READY-TO-USE DIPSLIDE MEDIA DA-212115.03 Rev.: Aug 2005

INSTRUCTIONS FOR USE – READY-TO-USE DIPSLIDE MEDIA DA-212115.03 Rev.: Aug 2005

BD™ BBL UROTUBE • BBL UROTUBE M • BBL UROTUBE E • BBL UROTUBE E. coli • BBL UROTUBE SXT

INTENDED USE BBL UROTUBE products are dipslides used for the isolation and determination of the colony count of microorganisms isolated from urine specimens. The surfaces of the dipslides are coated with two or three different culture media. All BBL UROTUBE products contain CLED Agar for the determination of the total count of bacteria and/or yeasts, and MacConkey Agar for the detection of Gram negative bacteria, e.g., Enterobacteriaceae. The third medium, if available, is dependent on the respective product.

PRINCIPLES AND EXPLANATION OF THE PROCEDURE Microbiological method. Dipslides are widely used today as a screening technique for the enumeration and isolation of microorganisms from routine urine specimens.1-5 After the dipslide is immersed into a properly collected fresh urine specimen and the slide is subsequently incubated, the colony number on the surface of CLED Agar is compared to a reference picture. CLED Agar was developed by Sandys in 1960 to prevent the swarming of Proteus by restricting the electrolytes in the culture medium which was modified later several times for use in urine culture.6 It was designated as Cystine-Lactose-Electrolyte-Deficient (CLED) medium and reported to be ideal for dip-inoculum techniques and for urinary bacteriology in general.6,7 The nutrients in CLED Agar are supplied by the gelatin and casein peptones, and beef extract. Lactose is included to provide an energy source for organisms capable of utilizing it by a fermentative mechanism. Bromthymol blue is used as a pH indicator to differentiate lactose fermenters from lactose-nonfermenters. Organisms which ferment lactose will lower the pH and change the color of the medium from green to yellow. The cystine permits the growth of "dwarf colony" coliforms.3 Electrolyte sources are reduced in order to minimize the swarming of Proteus species. The number of colonies on the CLED Agar is directly proportional to the number of bacteria per ml of the urine specimen. CLED Agar is included on all BBL UROTUBE dipslide products as medium 1.

The second medium is MacConkey Agar. It is only slightly selective since the concentration of bile salts, which inhibits gram-positive micro-organisms, is low in comparison with other enteric plating media. This medium is recommended for use with clinical specimens likely to contain mixed microbial flora, such as urine, because it allows a preliminary grouping of enteric and many other gram-negative bacteria in lactose fermenters and lactose nonfermenters.8,9 In MacConkey Agar, peptones provide nutrients. Crystal violet inhibits Gram positive bacteria, especially enterococci and staphylococci. Differentiation of enteric micro-organisms is achieved by the combination of lactose and the neutral red pH indicator. Colorless or pink to red colonies are produced depending upon the ability of the isolate to ferment the carbohydrate. MacConkey Agar is included on all UROTUBE dipslide products as medium 2.

A third medium is included to detect the presence of characteristic bacterial groups and yeasts. The type of medium depends on the product in use:

BBL UROTUBE, in addition to media 1 and 2 mentioned above, contains Cetrimide Agar, a widely used medium for the selective isolation of Pseudomonas aeruginosa.10,11 Gelatin peptone and casein provide nutrients. Potassium and magnesium salts enhance the pigment formation of P. aeruginosa. Glycerol is an energy and carbon source. Cetyl trimethyl ammonium bromide (=cetrimide) is a detergent that selectively inhibits most Gram negative rods other than P. aeruginosa.

