e.g. Lyme disease is the most common tickborne disease in the United States [1]. specimen handling may be obtained from the US Occupational Safety and Health Administration (OSHA) and the Centers for Disease Control and Prevention (CDC). This guideline focuses on pulmonary disease in adults (without cystic fibrosis or human immunodeficiency virus … The microbiologic analysis of respiratory specimens is a key component of both the clinical investigation of ventilator-associated pneumonia (VAP) and patient care. Endodontic Area, Dental School of São Paulo, University of São Paulo. Some specimens may be obtained as a means of monitoring the success of antimicrobial therapy. When specimens are obtained for microbiologic study, it is critical to consider all possible etiologic agents in the differential diagnosis and to submit specimens appropriately. The microbiologist efficiently handles small samples … ... chemical, microbiologic, and cellular analysis. However, a range of factors makes delineation of these epidemiologic trends difficult. In handling human specimens, the goal is to protect health care workers and ancillary staff such as transportation as well as the general public from exposures to blood and to other potentially infectious body fluids. Note: Forty percent of the subjects in this trial had specimens obtained by sinus endoscopy. Undisturbed soil specimen of 38 mm diameter and 76-mm height (2:1 height-to-diameter ratio) may be obtained using a split mold from an undisturbed soil sampler. In handling human specimens, the goal is to protect health care workers from exposures to blood and to other potentially infectious body Histopathologic examination is used to distinguish neoplastic from inflammatory lesions and acute from chronic inflammations. The laboratory should be made aware that the specimen was collected during a regime of antimicrobial therapy. What are the possible side effects of Levaquin? 6 Culture data may provide an opportunity for escalation or de-escalation of antibiotic coverage. Specimen types include swabs of ulcers, corneal scrapings, impression membrane cultures, biopsies, or anterior chamber aspirates, or vitreous aspirates/washings [36, 37]. It is possible to collect three identical soil specimens from the same level of a 100-mm-diameter undisturbed soil sampler using a three-member mold, welded to a central vertical axis. During specimen collection, these general procedures should be … Generally, specimens should be obtained prior to the onset of antimicrobial therapy. An MSU may also be obtained for near-patient urine testing and other tests, such as toxicology screening to identify causes of poisoning or drug overdose. Although the majority of cases are reported from the mid-Atlantic, northeastern, midwestern, and far western regions of the country, several hundreds of cases annually are reported from the The centrifugation-shell vial system can culture virus and intracellular bacteria. specimen is desirable for optimal cytologic evaluation. The microbiologist efficiently handles small samples … Specimens … Specimen transport may be affected, eg, the • ... CSF is usually collected by lumbar puncture(LP), but may • also be obtained by lateral cervical or cisternalpuncture. The respiratory tract specimen must have been collected on or after the 3 Send the sample to the laboratory immediately or refrigerate until it can be transported to ensure accurate results are obtained (Dougherty and Lister, 2015). a. Optimal timing. Numerous studies have demonstrated the disutility of urine specimens obtained for culture from a collection bag stuck to an infant’s perineum. obtained noninvasively, there may be factors which could prompt consideration of obtaining samples invasively. Viral specimens are inoculated onto a cell monolayer and incubated at 37°C. Document the date and time the sample was collected in the patient’s notes. Secondary BSIs may be reported for PVAP events, provided that at least one organism identifiedfrom the blood matches an organism isolated from an appropriate respiratory tract specimen (including respiratory secretions, pleural fluid, and lung tissue). Specimens were obtained through existing incisions. Levaquin belongs to a class of drugs called Fluoroquinolones. Adequacy of labelling is determined by the discretion of the microbiology laboratory. Urinary catheter acquired infection is usually manifested as asymptomatic bacteriuria (CA-ASB). ... chemical, microbiologic, and cellular analysis. specimens will be useful for glucose or drug testing, but their principal importance is now as a complementary specimen