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Streptococcus pneumoniae

Gram positive cocci in pairs or chains

Hemolysis- alpha (greenish zone- partial hemolysis)

Catalse- negative

Optochin disc- sensitive

Bile solubility- positive (organism's growth is inhibited by bile salts)

Staphylococcus aureus

Gram positive cocci in clusters (grape like)

Growth on BAP and MAC (golden colony)

Hemolysis- beta (clear zone)

Catalase- positive

Coagulase- positive

Mannitol- ferments mannitol on mannitol salt agar (yellow colony)

Cefoxitin disc- determine if MRSA

Pseudomonas aeruginosa

Gram negative rods (grape smell)

Growth on BAP and MAC

Hemolysis- gamma

Oxidase- positive

Motility- motile

Pigment production- blue-green pigment (pyocyanin and pyoverdine)

Legionella pneumophilia

Gram negative bacilli, thin, pleomorphic

Buffered charcoal yeast extract (BYCE) agar, requires L-cysteine for growth

Catalase- positive

Urine antigen test- rapid test

Direct Fluorescent Antibody (DFA) staining

Haemophilus influenzae

Gram negative coccobacilli

Growth on CHOC

Require V and X factor for growth (satellite phenomenon around S. aureus)

Hemolysis- gamma

Oxidase- positive

Klebsiella pneumoniae

Gram negative rod bacteria (capsule)

BAP and MAC (lactose fermentor) growth

Oxidase- negative

Indole- negative

Citrate- positive

Moraxella catarrhalis

Gram negative diplococci

Growth on BAP and CHOC, not on MAC

Hemolysis- gamma

Oxidase- positive

Catalase- positive

Carb fermentation- assacharolytic

DNase- positive

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CoNs

Streptococcus viridans

non-pathogenic Neisseria sp.

Corynebacterium sp.

Rothia

Group F streptococcus

non-pathogenic Haemophilus sp.

Eikenella

Actinobacillus

Capnocytophaga

Moraxella enterococci

Fastidious GNB

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★ Bacteria, yeast, viruses, parasites, & fungi can cause pneumonia

Honorable mentions:

Nocardia

Histoplasma capsulatum

Coccidioides immitis

Cryptococcus sp.

Aspergillus sp.

Bordetella pertussis

C. diptheriae

Mycobacterium tuberculosis

Group B Strep (pediatric patients)

Influenza A, B

Parainfluenza

Adenovirus

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How long did it take to start processing the sample from the time it was collected?

samples processed > 2 hrs from time of collection

can interefere with the viability of potential pathogens and allow for overgrowth of bacterial contaminants from the upper respiratory tract

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Sputum:

Color: can be yellow, green, red (blood)

Consistency: thick

Gram stain:

<10 epithelial

> 25 WBC/lpf

Reject specimen if contaminated with saliva

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No agent is isolated in 40-60% of these cultures

Specimen type

Overcrowding of contaminants

Lack of culture sensitivty

Patient empirically treated prior to culture

Other agents of infection (viral, fungal, etc.)

Improper collection

Transport media

fastidious organism

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Essential that these cultures are handled in a biological safety cabinet/hood

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Some of these organisms have the ability to cause disease....

Consider the quantity of organism

Is there a predominance of one of these organisms?

Are they present in large amounts?

growth in quadrants II, III, IV?

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Community Acquired Pneumonia (CAP)

vs.

Ventilator-Associated Pneumonia (VAP)

likely to have more resistance to commonly used antibiotics

Common pathogens:

E. coli

Pseudomonas aeruginosa

Acinetobacter baumannii

MRSA

Cystic Fibrosis Patients

Decontamination methods for culture (NTM)

16S rRNA gene sequencing

Common pathogens:

Nontuberculosis mycobacterium

Burkholderia cepacia complex

MRSA

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Susceptibility testing is key in finding the best antimicrobial therapy for treating infections that are in the lower respiratory tract

Types of Susceptibility Testing

Disk Diffusion

Looking at the zone of inhibition are measured to determine the effectiveness of the drug

Simple and cost effective

More limited

Broth Microdilution method

Determining the MIC

More precise and allows us to test more antibiotics

E test

Antibiotic strip has a gradient of antibiotic concentrations is placed on the agar and determines the MIC

More expensive

Automated systems

VITEK - more rapid results and testing a variety antibiotics at once

Interpretation

Sensitive (S)- pathogen is inhibited by antibiotic

Intermediate (I)

Resistant (R)- pathogen is not inhibited by the antibiotic

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Lower Respiratory Culture Site Project - Claire Bryant and Olivia Doctor - Details - Kahoot!

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Join a game of kahoot here. Kahoot! is a free game-based learning platform that makes it fun to learn - any subject, in any language, on any device, for all ages!

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Sputum

Expectorated sputum- Patient does not clean mouth and is asked to cough deeply to produce the sputum specimen

Induced sputum- Patient rinses mouth with sterile water or sailine before collection

Best for non intubated patients who are able to produce a good sputum sample

Endotracheal Tube (ET) Aspirate

Patients who are intubated, sample is aspirated from the ET tube

Bronchial Washing/Bronchoalveolar Lavage (BAL)

Collected during bronchoscopy procedure, saline is put into the airway and then aspirated back up for analysis

Considered gold standard when they need to obtain a sample from deeper parts of the lungs

Required for patients on ventilators

Lung aspirates

Removes fluid or air from the pleural space

Lung biopsy