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Hello, I hope you can help. Explain the meaning of the following lab results (mirobiol), and as a provider what actions should be taken? Any help would be greatly appreciated. Also if you know of any web links for additional information. Thank you so much in advance!
1. Positive blood culture with staphylococcus aureus, coagulase negative.
2. Urine culture growing E.Coli, with a minimum inhibitory concentration indicating resistance to TMP-SMX and sensitivity to cephalexin.
3. Rapid strep throat culture negative for streptococcus pyogenes.
lling venous catheter) positive for Candida albicans.

4. Surgical wound culture positive for beta-hemolytic streptococcus pyogenes in an AIDS patient.

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Female , Age: 40

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1 - This indicates that the organism stapylococcus aureus is present in the bloodstream of the patient. It is possible that the blood that was taken from the patient was contaminated by bacteria that is present on the skin of most of us. However, this is not usually the case. Treatment consists of intravenous antibiotics that are shown by the sensitivity test done on the particular patient's blood to be effective in halting the growth of the s. aureus.

2 - The bladder and/or kidneys of the patient have become infected with the organism escherichia coli. This is determined by sampling the urine of the patient. It is possible that the urine sample, if taken from a voided (not catheterized) specimen, was contaminated by stool that was in the area of the urethral meatus. However, it is just as likely that the organism is truly in the urinary tract. This is a common source of infection in women due to the close proximity of the urethra and the rectum. Treatment is antibiotics that have been shown by the senitivity test done on the patient's urine sample to be effective in halting the growth of the e.coli.

3 - Candida albicans is a common source of infection in the patient who has received multiple antibiotics. This requires not an antibiotic but an antifungal medication. Either orally for the mouth and throat or intravenously if present in the blood. This organism is always present but becomes problematic when there is overpopulation by it in the immunocompromised patient.

4 - Beta strep pyogenes can release toxins into the bloodstream. This organism causes problems such as toxic shock syndrome. It is responsible for rheumatic fever, scarlet fever and other disease as well. Treatment with the antibiotic shown by sensitivity tests on the patient's wound drainage to be effective against that particular strain of organism.

This patient will need multiple antibiotics at the same time. Antivirals for the underlying HIV infection will need to be continued. Kidney and liver function will need to be monitored for signs of toxicity from these and other drugs.
http://en.wikipedia.org/wiki/Staphylococcus_aureus
http://en.wikipedia.org/wiki/Escherichia_coli
http://en.wikipedia.org/wiki/Candida_albicans
http://en.wikipedia.org/wiki/Streptococcus_pyogenes

Edited by judi1 on July 29 2006 at 10:36 PM

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Reply to Judy's Post: Hello Judy,

I appreciate your quick response. However, I need in my answers to the questions above an Explaination of the lab results (example:. as if I am a lab director in a microbiology lab of a hospital).
As in #1 -staphylocossus aureus, coagulase negative
#2 - E coli growing; but indicating resistance to TMP-SMX and sensitivity to cephalexin.
etc....

Sorry but I also forgot to add one to the above:
5. Rapid strep throat culture negative for streptococcus pyogenes.

Also, I would need to reference these answers; is there a website of this information? (WebMD, Medline...?? If you can please provide with the web address links. Thanks, you are a big help!

Thanks,
Melin

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See the above sites as well as these overall good sites for health information:

http://www.cdc.gov/
http://www.nih.gov/
http://en.wikipedia.org/wiki/Main_Page

Info for the strep infection:
http://www.textbookofbacteriology.net/streptococcus.html
For the coag - bacterium
http://www.postgradmed.com/issues/2001/10_01/eiff.htm
e.coli - it appears that there is a growing number of bactrim resistant e.coli UTIs and there is a suggestion that care should be taken when picking the antibiotic to use.

Each facility develops its own group of commonly isolated organisms and of resistant organisms as well. As the director of your lab you would work with the infectious disease department and docs to restrict the use of some antibiotics to special circumstances to slow the population of these organisms. You would develop policies that would restrict use of certain antibiotics to only the infectious disease docs.

I've reconstructed to the best of my knowledge, hope I didn't leave anything out, LOL. Good luck with the project!

