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Exam 4 - Culturing Specimens
Culturing Specimens
224
Biology
Undergraduate 3
03/17/2015

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Term
True or False:
Do NOT Refrigerate CSF
Definition
True
Term
Match the timing of collection with the specimen:
Urine
Definition
1st morning pee is best
Term
Match the timing of collection with the specimen:
Blood Culture
Definition
Around the time of a temperature elevation (fever)
Term
In general, should you collect a specimen before or after the use of antibiotics?
Definition
Before the use of antibiotics
Term
True or False:
The lab needs Sufficient quantity of specimen for all test requests
Definition
True
Term
Appropriate container for the specimen
Definition
Must be sterile containers!
Depends on the type of specimen
Term
What is the purpose of transport media?
Definition
Prevents sample from drying out
Provides nutrients for MO
Inhibits specific microbial growth
Term
What are the following considered:
Stuarts, Cary-Blair, & Amies gel, viral
Definition
Types of transport media
Term
Transportation Time
Definition
Specimen should reach lab within 2 hours
Term
Other than CSF, how should you other Specimens be stored?
Definition
Refrigerate sputum, urine, stool, abscess, etc.
Term
True or False:
If a specimen is received unlabeled, missing any vital information, or does not match the requisition information, the specimen will be thrown out and a new one must be collected!
Definition
True
Term
What information is needed on the specimen label?
Definition
Patient name
Patient identification number
Source: VERY important
Date/time collected
Other information
-Doctor name
-Antibiotics
Term
True or False:
Of the types of specimens we went through in class the following are typically gram stained:
Abscess/Wound
Sputum
Body Fluids
Urethra (GC)
Stool (fecal WBC count)
Definition
True
Term
Describe a Cytospin Gram Stain
Definition
Concentrate specimen in a small area on the slide
Increase chances of finding MO
Term
True or False:
You should Perform Cytospin on all body fluids
Definition
True
Term
Is a HIGH # of PMNs indicative of a good quality or poor quality specimen?
Definition
Good Quality
Term
Is a HIGH # of Squamous Epithelial Cells indicative of a good quality or poor quality specimen?
Definition
Poor Quality
Term
What does a HIGH # of PMN's on a gram stain indicate?
Definition
bacterial infection or inflammation
Term
What does a HIGH # of Squamous Epithelial Cells on a gram stain indicate?
Definition
Contamination from skin surface
Term
What should you do if a sputum sample has too many Squamous Epithelial Cells on its gram stain?
Definition
Reject the sample and request a new sample
Term
Is the following appropriate or inappropriate GS Test:
Throat for GC?
Definition
Inappropriate
Term
Is the following appropriate or inappropriate GS Test:
Rectal for GC?
Definition
Inappropriate
Term
Is the following appropriate or inappropriate GS Test:
Vaginal for GC?
Definition
Inappropriate
Term
Is the following appropriate or inappropriate GS Test:
Throat for GAS?
Definition
Inappropriate
Term
True or False:
Do NOT set up stool gram stain for enteric pathogens
Definition
True
Term
True or False:
A stool gram stain is OKAY for staphylococcus infections
Definition
True
Term
True or False:
A stool gram stain may detect Campylobacter
Definition
True
Term
True or False:
A stool gram stain is OKAY for PMNs
Definition
True
(fecal WBC count)
Term
Upon review of a sputum Gram stain, the technician notes that the nuclei of all of the neutrophils present in the smear are staining dark blue. The best explanation for this finding is:
Definition
the slide was inadequately decolorized w/ acetone/alcohol
Term
True or False:
Urine is not routinely Gram stained
Definition
True
Term
A Gram stained smear of a sputum specimen revealed the following cells:
3+ Squamous Epithelial Cells
3+ GNR
What should the microbiologist do next?
Definition
Reject the specimen - it is mouth flora
Term
Is a stool GS acceptable for Salmonella/Shigella?
Definition
No
Term
Name a few of the normally sterile body fluids
Definition
CSF, pleural, pericardial, synovial
Term
How soon should you process the BF cultures?
Definition
STAT
Term
How soon should you read and result the gram stain of normally sterile body fluids?
Definition
30 minutes
Term
What does the Cytospin GS do?