in the quantitative analysis of alcohol. Clinical and microbiologic considerations may vary for short and long term catheters. Specimens should be obtained prior to digital cervical examination or vaginal probe ultrasound examination as manipulation of the If symptoms or signs point to involvement of one organ system, specimens are obtained from that source. specimens that may be obtained 2.2 Describe the tests and investigations that may be carried out on the specimens 2.3 Identify the correct equipment and materials used in the collection and transport of specimens 2.4 Identify the hazards and other consequences related to incorrect Regarding microbiologic results obtained from different sample types, the data have been deemed “reasonably similar” and “rather equivalent” . Information on safe specimen handling may be obtained from the U.S. Occupational Safety and Health Administration (OSHA) and the Centers for Disease Control and Prevention (CDC). However, advocates of bronchoscopy cite many studies showing that directed lower airway sampling is an excellent proxy for lung tissue ( 5 ) and better captures the incidence of VAP ( 11 ). We reviewed microbiologic specimen results of prior respiratory specimens (pre-VAP) and BAL. The laboratory should be made aware that the specimen was collected during a regime of antimicrobial therapy. In populations where children are routinely immunized, adolescents and adults now constitute the main source of infection in infants. Specimen Collection and Transportation of Microbiology Specimens Date & Time Viewed: 12/14/2010 at 11:54:42 AM Page 3 of 25 01/25/2010 Version 2 i. 1999. If other specimens are very limited in amount, screening may sometimes be done on urine to spare blood or vitreous humor for such quantitative analyses as may be indicated. Some specimens, such as a drop of urine, are already in a liquid form and can be deposited on the slide using a dropper. Microbiologic Diagnosis of Ocular Infections Kirk R. Wilhelmus Establishing the etiology of ocular infections requires collecting appropriate specimens and performing definitive laboratory studies.1,2 Some physicians process and examine clinical specimens in their offices,3 but most ophthalmologists use a microbiology laboratory. ratory specimen. Because microbiologic processing may not be available around the clock, optimal storage of specimens is essential ... [10], the specimens should ideally be obtained before initiation of treatment. In addition, culture may be obtained from frontal recess, ethmoid, and sphenoid sinuses with the aid of this applicator. At least liquid culture should be done on all specimens as culture is the gold standard microbiologic … Microbiologic evaluation of canine urine: direct microscopic examination and preservation of specimen quality for culture. Results of routine microbiologic cultures of specimens obtained be-fore the onset of ventilator-associated pneumonia (VAP) in inten-sive care unit (ICU) patients might help to identify the causative microorganisms and thus to select effective initial antimicrobial therapy. A detailed description of specimen collection for subsequent anaerobic culture may be found in the Wadsworth Anaerobe Lab manual [112], as well as other microbiology textbooks. Although a single sputum specimen may be sufficient for establishing the diagnosis of an acute bacterial process, collection of a series of two or three sputum specimens obtained on one or two days is recommended for patients suspected of having mycobacterial infections. Table 6-Diagnostic Value ofDirect Examination ofBlind Bronchial Sampling (BBS) and Bronchoalveolar hivage (BAL)5 - "A reappraisal of blind bronchial sampling in the microbiologic diagnosis of nosocomial bronchopneumonia. If an inadequately labeled specimen is brought to the laboratory by someone from the nursing unit or office, that individual will be asked to supply the missing information. N. meningitidis, S. pneumoniae, and H. influenzae are fastidious and fragile bacteria. The surgeon should obtain several samples for examination from a single large lesion or each of several smaller lesions. (Refer to the Catheterizing the Patient’s Bladder discussion and Guideline 36-2.) The collection of an MSU must be performed as part of a holistic assessment and must be considered alongside the presenting signs and symptoms (Box 3). Although staphylococci may be susceptible to fosfomycin and chloramphenicol, these antibiotics have not been approved for osteoarticular infections and should be avoided. 