Edited by judi1 on July 29 2006 at 11:37 PM

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Reply to Judy's Post: I am getting a little confused. In looking at the links for staphylococcus aureus it says its excludes if negative. I guess my questions are tricky because there are key things that could change the answer. Like the E. coli with a ristenance to TMP-SMX and sensitivity to cephalexin.

Also the Q. Rapid strep throat culture negative for streptococcus pyogenes. It is saying negative??

I guess what I'm looking for is:

You are the laboratory director for the microbiology lab of a small rural hospital.

Question: Explain the meaning of the following lab results. Next, as the provider that ordered these labs, what actions should you take?

Positive blood culture with staphylococcus aureus, coagulase negative.

Urine culture growing E.Coli, with a minimum inhibitory concentration indicating resistance to TMP-SMX and sensitivity to cephalexin.

Rapid strep throat culture negative for streptococcus pyogenes.

Portacath (indwelling venous catheter) positive for Candida albicans.

Surgical wound culture positive for beta-hemolytic streptococcus pyogenes in an AIDS patient.

I think (?) there is little points in the lab that can confuse the answer. Again words like negative, when usually it would be positive. Again, hope you can help!

Positive blood culture means that the blood has an organism in it. The particular organism this time is one that does not produce coagulase, an enzyme that the bacteria uses to produce a clot around it which then protects it from the host's (the person who has the blood) immune system. So the organism is coagulase negative but the blood positively has the organism in it. Treat with the appropriate antibiotic.
Strep - if the infection is not there, (negative result), then there is no action to be taken.
Urine grew e. coli, so the e. coli that isn't supposed to be in urine needs to be treated. But not with Bactrim which we usually use because the e. coli is able to resist it so it won't kill it. Use the one it is sensitive to the cephalexin.
The portacath needs to come out if it's infected and the person needs to be treated with whatever drug the organism is sensitive to, probably caspofungin or amphotericin.
Strep needs treatment since it's present in the wound - use whatever the sensitivity test says will work.

I see you've gone to bed, so will I. I will be online tomorrow, but not until after 4 pm if you need any more help with this.

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Reply to Judy's Post: Hi, Not to bed yet. I'm still pluging away at this. I'm on west coast time. I am starting to see the light some what on these questions.(lol)
**Can you please provide meaning of the lab results to each question (with web reference). I need something related to the microbiology on this part. Again, as if I am the lab director for the micro lab.
I really appreciate your help in helping me to tackle my project! Looking forward to the answers.

I'm not quite sure what it is that you do not understand. Please look at the sites I gave you and see if you can line up the answers. Otherwise, I will get back to you in the afternoon! Good night for real this time Images available only to Customers.

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Reply to Judy's Post: I will continue to look at the sites you gave. However, any assistance would be Greatly appreciated!

I guess it's that whole microbiology thing; explaining the lab results relating it to each of the questions.
Maybe I am reading too much into it? When looking at the site it explains the pathogen; but I guess I'm confused on relating it to an answer to the lab result explaination.
Sorry, again I hope you can help with any of the above lab result explaining stuff (with reference).
Good night! I'll look in the afternoon for any response.

Have you had a chance to look at those sites?

1 - So the patient's blood has coagulase negative staphylococcus aureus in it. This needs to be treated. The lab would call the result to the floor nurse and she/he would call the doc with the result. The lab's job is then complete. As the Dr. who is provding care (i.e. writing orders) for this patient, he/she would choose the antibiotic that the lab says is most likely to result in eradication of the organism. This would be on the sensitivity test that they performed on the patient's blood specimen.
http://en.wikipedia.org/wiki/Staphylococcus_aureus
Re the coagulase issue:
http://www.postgradmed.com/issues/2001/10_01/eiff.htm

2 - The e.coli is not sensitive to the usual antibiotic that we would choose, Bactrim (TMP-SMX), so a different one will be chosen - that should be the cephalexin that you in the lab reported to be the effective one. As the lab director, you would then watch for other cases of this organism so that the medical staff of the hospital can be made aware that there is a trend toward this strain and they can pick antibiotics accordingly.
http://en.wikipedia.org/wiki/Escherichia_coli