Definition
concentrates MOs
Term
Where should you inoculate normally sterile body fluid onto?
Definition
BAP
CHOC
Thio Broth
Term
What does Acridine Orange stain?
Definition
nucleic acids of living or dead cells
Term
What is the process of the Acridine Orange Stain?
Definition
Prepare smear & fix with methanol
Flood with stain, rinse
Examine with 40X objective
Term
With the Acridine Orange Stain what will fluoresce orange?
Definition
Bacteria and Yeast
Term
With the Acridine Orange Stain what color will Bacteria and Yeast fluoresce?
Definition
Orange
Term
True or False:
CSF should be clear
Definition
True
Term
If CSF is turbid what will that indicate?
Definition
Possible Infection
Term
What do you sub CSF to?
Definition
BAP, CHOC, THIO
Term
At what incubation environment do you hold CSF specimens?
Definition
37oC in CO2
Term
CSF leak through the nasal passage due to:
Definition
Skull fracture
Blunt trauma
Tumors
Term
True or False:
Strep pneumoniae can invade the CNS and cause meningitis
Definition
True
Term
Specimen Collection for Abscess/Wound Culture
Definition
Avoid surface contamination
Look for PMNs in gram stain
Term
Types of specimens for Abscess/Wound Culture?
Definition
Tissues
Pus
Swabs
Term
Which specimen is BEST for Abscess/Wound?
Definition
Pus
Term
What do you sub Abscess/Wound specimens to?
Definition
BAP
CHOC
MAC/EMB
CNA/PEA
Term
True or False:
You can add anaerobic media for Abscess/Wound cultures when requested
Definition
True
Term
True or False:
Must chop or grind the tissues to release any embedded MOs
Definition
True
Term
What are the following considered:
Staph aureus
GAS
Enterics
Anaerobes
PSAR
Enterococci
Definition
Common Wound/Tissue Pathogens
Term
What are the following considered:
Haemophilus influenzae
Strep pneumoniae
Neisseria meningitidis
GBS
Listeria
Staphylococcus (CNS)
Definition
Common Pathogens of CSF
Term
Define Gastroenteritis
Definition
inflammation of stomach and intestines
Term
What are the specimens generally used for stool cultures?
Definition
Stool
Rectal Swab
Term
What do you store Stool or Rectal Swabs in?
Definition
Sterile fecal collection container
Stool transport media (Cary Blair)
Term
What are the following considered:
Stool culture (Salmonella & Shigella)
Fecal Gram Stains
Occult blood
Clostridium difficile toxin
Campylobacter sp.
Definition
Common Fecal Tests
Term
What do you perform fecal gram stain for?
Definition
Fecal Leukocyte Count
Campylobacter
Staphylococcus
Term
What are the following considered:
Salmonella
Shigella
E. coli 0157:H7
Yersinia enterocolitica
Campylobacter
Definition
Common GI Pathogens
Term
What are the following considered:
Vibrio species
Aeromonas
Plesiomonas
Clostridium difficile
Staphylococcus aureus
Definition
Common GI Pathogens
Term
Stool cultures are usually for isolating ______ & _______.
Definition
Salmonella or Shigella
Term
What do you sub Stool cultures to?
Definition
BAP
MAC/EMB
HE/SS/XLD
GN Broth
Term
What is the incubation environment for stool culture media?
Definition
Air @ 37oC
Term
What is the incubation environment for Campy BAP?
Definition
Microaerophilic at 42oC
Term
What is the incubation environment for CIN?
Definition
Room temp (24oC) for 48 hours
Term
What do you use the following specific stool cultures to isolate/identify:
Campy BAP
Definition
Campylobacter
Term
What do you use the following specific stool cultures to isolate/identify:
CIN
Definition
Yersinia
Term
What do you use the following specific stool cultures to isolate/identify:
TCBS
Definition
Vibrio
Term
What do you use the following specific stool cultures to isolate/identify:
SMAC
Definition
E. coli 0157:H7
Term
What are the following considered:
Cervical swab, vaginal, urethral discharge, prostatic fluid
Definition
Genital Culture Specimens
Term
When you setup the gram stain on a genital culture what are you looking for?
Definition
Clue cells
GNDC (male urethral specimen only)
Yeast
Term
What do you sub genital specimen to?
