Sputum culture

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Sputum culture

7. Reporting

ALWAYS date/time/initial reports, beginning of overnight tests, susceptibility testing, etc.

Final report

Date/time/initial

Note relevant biochemical/susceptibility testing

Report pathogen ID/contaminant/normal flora

Quantitate growth

Other

Quantitate qualitatively (i.e. many, few, etc.)

Urine/BAL

Quantitate numerically (i.e. >100,000 CFU/ml)

Interim report

Run & record any more tests performed (biochemical/susceptibility testing)

Record if there is any additional growth

Preliminary report

Potential pathogen isolated

Report relevant info (i.e. LF GNR) or use abbreviated ID & quantitate

Pathogen ID known or antibiotic susceptibilities known = report as is & do not perform susceptibility testing (i.e. beta hemolytic strep is known to be susceptible to penicillin)

Pathogen ID unknown or pathogen antibiotic susceptibilities unknown = report as antibiotic susceptibility/ID pending

Normal flora/contaminant isolated

Report as normal flora/possible contaminant & quantitate

Unable to isolate colonies/subculture/perform gram stain/get colonies to grow

Report as culture ID pending

6. For every phase of testing, determine if additional testing is needed

Pathogen

Continue testing

Contaminant

Discontinue testing

2. Look at different colony types

Multiple colony types

Mixture of normal flora & pathogens

Pathogens

Normal flora

4. Perform gram stain

GNC

GNDC

GNR

GNCB

GPR

7. Use abbreviated ID if possible

1. First & foremost = always consider source type

May change battery of tests performed

5. Correlate colony morphology with gram stain results

GNR/GNCB (growth with only fastidious organisms)

Perform gram stain

GNCB with school of fish/railroad tracks

Consider other organisms

Suspect Haem ducreyi

Perform XV tests on horse BAP

X & XV growth

Haem ducreyi

Consider other organisms/repeat testing

Perform XV tests on horse BAP

V & XV growth

Haem parainfluenzae

Haem parahaemolyticus

X growth

Haem species

XV growth

Haem influenzae

Haem haemolyticus

GNR/GNCB (growth on BAP, CHOC, & MAC)

Growth on MAC

Growth on BAP

Perform oxidase

NLF

Observe swarming on BAP

Probable Acinetobacter species (if ADH/ODC -, plump GNCB, colorless/pink colonies on MAC)

Streno maltophilia (if ADH/ODC -, strong maltose oxidizer, pale yellow/lavendar colonies on BAP)

Perform spot indole

Ampicillin R

ODC -

Prot penneri

ODC +

Ampicillin S

Prot mirabilis

Prot vulgaris

(Non-sterile body source, LF) observe lactose fermentation

(GI site) perform GNR ID panel

(Non-GI site) perform spot indole

Perform GNR ID panel

Esch coli

(Sterile body source, LF) perform GNR ID panel

G

Glucose asaccharolytic

Glucose oxidizer

ADH

LDC

Probable Elizabeth meningoseptica (if ODC -, indole +, yellow pigment)

Perform polymyxim B susceptibility

Burk cepacia complex (if ODC variable, pale yellow colonies)

Additional test results needed for definitive ID

Growth @ 42 C

Additional results needed for definitive ID

Pseudo aeruginosa (if green/red/brown pigment, LDC -, ODC - , nitrate +)

Glucose fermenter

Correlate with key biochemical reactions

GPC

Perform catalase

Possible streptococci

Gamma

Non-hemolytic strep

Alpha

Perform optochin

Strep viridans

Strep pneumoniae

Beta

Perform PYR

Perform hippurate hydrolysis

Perform bile esculin

Beta strep, not A, B, or D, or Enterococcus species

Perform 6.5% NaCl

Group D strep

Enterococcus species

Group B strep

Perform bacitracin

Group A strep

+

Perform coagulase

-

Perform bacitracin or modified oxidase

Baccitracin R/modified oxidase -

(Urine) novobiocin

R

Probable staph saprophyticus

S

Coag neg staph

(Other) coag neg staph

Bacitracin S/modified oxidase +

Micrococcus species

Staph aureus

3. Examine colony morphology

Wide variety of colony morphologies

GNR/GNCB

Gray/tan/bluish-gray/white, small, translucent, raised, convex, smooth, hockey puck

Think possible GNDC

Gray, smooth, pinpoint, flat/raised, alpha, translucent

Think possible GPC in chains

White/gray, smooth, raised, beta or gamma, opaque

Think possible GPC in clusters or chains