 04/29/2007)
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What is the current accepted practice regarding wearing gloves while reading plates on the open bench?
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(answered 06/21/2007)
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Quality Control
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Is user QC required for the tubes used to set up AFB in the Bactec MGIT 960 or is the manufacturer QC sufficient?
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(answered 06/01/2007)
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Bacteriology - gram negative bacilli & cocci
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can I report shigella as final report with wellcolex by remel
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(answered 04/12/2007)
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Is there any value in speciating Acinetobacter lwoffii from Acinetobacter junii? Is this important for determining antibiotic susceptibilities?
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(answered 04/21/2007)
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We had isolated a nonfermentative bacterium which shows a lemon-yellow nondiffusible pigment.After 48hrs of incubation at 30oC, a greenish pigment could also be seen.we suspect it to be Agrobacterium yellow group.Since we rely completely on manual methods of identification, what are the possible features for identifying this organism, or does any other nonfermenter produce this peculiar pigment(a mix of lemon-yellow and green)?
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(answered 04/26/2007)
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I would very much like to get a complete textbook/atlas on nonfermentative gram negative bacilli.Kindly help me in the search.
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(answered 04/26/2007)
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I have a slow growing gram negative rod I cannot identify. The gram stain showed long gnr with tapered ends so I began to take the Capnocytophaga route. All roads lead away from that organism. The isolate is catalase, oxidase, and indole negative. It doesn not grow on Mac. It doesnt exactly swarm the agar, rather it reminds me of what an Eikenella looks like, but on a longer scale. I have tried a few ID systems and it does not come close to any ID.
Help?
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(answered 04/27/2007)
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i have a gm-ve isolate from et tip in my lab which is oxidase -ve, indole -ve, all sugars -ve , motile ,urea -ve, citrate-ve tsi k/a which is declared alcaligens spp by api on basis of id 32 i,m confused tell me what it is?
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(answered 04/27/2007)
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can Klebsiella oxytoca produce green sheen on EMB agar? thanks in advance..!
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(answered 05/01/2007)
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I have isolated a gram negative bacillus, oxidase negative, catalase negative, onpg positive, grows in CO2 and anaerobically, glucose positive, maltose positive, sucrose positive, trehalose positive, nitrate negative, esculin negative mannitol negative, ornithine negative, lysine negative, arginine negative, no growth on macconkey and non motile. What is it?
More information - vitek 2 identified this as Sphingomonas paucimobilus but it is esculin negative. Grows on blood agar and chocolate well at 48 hours. Isolated from the blood of a cancer patient.
Thank you
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(answered 05/17/2007)
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I have an isolate from a blood culture which is a gram negative bacilli. Oxidase and catalase negative. Grows in CO2 no growth anaerobically. Growth on chocolate but not macconkey agar. Utilizes no sugars but urea positive. Neither fermentative nor oxidative.
Can you help?
Thank you
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(answered 05/25/2007)
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Virology - general
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We currently perform rapid Influenza testing for Flu A and B. My understanding is that Avian Flu H5N1 is a Flu A virus. My question is, in the event of a suspected pandemic flu event with avian flu, I expect that our physicians will want to rule out Influenza A and B. Will the avain flu cross react with non-avian flu type A? And if so, how do we rule it out?
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(answered 04/11/2007)
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Is it recommendet to use swabs with AMIES transport medium for collecting influenza samples? Thank you.
iris_hatibi@hotmail.com
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(answered 05/02/2007)
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Anaerobic Bacteriology
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What is your opinion on the use of a broth medium (such as thioglycollate) to replace "regular" anaerobic culture on selected sterile body fluids, such as pleural, synovial, CSF? If this seems to be an acceptable practice, should we be holding the broth for 3 days or 5? Also, what about sterile fluids that are more likely to exhibit growth, such as abdominal?
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(answered 06/01/2007)
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HOW LONG SHOULD ANAEROBIC SPECIMENS BE EXPOSED TO ROOM AIR WHILE SUB CULTURING OR EXAMINING PLATES?
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(answered 05/29/2007)
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Parasitology
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We want to switch from PVA to Protofix for ova and parasite collection. What validation is required? Do we need to collect samples from patients in duplicate? If so, how many positives/negatives? Is there another way to validate without involving patients?
