Mohd Farid Laporan Latihan Industri Sarjana Muda Sains Bioperubatan UKM Tahun 3 Sesi 2007/2008-Hospital Selayang Part VI-Urine Stool Respiratory Tract Bench

URINE, STOOL AND RESPIRATORY TRACT BENCH

SPUTUM AND TRACHEAL ASPIRATE SPECIMEN

Purpose: For the diagnosis of nosocomial respiratory tract infections in patient who are ventilated with endotracheal tubes.

Common Pathogen

Gram positive organism	Gram negative organism
Streptococcus pneumoniae Staphylococcus aureus	Haemophilus influenzae Klebsiella pneumoniae Pseudomonas aeruginosa Acinetobacter spp Proteus spp. Yersinia pestis Moraxella catarrhalis

Method

STOOL SPECIMEN

Purpose: To detect the causative pathogens of watery diarrhea, dysentery and enteric fever which involve the gastrointestinal tract. Pathogen that are common found are Salmonella sp, Shigella sp, E.coli, Campylobacter sp., Yersinia enterocolitica and Clostridium difficite.

Method

• Inoculation of fresh stool on MacConkey agar and XLD agar
• Inoculation onto Selenite F Broth and onto XLD agar and MacConkey agar the next day
• Inoculation onto Alkaline peptone water for vibrio cholerae and culture on TCBS agar the next day
• Biochemical identification and antimicrobial susceptibility testing.
• Incubation of all agar Selenite F Broth and Alkaline peptone water in incubator at 35 to 37^oC for 18 to 24 hours.

Interpretation

Bacteria	XLD agar	MacConkey agar
Salmonella spp	Red colony with black center	Colorless colonies size 2mm
Shigella spp.	Red colony	No growth
Escherichia coli	Pink colonies with bile precipitation	Pink colonies size 2mm
Yersinia enterocolitica	No growth	Colorless or light pink. Size 1-2 mm

Bacteria	TCBS agar
Vibrio cholerae	Yellow, flat with 2-3 mm diameter
Vibrio parahemoliticus	Blue green with 3 to 5 mm diameter
Vibrio alginolyticus	Yellow with 3-4 mm diameter
Proteus spp.	Yellow green with 1-2 mm diameter
Pseudomonas spp.	Blue green with 1-2 mm diameter

URINE SPECIMEN

Purpose : Diagnosis of urinary tract infection by the detection of abnormal presence of bacteria or fungi at any site of the urinary tract

Method

• Macroscopy examination-urine appearance; clear, turbid or blood stain
• Culture on CLED agar using urostrip for colony count
• Culture on CHROM agar using urostrip for colony count and colony morphology
• Biochemical identification
• Antimicrobial susceptibility testing

Interpretation Of CLED Agar Culture

Colony count	Interpretation
5-25 colony with pure growth, more than 1 type of organism	Colony count between 10,000-100,000 organism/ml urine. Borderline significant. Culture [organism] isolated
5-25 colony with 2 type of organism	Colony count between 10,000-100,000 organism/ml urine. Borderline significant. Culture [organism] + [organism] isolated
5-25 colony with 3 type of organism	Colony count between 10,000-100,000 organism/ml urine. Borderline significant. Heavily mixed growth. Repeat
Count >25 colonies with 1 type of organism	Colony count more than 100,000 organism/ml urine. Significant for bacteriuria. Culture [organism] isolated
Count >25 colonies with more than 2 type of organism	Colony count more than 100,000 organism/ml urine. Culture [organism] + [organism] isolated
Count >25 colonies with more than 3 type of organism with 1 predominant organism	Colony count more than 100,000 organism / m. Culture mixed growth predominantly [organism] isolated
Count >25 colonies with more than 3 type of organism	Colony count more than 100,000 organisms/ m. Culture heavily mixed growth. Repeat.