Definition
BAP
MTM or equivalent
Term
What is the incubation environment for genital culture media?
Definition
37oC in CO2
Term
What is the supplemental media for Genital cultures?
Definition
Todd Hewitt/Carrot Broth
HBT or V agar
MAC/EMB
Term
What is the MO that is hoped to be identified with the following Genital media:
MAC/EMB
Definition
Enterics
Term
What is the MO that is hoped to be identified with the following Genital media:
HBT or V agar
Definition
Gardnerella
Term
What is the MO that is hoped to be identified with the following Genital media:
Todd Hewitt/Carrot Broth
Definition
GBS
Term
What are the MOST common Genital Pathogens?
Definition
N. gonorrhoeae
G. vaginalis
Yeast
Term
What are the following considered:
H. ducreyi
Chlamydia trachomatis
Ureaplasma
Treponema pallidum
Herpes simplex
Definition
Other Common Genital Pathogens that require special techniques
Term
What are the Normal Flora MOs for the Genital area?
Definition
GBS
Listeria
Term
What is the specimen for a Pharyngitis Culture?
Definition
Throat Swab
Term
What AGN are you trying to detect with a Pharyngitis Throat Swab?
Definition
GAS
Term
What are the following considered:
Group A strep
Groups C & G strep
Arcanobacterium haemolyticum
Gonococci
Viruses
Definition
Common Throat Pathogens
Term
What is the most appropriate primary media battery for a CSF?
Definition
BAP, CHOC, & broth
Term
What is the most appropriate primary media battery for a wound source?
Definition
BAP, MAC, PEA
Term
What is the most appropriate primary media battery for a stool source where the doctor suspects E. coli 0157:H7?
Definition
BAP, MAC, XLD, SMAC
Term
What are some common organisms that cause meningitis?
Definition
S. pneumoniae, Group B streptococcus, H. influenzae
Term
The patient has pharyngitis and doctor suspects Neisseria gonorrhoeae. When the technologist receives the throat culture she/he should
Definition
Set-up the culture on BAP & MTM
Term
What are considered locations for/of Upper Respiratory Tract Infections?
Definition
Pharyngitis
Sinusitis
Otitis Media/Externa
Epiglotittis
Term
What is a Good Specimen for Sinusitis?
Definition
Sinus Needle Aspirate
Term
How is a good specimen collected for Sinusitis?
Definition
Sinus cavity is punctured with a needle and a sample of the sinus contents are collected
Term
What is a Poor Specimen for Sinusitis?
Definition
Nasal Swab
Term
When you perform a GS for Sinusitis what do look for?
Definition
Predominant MO
Term
What are the following considered:
Strep pneumoniae
H. influenzae (not Type B)
Moraxella catarrhalis
Definition
Common Acute Sinusitis MOs
Term
What are the following considered:
Anaerobes
Staph aureus
H. influenzae
M. catarrhalis
Definition
Chronic Sinusitis MOs
Term
What are the following considered:
Pseudomonas
Anaerobes
Enterics
Definition
Nosocomial Sinusitis MOs
Term
Inoculate sinus specimen to:
Definition
BAP
CHOC
Broth
Anaerobic media
Term
What is the incubation environment for a Sinus culture?
Definition
37oC in CO2
Term
What is a GOOD specimen for Acute Otitis Media?
Definition
Tympanocentesis
Term
What is a POOR specimen for Acute Otitis Media?
Definition
Nasopharyngeal/throat swab
Term
When you perform a GS for Acute Otitis Media what are you looking for?
Definition
Predominant MO
Term
How do you collect a GOOD specimen for Acute Otitis Media?
Definition
puncture the typmanic membrane and apsirate fluid
Term
What are the following considered:
H. influenzae
Moraxella catarrhalis
Strep pneumoniae
Definition
Common AOM MOs
Term
Inoculate tympanic fluid to:
Definition
BAP
CHOC
Broth
Anaerobic media
Term
What is the incubation environment for Otitis Media Culture?
Definition
35oC in CO2
Term
Which specimen is associated with "Swimmer's Ear"?
Definition
Otitis Externa
Term
What is the specimen usually for Otitis Externa?
Definition
Swab
Term
What is the MOST Common MO for Otitis Externa?