DA-212115.03 Page 1 of 10 BBL UROTUBE M, in addition to media 1 and 2 mentioned above, contains Malt Agar, a partially selective medium for the isolation of yeasts, e.g. Candida albicans. Malt extract and lactic acid provide nutrients and maintain the pH at a low level which provides selectivity to inhibit many bacterial species.11 BBL UROTUBE E, in addition to media 1 and 2 mentioned above, contains Enterococcus Agar, a selective differential medium for Enterococcus species.11 In Enterococcus Agar, casein and yeast extract provide nutrients. Sodium chloride maintains osmotic stability. The combination of citrate, azide, kanamycin, polymyxin B, nalidixic acid, and neomycin inhibit most bacteria other than Enterococcus species. Esculin is a substrate for beta-glucosidase, characteristically found in Enterococcus species. One of the products of enzymatic hydrolysis, esculetin, reacts with ferric ions to produce a brown to black precipitate in the medium surrounding Enterococcus colonies. BBL UROTUBE E. coli, in addition to media 1 and 2 mentioned above, contains Beta- Glucuronidase (=BGLU) Agar, a differential medium for the specific detection of E. coli and Proteus species. The medium contains nitrophenyl-ß-glucuronide, a chromogenic substrate to detect beta-glucuronidase activity which is typically found in Escherichia coli, while many other bacteria, including Proteus, Providencia, and Morganella, are negative.11,12 Upon degradation of the substrate, yellow nitrophenol is accumulated in the medium and the colonies, while glucuronidase-negative colonies are colorless to grayish on a colorless medium. Yellow growth from this medium can be subjected to an indole test which, if positive, confirms the identification of E. coli. The indole formation on this medium is enhanced by the addition of the indole precursor (tryptophan). Additionally, this amino acid is the substrate for the enzyme tryptophan deaminase (TDA) which is characteristically found in Proteus, Providencia, and Morganella species. This enzyme can be easily detected by performing a TDA test with ferric chloride. For further confirmation, an indole test may be performed from colorless growth which is positive in Proteus vulgaris, Providencia species, and Morganella morganii, too. BBL UROTUBE SXT, in addition to media 1 and 2 mentioned above, contains antagonist-free susceptibility test medium (PDM Medium) with trimethoprim/sulfamethoxazole (SXT), for the determination of resistance or sensitivity against SXT. Growth of any bacteria on this medium means resistance to SXT.

After inoculation, or after inoculation and incubation, the dipslides may also be used as transport media from the physician’s office to analytical laboratories. Growth from the media on the dipslides may be used for identification and susceptibility testing of the isolates.

REAGENTS Formulas* Per Liter Purified Water Medium 1 and 2 are common to all BBL UROTUBE dipslides.

Medium 1: CLED Agar Medium 2: MacConkey Agar Peptic Digest of Casein 4.0 g Peptic Digest of Casein 17.0 g Selected Peptones 4.0 Meat Peptone 3.0 Meat Extract 3.0 Lactose 10.0 Lactose 10.0 Sodium Chloride 5.0 Cystine 0.128 Bile Salts Mixture 1.5 Bromthymol Blue 0.02 Neutral Red 0.03 Agar 15.0 Crystal Violet 0.001 pH 7,3 ± 0,2 Agar 13.5 pH 7.1 ± 0.2

Medium 3: The type of medium 3 (if available) depends on the product in use (see PRINCIPLES AND EXPLANATION OF THE PROCEDURE).

BBL UROTUBE, in addition to media 1 and 2 mentioned above, contains Cetrimide Agar:

Peptic Digest of Gelatin 16.0 g Glycerol 8.0 g Hydrolysed Casein 10.0 Cetyl Trimethyl Ammonium Bromide 0.3

DA-212115.03 Page 2 of 10 Potassium Sulfate 10.0 Agar 13.0 Magnesium Chloride 1.4 pH 7.1 ± 0.2

BBL UROTUBE M, in addition to media 1 and 2 mentioned above, contains Malt Agar:

Malt Extract 30.0 g Agar 18.0 g Lactic Acid 6.3 pH 4.0 ± 0.4

BBL UROTUBE E, in addition to media 1 and 2 mentioned above, contains Enterococcus Agar:

Peptic Digest of Casein 20.0 g Kanamycin 0.02 g Yeast Extract 5.0 Polymyxin B 0.002 Sodium Chloride 5.0 Nalidixic acid 0.0075 Citrate 1.5 Neomycin 0.002 Sodium Azide 0.15 Agar 15.0 Esculin 1.0 pH 7.1 ± 0.2 Ferric Ammonium Citrate 0.5

BBL UROTUBE E. coli, in addition to media 1 and 2 mentioned above, contains Beta- Glucuronidase (=BGLU) Agar:

Peptone 10.0 g Sodium Chloride 5.0 g Nitrophenyl-ß-Glucuronide 0.1 Agar 15.0 Tryptophan 0.3 pH 7.2 ± 0.2

BBL UROTUBE SXT in addition to media 1 and 2 mentioned above, contains antagonist-free medium (PDM Medium) with trimethoprim/sulfamethoxazole (SXT).

PDM Medium 32.3 g Trimethoprim 0.003 g Sulfamethoxazole 0.04 pH7.3 ± 0.3

*Formulas may be adjusted and/or supplemented as required to meet performance criteria.

PRECAUTIONS . For professional use only. Do not use dipslides if they show evidence of microbial contamination, discoloration, drying, cracking or other signs of deterioration. Observe aseptic techniques and biohazard protection measures throughout the whole procedure. Wear protective gloves when collecting and handling specimens and positive slides containing infectious agents. Consult GENERAL INSTRUCTIONS FOR USE document for aseptic handling procedures, biohazards, and disposal of used product. When using these products as a transport medium from a physician’s office to a diagnostic laboratory, observe local regulations for shipping infectious specimens.