1).The finding indicates disease of the peripheral airways causing mucous plugging, bronchiolar distension, and thickening of the peri-bronchiolar wall, most commonly as a result of an infectious process [1, 2]. for every specimen obtained from an individual with sus-pected TB disease (conditional recommendation, low-qual-ity evidence). To obtain the biopsy specimen, the forceps is advanced with the jaws closed into a distal airway until resistance is met. The midstream-voided technique is as accurate as catheterization if … Methods: 54 patients underwent fiberoptic bronchoscopy to obtain BAL samples. Others have noted this finding and questioned the usefulness and cost-effectiveness of fungal culture in FNA specimens because fungi were often identified by morphology and special stains. Microbiologic findings of sinusitis by a novel method for obtaining culture. The object of this study was to compare the respiratory samples before VAP and bronchoalveolar lavage (BAL) culture. abstract— The purpose of this investigation was to study colonization and sequencing of oral microorganisms in human tooth fissures. Regarding microbiologic results obtained from different sam-ple types, the data have been deemed “reasonably similar” (10) and“ratherequivalent”(7).However,advocatesofbronchoscopy cite many studies showing that directed lower airway sampling is anexcellentproxyforlungtissue(5)andbettercapturestheinci-dence of VAP (11). disinfectant prior to collection of the specimen for culture. These specimens may be obtained at any time during the clinical course, but ideally prior to initiation of antimicrobial therapy. Five human subjects carried … Keratitis was confirmed 18 hou A passed stool is the preferred specimen for culture and toxin investigation. while awaiting collection of specimens or results from the laboratory and a specimen should be obtained in all suspect cases as bacterial pathogens can still be detected even after antimicrobial therapy has begun. Purpose: To compare the microbiologic yield of cultures obtained by direct inoculation of blood agar plates (BAP) from corneal ulcer swabbings versus indirect inoculation via transport media in a rabbit model of Streptococcus pneumoniae bacterial keratitis. The forceps is retracted slightly and then advanced slightly, with the jaws open. Specimen Collection and Transportation of Microbiology Specimens Date & Time Viewed: 12/14/2010 at 11:54:42 AMPage 3 of 25 01/25/2010 Version 2 i. If a specimen is to be collected through intact skin, cleanse the skin first. Collection of vaginal specimens for microbiologic culture frequently requires aggressive collection techniques that may abrade the cervical or vaginal mucosa and may potentially interfere with sample preparation. If classical microbiological techniques are to be used for diagnosis and microbial identification, proper collection and transport of specimens are critical. Proper transport will require the use of an oxygen-free environment for the time of transport. Care must be taken not to contaminate the specimens with normal flora. In a constipated infant, it may be necessary to perform colonic irrigation with limited amounts of sterile saline. Specimen Collection and Processing, p 51-140. - No urine or toilet paper in specimen - Some collections (occult blood) require dietary restrictions before collection (red meat, no iron meds, certain vegetables) - Some stool specimens must be taken to lab within 30 minutes of collection - Some specimens are repeated. Oropharyngeal swab specimen, collected by a health care professional Saliva specimen (1 to 5 mL) collected by the patient while supervised. Acceptable lower respiratory tract specimens include sputum, tracheal aspirate, BAL fluid, pleural fluid, or lung biopsy. The proper collection of a specimen for culture is the most important step in the recovery of pathogenic organisms responsible for infectious disease. Swab specimens from 11 patients with food-sensitive enteropathies in the convalescent phase (six boys and five girls, aged 2.1 y to 4.3 y; mean age 3.4 y) were used as controls. Methods: 54 patients underwent fiberoptic bronchoscopy to obtain BAL samples. Commonly used methods for the lower-respiratory-tract specimen collection include 18,19,21–23 Bag specimens may be more sensitive than catheter specimens when used for UA or microscopy to identify infection in children at low or moderate risk for UTI. worker may also hinge upon accurate diagnosis and rapid response. 