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(answered 05/15/2007)
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Mycology
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We received an identification of Saccharopolyspora species from an aortic valve. Are there any cases reporting this organism as a pathogen at this site?
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(answered 04/19/2007)
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Is there an antimicrobial agent that I can add to my fungal culture plates (PDA or SDA) that will prevent bacterial growth without inhibiting fungal growth?
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(answered 05/01/2007)
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We are interested in the ChromAgar Candida to give our doctors a presumptive Id on yeast for treatment. Since this a singl, presumptive ID, do we need to have a survey for this? Any help would be appreciated.
thanks
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(answered 05/30/2007)
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We are currently using a modification of the hair test for dermatophytes. The hair is unsterile and plate media is SAB with chloramphenicol and getamicin (Mycology agar PML)to suppress the bacteria on the hair . I don't find this method very scientific even though it has been vlidated with appropriate organisms In your opinion is this method acceptable?
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(answered 05/04/2007)
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Mycobacteriology
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mycobacteria
is it ok to heat fix afb stains at 80 degrees celcius for 15 mins?
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(answered 05/11/2007)
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mycobacterium other than tuberculosis was reported by pcr in endometrial cureettage, is it significantor contaminant/ which are the significant mott in endometrium ?
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(answered 04/21/2007)
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does qc need to be perform on middlebrook 7h11(nonexempt) by the user lab? also which control organisms should be run?
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(answered 05/07/2007)
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Compliance
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I was refered to ASM as a source of CPT codes for many of the misc. procedures performed by Micro. such as Optichin, Tisse grinding, germtube, etc. Can you help?
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(answered 04/16/2007)
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WE DID A SKIN STREP TEST WITH A DX OF 691.0, WHAT WOULD BE THE CPT CODE? THANKS, KERRY
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(answered 05/04/2007)
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Culture, genital
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What is the significance of Gardnerella vaginalis in male genital cultures? Should this organism be reported, and is it a cause of UTI in males?
Thanks
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(answered 04/17/2007)
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We do a few genital cultures still, and the physician is good about including the diagnosis. But I've been concerned about the situation in which the genital smear suggests bacterial vaginosis (no Lacto, many small variable rods and rare yeast), but then the culture grows many yeast. We then feel obligated to ID the yeast, but actually the gram stain suggested yeast was a minor presence. When the gram stain shows rare yeast, should we limit our yeast workup? Possibly report as "Many yeast, no further ID indicated by original smear." In this case, the dx was polycystic ovaries. Thanks.
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(answered 04/17/2007)
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How should a negative (no pathogens) genital culture report (not a GBS screen) be worded? Can you include the statement "No Gp B Beta strep isolated" if you did not set up a LIM broth on these cultures? Should LIM broths be set up on all genital cultures if physicians sometimes order a genital culture instead of a GBS screen?
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(answered 04/05/2007)
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IS HEAVEY GROWTH OF GROUP F BETA STREPTOCOCCUS IMPORTANT IN A VAGINAL
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(answered 05/11/2007)
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Our lab is updating the genital culture. We are debating to get rid of the gram stain. Should the gram stain be ordered for the diagnosis of Bacterial Vaginosis? Or should BV be idenitified from the plate?
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(answered 04/24/2007)
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SHOULD 4+ STAPH AUREUS IN GENITAL CULTURE HAVE A SENSITIVITY PERFORMED?
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(answered 05/07/2007)
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Should we evaluate vaginal swabs for atrophic vaginitis in post menopausal women and desquamative inflammatory vaginitis and non infectious vaginitis in all women?
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(answered 06/20/2007)
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If a group B streptococcus is recovered from high vaginal swab for non pregnant lady should we continue for sensitivity and reporting or consider it normal colonization and is E coli a vaginal pathogen to report
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(answered 06/20/2007)
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Antimicrobial Testing - general
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On a few E.coli isolates, we received an interpreation of sensitive or intermediate for gentamycin and resistant for tobramycin. Should we change the interpretation for gentamycin to resistant to match the tobramycin result?