STORAGE AND SHELF LIFE On receipt, store BBL UROTUBE products in the dark at 15 – 20° C in the original package until just prior to use. Avoid freezing, overheating, desiccation, and temperature fluctuations. The slides may be inoculated up to the expiration date (see package label) and incubated for the recommended incubation times. Unopened slides from opened packages can be used up to the expiry date when stored in a clean area at 15 – 20° C. Once opened, slides must be used immediately.

USER QUALITY CONTROL Prepare suspensions of the test strains mentioned below in physiological saline, matching the McFarland 0.5 standard (appr. 5 x 107 CFU/ml). Dilute the suspensions to a CFU of 104 to 105 per ml. Dip samples of the slides into this dilution; allow excess of suspension to drain off and return the slides into their tubes. Incubate at 35 to 37° C for 18-24 hours. Inspect as described The expected results are mentioned in the Table:

DA-212115.03 Page 3 of 10

Product and Color Escherichia coli Proteus mirabilis Enterococcus Pseudomonas Candida Medium (unin- ATCC™ 25922 ATCC 12453 faecalis aeruginosa albicans oculated) ATCC 29212 ATCC 27853 ATCC 10231 BBL UROTUBE • Medium 1 yellowish to +; yellow +; colorless +; yellow +; pale to blue- +; small, whitish yellow- colonies; yellow colonies; yellow- colonies; yellow green colonies; colonies; green medium green to green medium blue-green yellowish to medium medium blue-green medium • Medium 2 rose +; pink colonies; +; colorless to - +; pale to blue- - red to pink beige colonies; green colonies medium orange-brown with or without medium fluorescence • Medium 3 colorless to - - - +; colonies - light amber yellowish to blue-green BBL UROTUBE M • Medium 1 yellowish to +; yellow +; colorless +; yellow +; pale to blue- +; small, whitish yellow- colonies; yellow colonies; yellow- colonies; yellow green colonies; colonies; green medium green to green medium blue-green yellowish to medium medium blue-green medium • Medium 2 rose +; pink colonies; +; colorless to - +; pale to blue- - red to pink beige colonies; green colonies medium orange-brown with or without medium fluorescence • Medium 3 colorless to - - - - +; whitish light amber colonies BBL UROTUBE E • Medium 1 yellowish to +; yellow +; colorless +; yellow +; pale to blue- +; small, whitish yellow- colonies; yellow colonies; yellow- colonies; yellow green colonies; colonies; green medium green to green medium blue-green yellowish to medium medium blue-green medium • Medium 2 rose +; pink colonies; +; colorless to - +; pale to blue- - red to pink beige colonies; green colonies medium orange-brown with or without medium fluorescence • Medium 3 light amber - - +; brown to black - (+)/- colonies, medium brown to black BBL UROTUBE E. coli • Medium 1 yellowish to +; yellow +; colorless +; yellow +; pale to blue- +; small, whitish yellow- colonies; yellow colonies; yellow- colonies; yellow green colonies; colonies; green medium green to green medium blue-green yellowish to medium medium blue-green medium • Medium 2 rose +; pink colonies; +; colorless to - +; pale to blue- - red to pink beige colonies; green colonies medium orange-brown with or without medium fluorescence • Medium 3 colorless to +; medium and +; colorless +; medium and - (+) light amber colonies yellow colonies colonies yellow Indole spot + - - - - testa TDAb - + - - -

DA-212115.03 Page 4 of 10 medium • Medium 2 rose +; pink colonies; +; colorless to - +; pale to blue- - red to pink beige colonies; green colonies medium orange-brown with or without medium fluorescence • Medium 3 colorless to - - - + + light amber - = no growth to trace growth; (+) = weak growth; + = good to excellent growth a, b Perform these supplemental tests with growth from medium 3. For availability of reagents, see Materials Not Provided.

PROCEDURE Materials Provided BBL UROTUBE, BBL UROTUBE M, BBL UROTUBE E, BBL UROTUBE E. coli, or BBL UROTUBE SXT Microbiologically controlled.

Materials Not Provided Ancillary culture media, reagents and laboratory equipment as described. For indole and TDA tests on medium 3 of BBL UROTUBE E. coli: Indole Dropper Reagent (cat. no. 261185) or Indole DMACA Dropper Reagent (cat. no. 261187). Ferric Chloride Dropper Reagent (cat. no. 261190). For oxidase tests on medium 3 of BBL UROTUBE: Oxidase Dropper Reagent (cat. no. 261181).