Definition
Pseudomonas aeruginosa
Term
What do you inoculate the swab for Otitis Externa to?
Definition
BAP
EMB/MAC
Term
What is the incubation environment for Otitis Externa Culture?
Definition
35o C in air
Term
Are Anaerobic cultures appropriate for Otitis Externa?
Definition
No
Term
What does Epiglottitis usually affect?
Definition
Children 2-6 years old
Term
What is the specimen typically used for Epiglottitis?
Definition
Throat Swab
Term
What are the MOST common MOs for Epiglottitis?
Definition
H. influenzae type B
Strep pneumo
Term
What do you inoculate the Epiglottis Culture Swabs to?
Definition
BAP
CHOC
MAC
Term
What is the incubation environment for an Epiglottis Culture?
Definition
35oC in CO2
Term
Name 3 Lower Respiratory Tract Infections
Definition
Pneumonia
Bronchitis
Lung Abscess
Term
True or False:
The LRT is usually a sterile environment, except in patients with chronic pulmonary disease or tracheal tubes.
Definition
True
Term
Is a Gram Stain routine on LRT Specimens?
Definition
Yes
Term
What are LRT Specimens?
Definition
Expectorated or Induced Sputum
Bronchoscopy specimen
Term
What are 3 types of Bronchoscopy specimens?
Definition
Bronchoalveolar Lavage (BAL)
Bronchial washing/brush
Biopsy
Term
True or False:
In order for the sputum to be cultured, a gram stain must indicate possible infection
Definition
True
Term
What are the following considered:
Strep pneumoniae
Group B streptococci (neonates)
Staphylococcus aureus
H. influenzae
Enterics
Pseudomonas
Anaerobes
Definition
Common Lower Respiratory MOs
Term
What do you Inoculate respiratory specimens to?
Definition
BAP, CHOC, & EMB/MAC
Anaerobic media (if appropriate)
Broth
Term
What is the incubation environment for Lower Respiratory Tract Culture
Definition
35oC in CO2
Term
Name 3-4 Special Culture Media for the Respiratory Tract
Definition
BCYE
BCSA/OFPBL
Regan-Lowe
Term
What Special Culture Media do you use to identify/isolate Legionella?
Definition
BCYE
Term
What Special Culture Media do you use to identify/isolate B. cepacia?
Definition
BCSA/OFPBL
Term
What Special Culture Media do you use to identify/isolate B. pertussis?
Definition
Regan-Lowe
Term
What are some causes for UTIs?
Definition
sex
kidney stones
catheterization
Diabetes melitus
Term
What is the BEST specimen for a UTI?
Definition
1st morning pee is the Best!
Term
What are 2 UNACCEPTABLE urine specimens?
Definition
Catheter tip (Foley catheter)
Pooled Urine
Term
What is The MOST Common UTI MO?
Definition
E. coli
Term
What are the following considered:
Enterics
Enterococci
Pseudomonas aeruginosa
Staph saprophyticus
Candida species (yeast)
E. coli
Definition
Common UTI Mos
Term
True or False:
You perform a GS on a Urine Sample by request ONLY
Definition
True
Term
What do you use to perform a urine culture?
Definition
Calibrated Loop
Term
When performing a urine culture do you streak for isolation or streak for growth?
Definition
Streak for Growth
Term
What do you Inoculate urine sample to?
Definition
BAP
MAC/EMB
Term
What is the incubation environment for a urine culture?
Definition
35oC in Air
Term
When performing a colony count on a urine culture, 1 colony type is what?
Definition
Usually significant
Term
When performing a colony count on a urine culture, 3 or more colony types in equal numbers is what?
Definition
Contaminated urine
Term
Urine Colony Count - If using a 1 μL loop, multiply the number of colonies by what?
Definition
1000
Term
Urine Colony Count - If using a 10 μL loop, multiply the number of colonies by what?
Definition
100
Term
After multiplying by 1000 for 1 μL or 100 for 10 μL for a Urine Colony Count then what do you multiply it by?
Definition
4, for each quadrant
Term
If a urine colony count is 100,000 or more, what will you report it as?
Definition
≥ 10^5 (significant)
Term
When processing throat swabs for a GAS culture, the medium of choice is:
Definition
sheep blood agar
Term
Would you use BCYE with Legionella species?