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(answered 02/04/2005)
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Is there a relation between MLS(B/c)and HLR-aminoglucosides resistency in Enterococcus spp?I have observed statistical relation between these two types of resistence.Please write me on iiosifov@yahoo.com
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(answered 02/07/2005)
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Is it necessary or helpful to perform routine susceptability testing on Haemophilus isolated from respiratory specimens? Is there helpful text information that can be added to the report to guide the physician in appropriate treatment?
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(answered 05/30/2006)
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Do I have to test Staph aureus with Cefoxitin disks? I use Microscan for MIC's and an Oxacillin screen agar to confirm Methicillin resistance. I do NOT report Oxacillin results on Staph epid or any coag neg Staph. We don't feel it is difficult to read and if that is the only reason to change, must I??
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(answered 04/10/2007)
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what do you do to confirm carbapenem resistance in automated system
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(answered 04/13/2007)
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should sensitivity be performed on group a beta strep from a wound culture?
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(answered 04/03/2007)
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When a panel on our Microscan flags a sensitivity as a possible ESBL, we do confirmatory tests. If the result is negative for ESBL, should we be confirming for Amp C??
any help would be appreciated. thanks
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(answered 05/08/2007)
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We perform only disc diffusion method of ABST in our lab.we tend to get isolates of pneumococci that exhibit resistance to oxacillin but are susceptible to penicillin and cephalosporins. How should we send the sensitivity report? What comment should we add in the report? We do not do MIC testing in the lab.
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(answered 05/17/2007)
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what are the current CLSI guidelines for screening for ESBL production amongst Pseudomonas and Acinetobacter?
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(answered 05/15/2007)
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While doing our antibiogram for 2006, we noticed on the Microscan that E.coli was only sensitive to Amp/Sulbactam 61% but sensitive to Augmentin 90%. We found that another local hospital had similar results. What causes that difference?
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(answered 05/26/2007)
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Should susceptibility testing be performed on organisms (e.g. S. aureus)isolated from different specimen sources from the same patient that were collected on the same day?
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(answered 06/17/2007)
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Would the MicroScan instrument ID a VRSA if it were not? For instance, a wound culture from a patient in a nursing home is ID'd as VRSA by the instrument when reading the susceptibility panel. Is it likely to
have been an instrument error? It was not recognized as significant at the time by the tech and there was no follow-up, reset, etc. Eastern USA, Ohio.
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(answered 06/08/2007)
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How likely is it that the MicroScan has
incorrectly ID'd Aerococcus viridans from a urine culture? It was the only organism ID'd and the patient was symptomatic and reides in a nursing home.
Levofloxacin was used to treat. Was it
Aerococcus viridans? It's the first i've seen in 7 + years of reading the
antibiograms.
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(answered 06/08/2007)
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How is the modified Hodge test performed & interpreted?
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(answered 06/15/2007)
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Should susceptibilities be performed on Group B Beta Strept. in a Urine culture of significant amount?
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(answered 06/15/2007)
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We currently do not perform anaerobe susceptibilities routinely but we call the physician when we isolate an anaerobe from a blood or critical source. The phone call seems to prompt a "yes" answer regardless of what the anaerobe is. Are there some anaerobes where, even when isolated from a critical source, susceptibilities need not be performed?
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(answered 06/21/2007)
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Bacteriology - general
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what is enteric gram negetive?
and can u give me the best site for this?
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(answered 04/20/2007)
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Does store bought H2O2 (i.e grocery store) work just as accurately as Microbiology Test Suppliers H2O2 when performing the catalase test on a Staph or Strep?
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(answered 06/15/2007)
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Bacteriology - gram postive cocci
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What is the significance of isolating MRCons from Umbical Artery Catheter & Umblical Venous Catheter of neonates.Baby is Clinically stable do we have to report it.We isolate Lot of MRCoNS from ET TIP,Trachestomy tips any guidelines on reporting.Thank you.
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(answered 05/15/2007)
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Is beta strep. group b ever considered a pathogen in a throat or respiratory specimen.