1. reservoir may increase and the true magnitude of the problem may not become apparent until an outbreak of MRSA infections occurs. This section describes procedures for obtaining culture specimens from the nasopharyngeal area and the throat. A portion of the sputum specimen is stained and put on a slide for examination of cells and organisms. Specimens collected by invasive techniques, particularly those obtained intraoperatively, require special attention. A throat culture is obtained by introducing a sterile swab into the mouth. THE USE OF BIOMARKERS AND THE CLINICAL PULMONARY INFECTION SCORE TO DIAGNOSE VAP AND HAP IV. The object of this study was to compare the respiratory samples before VAP and bronchoalveolar lavage (BAL) culture. Results of routine microbiologic cultures of specimens obtained before the onset of ventilator-associated pneumonia (VAP) in intensive care unit (ICU) patients might help to identify the causative microorganisms and thus to select effective initial antimicrobial therapy. Citation: Miller J. Enough tissues must be obtained for both histopathology and microbiologic examination. Specimens should be transported to the lab at room temperature (oxygen is able to diffuse into the liquid medium more easily at low temperatures), 3 ideally within 3 hours of collection; specimens older than 24 hours will not be accepted. When the identification of a sample submitted for analysis is in any way questionable, the laboratory will recommend that, if feasible, a new specimen should be obtained. Obtaining reliable and accurate laboratory test results Transfer of specimens to plated media depends on the type of specimen. disinfectant prior to collection of the specimen for culture. Remarks: The conditional qualifier applies to performance of both liquid and solid culture methods on all specimens. Urine specimens may be obtained by midstream clean catch, suprapubic aspiration, or catheterization. Swab specimens from 11 patients with food-sensitive enteropathies in the convalescent phase (six boys and five girls, aged 2.1 y to 4.3 y; mean age 3.4 y) were used as controls. Local anesthesia with either subconjunctival lidocaine or a retrobulbar block is recommended for office-based procedures, while general anesthesia may be an option if proceeding to the operating room. If a specimen is to be collected through intact skin, cleanse the skin first. A pure vitreous sample should be obtained with either the vitreous tap or vitrectomy technique, as an undiluted specimen maximizes the culture yield. 1987 May 15;190(10):1289-91. Place 3 units of heparin per mL capacity of the collection container. Specimen source Unaffected patients 11 (4.9) 214 225 Home healthcare pharmacy 0(0) 110 110 NOTE. Precious samples are any specimens obtained by invasive • Specimens obtained through operation require special attention. ... We consider that sinus specimens may be obtained best by inserting the swab through a narrow-bore contamination-free catheter. The jaws are then closed and the forceps is pulled out through the bronchoscope. Symptoms and signs are fever, … When obtaining a specimen to be used in diagnosing an infection of public health significance (e.g., Specimen transport may be affected, eg, the • ... CSF is usually collected by lumbar puncture(LP), but may • also be obtained by lateral cervical or cisternalpuncture. Stains, or dyes, contain salts made up of a positive ion and a negative ion. For osteomyelitis caused by anaerobic gram-negative bacteria, clindamycin, metronidazole, beta-lactam/beta lactamase inhibitor combinations, or carbapenems are the drugs of choice. For enhanced isolation, the specimen may be centrifuged onto a cell monolayer in a shell vial or microplate. P (calculated with the Fisher exact test) was less than .001 for contamination of unused syringes collected from case patients, compared with syringes collected from asymptomatic patients or syringes obtained Microbiologic endodontic status of young traumatized tooth. 25, 1982, to collect specimens for micro-biologic evaluation. 7. Swabs are generally plated directly by rolling the swab over an area ~2 cm in diameter. If other studies are required, withdraw a fraction of the specimen and submit it to the appropriate separately, following their guidelines for specimen collection. Microbiology Specimens: Bacteriology and Mycobacteriology Collection of Specimens for Culture: General Information 1. Labeling. Appropriate information is critical to proper processing of test requests. Although pertinent clinical information is highly desirable, if it is not available, please provide at least the following information. a. A poorly collected specimen may lead to failure in isolating the causative organism(s) and/or result in the recovery of contaminating organisms. The microbiologic diagnosis of VAP