Sputa Flashcards

Question

What extra plates do transplant patients get

Answer 1

(Same as BALS +) CxSA MRSA FAA + Mtz B. Cepacia Own Candida plate

Answer 2

Lateral flow for aspergillus

Answer 3

○ Done for ICU/HDU patients ○ Done for CF patients ○ Any transplant patient under aged 55 ○ Done as a screen for any patients entering ICU Outbreak last year No positives since initial positive during outbreak

Answer 4

Read on day 2 with other plates -> interim report Put up for an additional 3 days and read again

Answer 5

○ A positiev Burkholderia would mean removal from the transplant list for a patient ▪ Burkholderia causes necrotising pneumoniae Failure of transplant etc

Answer 6

B. Cepacia Some GNBs such as seratia sometimes grow

Answer 7

Same as BALS + SA + MRSA

Answer 8

Read twice, first on day 1, second on day 2

Answer 9

○ 3 or < colonies = 10^6 ○ 3 – 25 colonies = 10^67 ○ 25+ colonies = 10^7

Answer 10

>25 colonies on plate should be ID'd, might just come back as a commensal but better to be safe than sorry

Answer 11

▪ Clox/C30 sensitive ▪ Usually display a black halo on chocolate agar ▪ On day 2 will appear orangey on MacConkey agar ▪ If query staph carry out a staphyslide agglutination test to confirm ○ If positive p0ut up a purity plate for sens (don't have to ID/MALDI first unlike with GNBs) ▪ Gram + clusters, grape like clusters in 2, 4, 8, etc ▪ If query SA then staphaurex card agglutination test * SA = SS+ * SS- colonies do not have to be picked for ID (unles requested) ▪ DNase agar + ▪ Tube coag + ▪ API biochemical tests or VITEK can also be used to ID SA ▪ Should grow as golden colonies on chocolate but are most of the time a pale yellow/white ▪ On chocolate SA will often grow with a dark halo around the colonies ▪ Will appear orange coloured on MacConkey after 2 days growth -> may even be coral coloured but are still a NLF ? SA should always be picked if sen

Answer 12

H. influenzae, S. pneumoniae, M. catarrhalis, S. aureus, MRSA, Pseudomonas If we query any of these they should always be picked and ID'd

Answer 13

▪ If query can put up a purity plate with an optochin disc * Optochin between 1' and 2' inoculum * Hoping for pure growth on PP ▪ MALDI cannot ID S. pnemo well which is why optochin susceptibility is so important ▪ Alpha haemolysis (green haemolysis) ▪ Optochin disc suscpetible i.e. zone of clearance ▪ If query S. pneumo -> put up a purity plate to rule out pseudoneumo Optochin disc in the centre

Answer 14

▪ Grows as grey coloured colonies on chocolate agar ▪ Small, round, grey colonies ▪ Will grow right up to C30 disc on chocolate ▪ Tell tale sign is growth only of colonies on the chocolate agar plate only * X and V factors only present in chocolate Gram negative coccobacilli

Answer 15

▪ Gram negative diplococci ▪ Catarrhalis = oxidase and catalase positive Hockeypuck colonies Catalase positive

Answer 16

▪ Non Lactose fermenter (yellow colonies on MacConkey) ▪ Oxidase positive ▪ Usually dark colonies on Chocolate agar ▪ Pseudomonas aeruginosa will grow greenish – may have a metallic sheen to it ▪ Pseudomonas aeruginosa is the most common infectious agent in CF and COPD or any intubated patients Resistance is common

Answer 17

▪ Only of interest in bronchial washings/BALS etc ▪ Part of normal throat flora so not of interest in normal sputa ▪ i.e. BHS only significant if not part of expected flora But if pure growth of a BHS then you should pick this as it is may be the infecitous agent