3 - Again, the strep is negative - no action needed

4 - Surgical wound culture - needs to be treated with the antibiotic noted on the sensitivity test to be most effective. Nedd to prevent above noted problems with toxic shock, etc.
http://en.wikipedia.org/wiki/Streptococcus_pyogenes
http://www.textbookofbacteriology.net/streptococcus.html

5 - Candida needs treatment and the line needs to be removed. This is not an uncommon organism in this population, but needs treatment as it is lifethreatening when in the bloodstream. Antifungal based on sensitivity results.
http://en.wikipedia.org/wiki/Candida_albicans

http://www.cdc.gov/
http://www.nih.gov/
http://en.wikipedia.org/wiki/Main_Page

As the director of the micro lab you will sit on committees with the infection control dept. and the infectious disease docs. Committee will watch for resisteant strains that develop within the institution and work on preventing their spread. Policies will be developed that will hopefully prevent the development of resistant strains of bacteria within the institution. These may include limiting the use of certain antibiotics to the infectious disease docs or to other docs who consult with them first.
Resistant organisms cost the hospital big bucks because the patients who develop them are often banned from nursing homes and rehab centers, resulting in longer stays in the hospital than are reimbursible by the insurance companies. We all work together to prevent the spread of infection and the growth of new strains that are likely to be resistant to overused antibiotics.

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Reply to Judy's Post: Hello,

I called it quits last night. I did find more information on a differenct site. Just to give you an idea I what I THINK I need. From your professional stand point, do you think this answers it?
*****Rapid strep throat culture negative for streptococcus pyogenes.
A number of rapid antigen detection tests are available and can in a matter of 15 minutes indicate if a person is infected with Streptococcus pyogenes. These tests use monoclonal or monospecific antibodies to detect the streptococcal group A capsular polysaccaride. These tests are highly specific (around 95%) but are not as sensitive (70-90%) as throat cultures. They can with certain precautions be useful in the rapid diagnosis of "strep throat".
In Adult patients with a high probability of having "strep throat" should be tested for GABHS infection by either throat culture or by a rapid antigen detection test. If testing initially with the rapid antigen detection tests a negative result they do not have to be followed up with a throat culture. Specificity of the rapid antigen detection tests is very high around 95%, so false positive results are rare. However, sensitivity of these tests can be as low as 70% meaning up to 30% of patient with "strep throat" will have a negative test. In spite of the low sensitivity of these tests, it is okay to not treat adults since the incidence of "strep throat" is lower in adults than children and the chances of this infection developing into rheumatic fever is also very low compared to children. If either the throat culture or rapid antigen detection test is positive give antimicrobial therapy.
In Children: Once again all patients with acute pharyngitis should be offered appropriate doses of antipyretics, analgesics, and supportive care. Children (less than 18 years of age) are more likely to get "strep throat" and if they get "strep throat" are more likely to develop suppurative and nonsuppurative complications if not treated. Therefore if a child by clinical and epidemiologic means is likely to have "strep throat" then further testing by rapid antigen detection tests and/or throat culture is indicated. If the rapid antigen detection test is positive then a throat culture is not needed and the child should be treated. If the rapid antigen detection test is negative then a throat culture should also be performed. A prescription should be given only if either test is positive. (http://www.geocities.com/CapeCanaveral/3504/)

I guess, I'll keep seaching around for the rest. I need this by tomorrow, so hopefully I'll be done soon.

Sounds good so far....are you a student in a school specific for laboratory tech or ????

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Reply to Judy's Post: I am a pre-nursing student. This is for a microbiology class. This is just a portion of my assignment. In talking with another student, she is also running into a road-block with this section.

This seems a bit extreme for a nursing class, we got very little, and most of what I told you I did learn as I went limping along over the last 33 years. Anyway, welcome to the world of nursing as we know it today! Let me know if you need any thing else.

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Reply to Judy's Post: I agree, I thought this was a bit much for a microbiology class. It seems more toward Phatho/Pharm. I haven't even learned this stuff yet. I guess that's were the frustration comes in; trying to google and search. I guess this is preping us the hard way!
I will let you know in I need anything else, or if you come up with anything else please let me know. I'm starting to give up.

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