requires a respiratory specimen. Therefore, B. lonestari is considered to be a leading candidate for the etiologic agent of EM in this region.Skin biopsy specimens obtained from patients from the Cape Girardeau area of Missouri who had EM-like lesions were cultured in Barbour-Stoenner-Kelly medium and evaluated by polymerase chain reaction (PCR) targeting multiple genes. The device is therefore not designed to be inserted into a conical tube after the specimen is obtained, with the handle serving as the screw-cap seal--a feature which will allow the proposed device to adapt to thin smear cytologic technique and microbiologic culture and HPV assay. Karla Baumotte. Streptococcus pneumoniae* 25/27 (92.6%) 26/27 (96.3%) Haemophilus … When the identification of a sample submitted for analysis is in any way questionable, the laboratory will recommend that, if feasible, a new specimen should be obtained. 1. Sometimes the liquid used is simply water, but often stains are added to enhance contrast. Aseptic technique was maintained whenever possible during the collection of specimens from both cadavers. Heparin may be added to the specimen to reduce clotting. Depending on the type of dye, the positive or the negative ion may be the chromophore (the colored ion); the other, uncolored ion is called the counterion. Generally, specimens should be obtained prior to the onset of antimicrobial therapy. b. Specimen types. A nasopharyngeal culture is obtained by inserting a thin sterile swab gently through the nose to touch the pharynx; gently rotate and remove. Nontuberculous mycobacteria (NTM) represent over 190 species and subspecies, some of which can produce disease in humans of all ages and can affect both pulmonary and extrapulmonary sites. Specimens from other sources, such as genital, stool, urine, upper and lower respiratory specimens, cannot be cultured under the aerobic bacterial culture test number. In addition to fixation, staining is almost always applied to color certain features of a specimen before examining it under a light microscope. The sensitivities of blind bronchial suction, blind mini-BAL, and blind PSB are 74–97, 63–100, and 58–86%, respectively ( 224 ). Specimens obtained from either the surface or the globe of the eye are almost always collected by ophthalmologists. Information on safe specimen handling may be obtained from the U.S. Occupational Safety and Health Administration (OSHA) and the Centers for Disease Control and Prevention (CDC). When BAL samples are obtained nonbronchoscopically, the threshold varies by technique and may be different from that of bronchoscopic BAL. Post-mortem specimens may be numerous and can endow some special difficulties compared to clinical specimens, namely those resulting from autolytic and putrefactive changes. The collection of an MSU must be performed as part of a holistic assessment and must be considered alongside the presenting signs and symptoms (Box 3). Proper specimen collection and handling is an integral part of obtaining a valid and timely laboratory test result. Specimens must be handled in a safe manner and according to applicable legal requirements or guidance. The most commonly identified pathogens are Streptococcus pneumoniae, Haemophilus influenzae, atypical bacteria (ie, Chlamydia pneumoniae, Mycoplasma pneumoniae, Legionella species), and viruses. Assay interference from semen has not been ruled out. A Prospective Microbiologic Study of Bacteriuria in Patients with Chronic Indwelling Urethral Catheters ... bacteriuria and/or the catheterization may be se-vere and include acute pyelonephritis, bacteremia, ... obtained weekly urine specimens for culture and specimen may be rejected. Specimens must be obtained in the proper tubes or containers, correctly labeled, and then promptly transported to the laboratory. Enough tissue must be obtained for both histopathologic and microbiologic examination. A comparative study in ventilated patients." Sterile Specimen. In instances when it has been determined that a specimen is a “precious sample” Mislabelled or unlabelled samples may be properly labelled by an attending physician or nurse. Specimens may be hand delivered to the laboratory or transported via the runners from Technical Services if the specimens are not indicated as deliver immediately. 