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(answered 05/02/2007)
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Should optican disk be incubated in c02 or room air? The product insert states that room air may give larger zones. Does the interpretation change depending if it is incubated in CO2 or room air. Does the QC zone size change. We currently incubate the plate for the patient and QC in CO2
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(answered 04/27/2007)
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What is the significance of a pure culture of Lactococcus sp. in a urine culture?
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(answered 05/03/2007)
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Is it necessary to identify and report staphylococcus lugdunensis from all the wound specimens?
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(answered 06/22/2007)
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Bacteriology - gram postive bacilli
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blood culture growing grampositive bacilli grew on bap and chocolatewith dry yellow colonies with musty odor thanks
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(answered 05/16/2007)
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Culture, blood
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Do you know if there is any reason why LMX/Lidocaine creme could not be used on a pediatric patient if blood cultures are being drawn. Would cleaning the site immediately prior to drawing the blood culture negate the effect of the lidocaine?
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(answered 05/29/2007)
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I have a question regarding decontamination of indwelling catheters prior to collection of blood cultures from that line. It seems to me it should be decontaminated the same way you would a peripheral draw. Any info would be helpful along with any references I might find. Thanks!
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(answered 04/07/2007)
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Can you tell me where I can find a comparison of the Trek, Bactec , and Bac T ALERT blood culture systems ?I am specifically interested in Trek's claim that their bottles do not require solids to absorb antibiotics ( as the FAN and PLUS bottles are designed to do.
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(answered 05/29/2007)
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my clinician had send my lab blood culture and urine culture from a pt. who hhad h/o fever three days and uti symptoms. urine showed pyuria and grew candida spp where as blood culture grew e.coli sensitive to ceftriaxone. now clinician is asking he was suspecting uti so why did urine culture despite pyuria did not grow e.coli? second what is the relivance of e.coli in blood when pt. is not showing any signs of sepsis other than fever. at the same time he admits that pt. was put on hrs.ceftriaxone to which pt. responded in 48 hrs. pl answer this.
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(answered 06/06/2007)
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Culture, stool
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What is the recommended method of reporting leukocytes in stool? What is the recommended stain to use? What is considered normal?
Thanks,
anewman@olbh.com
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(answered 04/15/2007)
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How important is it to place stool material for culture into transport media if there is a delay in plating the samples? We currently refrigerate the samples if there are delays in plating? Is the costs of tranport media justified vice refrigeration? Also, the guidelines are confusing on temperature?
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(answered 04/23/2007)
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How long will C. difficile toxins be detectable in the stool after a patient is treated for C. difficile? We use a EIA kit test to detect the A and B toxins.
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(answered 04/21/2007)
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Is it clinically relevant to test for C diff toxin in patients who are currently receiving either Vancomycin or Metronidazole?
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(answered 04/25/2007)
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What is the recommended frequency for performing cdiff toxin assays? We often get multiple samples collected on the same day. Are there recommended quidelines to follow?
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(answered 05/20/2007)
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WHEN THERE IS NO GROWTH ON MEDIA PLATES,IS IT OK TO REPORT NO GROWTH ON STOOL CULTURE INSTEAD OF REPORTING NO SALMONELLA, SHIGELLA, E.COLI O157:H7 AND CAMPYLOBACTER ISOLATED?
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(answered 05/12/2007)
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Is there an recent paper available comparing various EIA kits for C. difficile toxin A and B?
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(answered 06/13/2007)
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Could you tell me the significance of isolating Klebsiella oxytoca from a stool culture? When should this organism be identified and reported from a stool culture? Thanks!
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(answered 06/17/2007)
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Culture, respiratory
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how soon may a group a beta strep plate be finalized?
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(answered 04/17/2007)
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how many colonies needed to call a positive group a strep culture. I have seen some labs use a <10 colonies are considered neg, but some think only one colony is significant.
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(answered 04/19/2007)
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This question is in regard to Cystic fibrosis cultures. We are a small lab and have a few patients with cystic fibosis that have respiratory cultures done on a routine basis. We currently process them the same as the other respiartory cultures. At this point we have not isolated any Pseudo in the cultures. From what I read these type of cultures should have some specialized media and possibly held longer than a routine culture? Would it be appropriate for us to screen at our facility on our routine media or would we be missing an important pathogen. Any protocols or references would be appreciated.