Definition
Yes
Term
What primary media battery would you use for Sputum?
Definition
BAP
CHOC
EMB
Term
Which of the following is the most appropriate method for collecting a urine specimen from a patient with an indwelling catheter?
Definition
Aspirate urine aseptically from the catheter tubing
Term
The lab receives a sputum specimen for routine culture. The direct Gram stain shows a predominance of pleomorphic GNB. The next day there is no growth on the BAP, but growth on the CHOC agar. What potential pathogen do you suspect?
Definition
Haemophilus influenzae
Term
What is the incubation environment for a urine culture?
Definition
35oC in Air
Term
When performing a colony count on a urine culture, 1 colony type is what?
Definition
Usually significant
Term
When performing a colony count on a urine culture, 3 or more colony types in equal numbers is what?
Definition
Contaminated urine
Term
Urine Colony Count - If using a 1 μL loop, multiply the number of colonies by what?
Definition
1000
Term
Urine Colony Count - If using a 10 μL loop, multiply the number of colonies by what?
Definition
100
Term
After multiplying by 1000 for 1 μL or 100 for 10 μL for a Urine Colony Count then what do you multiply it by?
Definition
4, for each quadrant
Term
If a urine colony count is 100,000 or more, what will you report it as?
Definition
≥ 10^5 (significant)
Term
When processing throat swabs for a GAS culture, the medium of choice is:
Definition
sheep blood agar
Term
Would you use BCYE with Legionella species?
Definition
Yes
Term
What primary media battery would you use for Sputum?
Definition
BAP
CHOC
EMB
Term
Which of the following is the most appropriate method for collecting a urine specimen from a patient with an indwelling catheter?
Definition
Aspirate urine aseptically from the catheter tubing
Term
The lab receives a sputum specimen for routine culture. The direct Gram stain shows a predominance of pleomorphic GNB. The next day there is no growth on the BAP, but growth on the CHOC agar. What potential pathogen do you suspect?
Definition
Haemophilus influenzae
Term
Define Bacteremia
Definition
Presence of bacteria in the bloodstream
Term
Define Endocarditis
Definition
Infection of the endocardium or heart valves
Term
What are 2 causes for/of Endocarditis
Definition
Previously damaged heart valves
Artificial heart valves
Term
Sepsis
Definition
Usually occurs as a result of continuous bacteremia
Term
Sepsis/Septicemia
Definition
actively dividing bacteria
their harmful by-products
activation of the body’s inflammation and immune response
Term
Describe Transient Bacteremia
Definition
Brushing teeth & surgery in infected site
Term
Describe Intermittent Bacteremia
Definition
Abscess that periodically leaks
Term
Describe Constant Bacteremia
Definition
Endocarditis or infected intravascular site
Term
If a doctor suspects a patient of having:
Acute primary bacteremia or fungemia
Meningitis, osteomyelitis, arthritis or pneumonia,
What should you collect?
Definition
2 or 3 sets of blood cultures
One right after the other from different sites
Term
If a doctor suspects fever of uncertain origin, what should you collect?
Definition
2 or 3 sets of blood cultures
One right after the other from different sites
Term
If a doctor suspects fever of uncertain origin and the cultures are negative after 24-48 hours, what should you do?
Definition
collect 2 more sets of blood cultures
Term
True or False:
BC should be obtained ASAP!
after the onset of fever or chills
prior to receiving antimicrobial therapy
Definition
True
Term
True or False:
Both the skin and BC bottles should be disinfected
Definition
True
Term
True or False:
Blood from an IV catheter should not be drawn if peripheral site available
Definition
True
Term
True or False:
If limb with IV catheter is used:
Blood should be drawn below the catheter
Definition
False
Term
True or False:
If limb with IV catheter is used:
Blood should be drawn above the catheter
Definition
True
Term
By drawing a blood sample above a IV catheter, what does this ensure?
Definition
Ensures blood collection is not diluted with fluid being infused
Term
What is the Single MOST Important Variable in recovering MOs?
Definition
Volume of Blood
Term
What is the volume of blood typical for adults?
Definition
8-10 mL per bottle
Term
What is the volume of blood typical for children?