Answer 18

▪ If growth = 6 we don't pick, if from a normal ward/GP ▪ Colony count greaer than 25 needed for a GNB to be picked from a GP sample i.e. growth of 10^7 cfu/ml on chocolate dilution plate ▪ GNBs are rarely infectious in healthy patients so there needs to be a large number of them in order to suspect infection ▪ We only pick a GNB for our immunocompromised patients or if there is a lot of growth ▪ These tend to be commensals and rarely cause infection in healthy population ▪ Tend to be big wet and gloopy colonies on the MacConkey (majority that you will see are non-lactose fermenters) ▪ We don't pick GNBs for normal patients if colony count of 6 ▪ Lactose fermenters= E. Coli, Klebsiella, Enterococci Non lactose fermenters = Pseudomonas, proteus

Answer 19

▪ All fungi are very important in our immunocompromised patients e.g. our ICU or transplant patients * Hence why these patients get their own candida plate instead of the shared one between 4 for notmal sputa Want to be super confident that any fungi on the plate is actually infectious and not just contaminants ▪ We type any fungi for our transplant patients -> need to know if candida or not ▪ Candida and Aspergillus are the most commonly seen infectious fungi ▪ Only have to ID C. albicans for immunocompromised patients e.g. ICU, HDU, transplants etc Fungi cause fungal pneumoniae e.g. pneumocystis jirovecci which causes life threatening pneumoniae etc

Answer 20

Put up done in cat 3 => aseptic ○ Normally we have the same person doing the put up that is doing the reading to ensure confidence in aseptic technique etc MS should be confident in their technique in that any fungi found are trtuly infectious etc

Answer 21

▪ Fungi can be ID'd using the MALDI or through microscopy by a specialist scientist * Light microscopy ID ○ Tape technique + blue dye (?) ○ Looking for features e.g. phylites etc ○ Tape technique can be done on day one -> if query fungi -> great if urgent and cant wait for MALDI ID If any hyphae/apores are seen you can put up a PDA plate to be read on day 2

Answer 22

For any immunocompromised patients e.g. ICU/HDU/transplants etc Only have to ID C. albicans

Answer 23

* When working with aspergillus be very careful to not inhale any of the spores * Any MS with asthma should wear a mask when working with aspergillus * Wrap all PDA plates in parafilm to prevent contamination of plates as well as accidental inhalation of fungal spores Nobody should be inhaling aspergillus spores ever

Answer 24

* Resistance against Azoles * VIPs * Fungi e.g. Aspergillus will go for VIP sensitivity testing for anti-fungal treatment * Looking for resistance against azols * Controls: positive and negative resistance against azoles ○ Each get own VIP plate * For every VIP we put up a pos and neg control ○ One organism is sensitive to the antifungal in each well ○ Resistant control is resistant to the antifungals in each well * Also sent out to Bristol for further sensitivities

Answer 25

Streps and Neisseria species

Answer 26

We pick anything that grows as BALS should be sterile

Answer 27

* If multiple organisms put up a purity plate for each colony type ○ Avoid mixed purity plates as this greatly delays sensitivites

Answer 28

- Infections usually start of with Staph infections - Infection develops into strep infection e.g. S. pneumo - As fluid builds up in the lung organisms such as Pseudomonas begin to take over as these prefer wet conditions - Prolonged antibiotic use in these patients leads to resistant Pseudomonas strains ○ There is a new drug available for these patients which means they arent havening to undergo lung transplants ▪ We don't know how long this antibiotic will work for though before resistance occurs again - Patients in end stage of the disease tend to get more serious infections such as Burkholderia ○ This means removal from transplant list ▪ Can be a death sentence for these patients Burkholderia -> necrotising pneumonia -> transplant rejection

Answer 29

Most grow in only about 5 hours Query streps are often put up anaerobically overnight though

Answer 30

Gram stains only done on request Grams only really made for new lung transplant patients

Answer 31

- Done mostly for GP samples using dilution plates - Qualitative measurement of infection A higher colony count is needed in GP samples in order to query a GNB as an infectious agent

Answer 32

Sample should be processed immediately but organisms should survive for approximately 48 hours

Sputa Flashcards

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