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(answered 04/21/2007)
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As Microbiologists are we required to recognize squamous epi's from other epi's found in gram stains, especially sputums? Some cells in the gram stain could be bronch cells, which mean the specimen is a good one. I believe some techs call all cells epi's. We do not differentiate the different epi's. this concerns me. I appreciate any advice. thanks.
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(answered 05/09/2007)
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For bronchial washing cultures,we set up BA,MAC,CNA,CHOC,BBE/KVA,PEA and BRUC agars, and a THIO broth. We identify only pathogens. Since many specimens grow normal oral flora, is it necessary to include THIO broth in our set up?
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(answered 05/16/2007)
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Culture, urine
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what is the sop for urine culture according to asm/ if 2-3 pus cells are there and growth is >100,000/ml so should i report and perform ast?
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(answered 05/18/2007)
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cystoscopic urine nephrostomy urines,how should we treat these cultures both in regard to plating and reporting.
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(answered 05/16/2007)
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Is any one rejecting urines for culture if the dipstick was negative for leukocyte esterase and or nitrates?
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(answered 04/01/2007)
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Is it acceptable to culture a urine specimen on a patient that is taking phenazophyridine (Azo-Standard)? If not acceptable, what time frame should you wait after the patient discontinues its use before culturing the urine?
Thanks.
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(answered 04/13/2007)
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Question about culturing of urines: We use NON-DISPOSABLE calibrated loops for plating urines. Is it necessary to flame the loop between plates (if the tech makes sure a drop of specimen is delivered)?
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(answered 05/08/2007)
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could you get a positive nitrate reading on urinalysis but then get a negative urine culture if the patient was being treated with Levaquin 500mg for 6 days?
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(answered 05/18/2007)
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coryneform bacteria seen in gram stain of sputum culture and the coryneform gpb grows 4+. Should further id be done?
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(answered 06/11/2007)
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Looking at a Clean Catch urine sample and you have less than 10,000 col/ml of an organism we do not work it up, however, I have the question can you call this a no growth or should it be reported <10,000 col/ml with a description of the colony type?
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(answered 06/11/2007)
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How do you calculate for urine colony count in cells per ml?
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(answered 06/20/2007)
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Culture, wound
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DO YOU CONSIDER GROWTH IN THIO ONLY TO BE A CONTAMINANT? THERE IS NO GROWTH ON ANY PLATE EXCEPT OUT OF THIO. ONE SPECIMEN IS A CSF WITH GNR. AND ONE IS A WOUND WITH GPC.
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(answered 04/29/2007)
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Specimen Collection, Transportation & Processing
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We use Amies transport medium for throat, genital and wound specimens which is collected by a swab Is there any advantage of using Stuart medium for this purpose.
Thank you very much
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(answered 04/03/2007)
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Is it recommended to submit multiple surgical specimens from the same site for culture? We sometimes recieve several sets of swabs labeled, A,B,C, and D, they usually all grow out the same thing.
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(answered 04/06/2007)
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Culture, other
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Is it appropriate to culture surgical hardware (e.g. metal screws) that has been removed? If so, what technique should be used?
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(answered 04/05/2007)
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which part of a central venous catheter do you send for tip culture and what length of catheter is required to have an accurate result?
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(answered 04/03/2007)
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Our CSF culture protocol includes aerobic culture, gram stain, and Cryptococcal antigen. Is there documentation for not performing repeat Cryptococcal antigens on multiple specimens? What is an acceptable time interval between repeat testing? Thanks!
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(answered 05/17/2007)
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We culture water from several "environmental" sources (chemistry instruments, histology reagent water, etc.), and are holding plates for 72 hours before reporting as negative. It's been this way for so long that we cannot remember where the 72 hour time fram came from. Is there any documentation for this? Do you think 48 hours would be sufficient?
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(answered 05/17/2007)
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Are quantitative tissue cultures still viewed as useful? I read that a regular culture combined with a pathologist-reviewed microtome is currently more favoured.
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(answered 05/25/2007)
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Miscellaneous
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Does HIV induce systemic lupus erytematosis? or, Does systemic lupus erytematosis cause false positive HIV results?
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(answered 05/16/2007)
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