Definition
1-3 mL
Term
True or False:
Some BC bottles require a dilution (1:5 to 1:10)
Definition
True
Term
What is the anticoagulant in BC bottles?
Definition
SPS
Term
What does SPS do in BC Bottles?
Definition
Inactivates PMNs
Inhibits serum complement
Term
What does Biphasic BC media improve recovery of?
Definition
Yeast & Other MOs
Term
What is the incubation environment for BC?
Definition
35o C
CO2 system is in each bottle
Term
True or False:
Length of BC incubation depends on system
Usually 5-10 days
Definition
True
Term
How long are BCs generally incubated for?
Definition
5-10 days
Term
What is the following called:
Subculture all bottles
At 6-12 hrs & 48 hrs
Definition
Blind subcultures
Term
What stain do you use for blind gram staining
Definition
acridine orange stains
Term
BC + Cultures can be detected in how many days?
Definition
1
Term
Newer systems measure BC CO2 using what?
Definition
Infrared spectrophotometry
Fluorescent sensor  
Colorimetric sensors
BacTec, BacT/Alert
Term
Describe BacT/Alert System
Definition
Colorimetric sensor in bottle measures CO2
Term
Describe Manometric System
Definition
monitors gas production/consumption
Term
Describe Lysis Centrifugation System
Definition
Centrifuge blood tube and inoculate agar plates
Incubate and examine for growth
Isolator tubes
Term
For Positive Cultures, Subculture Blood onto what if GNB are seen?
Definition
BAP
CHOC
MAC/EMB
Term
For Positive Cultures, Subculture Blood onto what if GPC are seen?
Definition
BAP
CHOC
CNA/PEA
Term
For Positive Cultures, what does the Join Commission require?
Definition
tech to verify the test result by having the person read back the information
Term
For Positive Cultures, Should you notify the physician?
Definition
Yes
Term
True or False:
When reporting a blood culture gram stain, it is important to indicate morphological characteristics
Definition
True
Term
What is used to rapidly ID the following MOs:
S. aureus, MRSA, E. faecalis, & Candida albicans
Definition
DNA Probe, PCR
Term
True or False:
AdvanDx uses FISH (fluorescence in situ hybridization) assay that uses PNA (peptide nucleic acid) probes
Definition
True
Term
What type of grower is Brucella?
Definition
Slow-grower
Term
With the manual method how long do you hold Brucella bottles?
Definition
30 days
Term
With the automated method how long do you hold Brucella bottles?
Definition
10 days
Term
What do you subculture Brucella specimens to?
Definition
BAP & CHOC Weekly
Term
Some MOs are always considered significant, Name 2
Definition
Staph aureus
E. coli
Term
Common Skin Contaminants, Name 4
Definition
Bacillus species
Corynebacterium species
Propionibacterium acnes
Coagulase negative staphylococcus
Term
How many bottles positive?
1 positive bottle equals
Definition
Probably contaminant
Term
How many bottles positive?
≥ 2 positive bottles equals
Definition
Probably significant
Term
How many different kinds of organisms present?
1 MO
Definition
Could be Significant
Term
How many different kinds of organisms present?
≥ 2 MOs
Definition
Probably Contaminants
Term
With IV Catheters, what are cultured?
Definition
Both blood from the IV and the catheter tip
Term
How do you culture the IV Catheter tip?
Definition
Roll catheter onto a BAP
Count number of colonies
Term
With the IV Catheter tip, how many colonies are considered significant?
Definition
15 colonies
Term
True or False:
A positive catheter culture and blood culture are required for diagnosis
Definition
True
Term
What is the principle of operation of the BacT/Alert blood culture system?
Definition
CO2 production that changes the color of the colorimetric sensor of the bottle
Term
The proper blood-to-broth ratio for BCs to reduce the antibacterial effect of serum in adults is:
Definition
1:10
Term
SPS is used as an anticoagulant for BCs because it...
Definition
inactivates neutrophils & components of serum complement
Term
What is required to diagnosis a catheter-related infection?
Definition
> or = 15 colonies on BAP + positive BCs
Term
Three sets of BCs were obtained from a patient with fever & suspected endocarditis. The aerobic bottle of one set had growth of S. epidermidis at 5 days of incubation. This indicates that:
Definition
The organism is most likely a contaminant
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