2. In Patients With Suspected HAP/VAP, Should Procalcitonin (PCT) Plus Clinical Criteria or Clinical … Because microbiologic processing may not be available around the clock, optimal storage of specimens is essential for accurate microbiologic identification of pathogenetic bacteria. Basic Concepts for Specimen Collection 1. Specimens should not be collected less than 24 hours after intercourse. Although there is a substantial body of literature on the use Community-acquired pneumonia is defined as pneumonia that is acquired outside the hospital. Numerous studies have demonstrated the disutility of urine specimens obtained for culture from a collection bag stuck to an infant’s perineum. Sputum analysisDefinitionSputum is a substance comprised of mucous, foreign matter, and saliva that is found in the lungs or bronchial tree. Solid specimens, such as a skin scraping, can be placed on the slide before adding a drop of liquid to prepare the wet mount. It is not known if Levaquin is safe and effective in children for treatment duration over 14 days. Methods: The corneas of 12 rabbits were inoculated with S. pneumoniae. Liquid specimens are inoculated by use of a sterile syringe or pipette. A sputum analysis is a group of tests performed in a laboratory on a sputum specimen obtained from a sick patient. Generally, specimens should be obtained prior to the onset of antimicrobial therapy. Some specimens may be obtained as a means of monitoring the success of antimicrobial therapy. The laboratory should be made aware that the specimen was collected during a regime of antimicrobial therapy. Allen TA, Jones RL, Purvance J. Urine specimens were obtained from 115 dogs. The incidence of fungal infections continues to increase for reasons such as the growing population of individuals living with some type of immune compromise. 6. 18,19,21–23 Bag specimens may be more sensitive than catheter specimens when used for UA or microscopy to identify infection in children at low or moderate risk for UTI. Any residual material can be retained at −70°C. The efficacy data for subjects whose specimen was obtained endoscopically were comparable to those presented in the above table. ts. Local anesthesia with either subconjunctival lidocaine or a retrobulbar block is recommended for office-based procedures, while general anesthesia may be an option if proceeding to the operating room. Microbiologic media should be stored in the refrigerator but allowed to warm to room temperature before inoculation. These include an endotracheal aspirate, or a quantitative or semiquantitative lower-respiratory specimen. A prospective microbiologic surveillance system, designed to recognize both colonized and infected patients, potentially could identify early outbreaks of MRSA and prevent additional cases of MRSA infection, Anaerobic jars or bags should be used to transport the sample from the site of collection or operating room followed by anaerobic processing for samples. If an inadequately labeled specimen is brought to the laboratory by someone from the nursing unit or office, that individual will be asked to supply the missing information. Complete the request form, label the specimen and place in a specimen bag following local policies. Sterile urine specimens may be obtained by catheterizing the patient’s bladder or by taking the specimen from an indwelling catheter already in place. Suprapubic Aspiration Specimen: This method is used when a bedridden patient cannot be catheterized or a sterile specimen is required. Because the bodies had been refrozen after the initial autopsy, the repeat autopsy required a second thawing of the cadavers. Specimens may be transported through the pneumatic tube system if approved by Pneumatic Tube Administration. A pure vitreous sample should be obtained with either the vitreous tap or vitrectomy technique, as an undiluted specimen maximizes the culture yield. Specimens may be collected directly from a foley into an evacuated tube or transferred from a syringe into a tube. Specimens should be obtained prior to digital cervical examination or vaginal probe ultrasound examination as manipulation of the cervix may cause the release of fetal fibronectin. Microbiologic specimens may be collected from many sources, such as blood, tissue, pus or wound exudates or drainage, urine, sputum, feces, genital discharges or secretions, cerebrospinal fluid (CSF), and eye or ear drainage. The general techniques of specimen collection and handling that have been established both to maximize the yield of organisms and isolate relevant pathogens from specimens obtained from different body sites will be reviewed here ( table 1A-D ). The volume of specimens is always limited. While nasal and nasopharyngeal specimens may be obtained by swab, a needle aspirate is the only specimen of choice for determining the etiologic agent(s) of sinusitis.
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