Specimen Types These products are suitable for the isolation and enumeration of bacteria and fungi from urine (mid-stream or catheter urine, or urine collected by suprapubic bladder puncture). Consult PERFORMANCE CHARACTERISTICS AND LIMITATIONS OF THE PROCEDURE.

Collection and Preparation of Specimens Observe aseptic techniques for collecting specimens. Use standard procedures for collection.1,13 Urine must be fresh or not older than 2 hours. Alternatively, urine specimens may be kept refrigerated (not longer than 24 hours) to avoid overgrowth of the infectious agents or contaminants before inoculation.13

Test Procedure 1. Inspect the agar surfaces with tube closed. Dipslides showing signs of desiccation, contamination, or other deterioration must not be used. 2. Label the tube with patient name, specimen number, and date of inoculation. 3. Unscrew cover and remove the slide from the plastic tube, without touching the agar surfaces (Fig. 1). Do not collect urine specimens in the BBL UROTUBE container tube! 4. Dip the slide three times briefly into the urine so that the agar surfaces are completely immersed (Fig. 2). Do not leave the slide in the liquid for more than 10 seconds since this might wash out the ingredients from the media and/or loosen the gel from the plastic carrier. If there is insufficient urine for dipping, it can be carefully poured over the agar surfaces. 5. Let excess urine drip off by holding the tip of the slide against the inside rim of the tube (Fig.3). The last drops can be eliminated from the tip of the slide with a tissue paper (Fig. 4). 6. Carefully return the slide into its plastic tube and close tightly. 7. Incubate the tube for 18 to 24 hours at 35 to 37° C (Fig. 5) or forward it to a bacteriology laboratory for further processing. Note that inoculated tubes should be transported to the laboratory within 24 hours. Avoid elevated temperatures and freezing of the slides during transport.

DA-212115.03 Page 5 of 10

Results and Interpretation After incubation, remove the slide from the tube for interpretation. For quantitative estimation of the viable counts, compare the growth on CLED agar with the reference pictures provided below; use good illumination for the interpretation (Fig. 6). Confluent growth, caused by viable counts ≥ 106/ml might be difficult to recognize as it might cover the whole agar surface evenly. Touching the surface with a loop or swab may be helpful in this case. Growth on MacConkey Agar (medium 2) indicates the presence of Gram negative rods. Presence of growth on medium 3 indicates the presence of the respective groups of microorganism, depending on the medium and type of slide used. A detailed description of the growth on the media is provided below. Do not attempt to determine the viable count of the organisms growing on side 2 and 3 since the selective agents contained in these media might influence the growth! After subculture onto appropriate plated media, growth from any of the media contained on the slides may be used for further biochemical or susceptibility tests.

• CLED Agar (Medium 1 on all BBL UROTUBE products): CLED Agar will grow Gram positive and Gram negative bacteria and yeasts. A yellow discoloration of the medium indicates lactose fermentation, while a yellow-green or green medium indicates non-lactose fermenters. The following guidelines and the interpretation guide (pictures) at the end of this document may be used for interpreting the viable counts obtained on CLED Agar:

Viable count Clinical Interpretation Less than Mid-stream urine: Contamination. Low counts may be significant in pretreated 10 000 patients or in patients with chronic infections. bacteria per Urine obtained by catheterization or bladder puncture: In these cases, less than ml 10.000 bacteria per ml may already indicate an infection.

10 000 to Mid-stream urine: Doubtful. It is recommended to repeat the test, since these 100 000 bacterial counts occur in chronic urinary tract infections, but may also be present in bacteria per midstream urine as contaminants. These counts may be significant in pretreated ml patients or in patients with chronic infections. Urine obtained by catheterization or bladder puncture: In these cases, less than 10.000 bacteria per ml may already indicate an infection. DA-212115.03 Page 6 of 10 More than These high viable counts indicate the presence of an infection in all types or urine 100 000 (including mid-stream urine). In these cases, the diagnosis may be confirmed by bacterial per the presence of high leukocyte counts in the urinary sediment. ml In women, a high bacterial colony count may occur as a result of external contamination (leukorrhea, vaginitis); this diagnosis is confirmed by the presence of an increased number of squamous epithelial cells without any increase of the leukocyte count in the urinary sediment.

• MacConkey Agar (Medium 2 on all BBL UROTUBE products): On this medium, all Enterobacteriaceae and certain nonfermenters (e.g., Pseudomonas aeruginosa) will grow. A pink to red discoloration is indicative of lactose fermentation, e.g. with E. coli, while colorless, beige or amber colonies on a orange-brownish medium indicate non-lactose fermenters.

• Interpretation of growth on the respective third medium (Medium 3) As stated above, the third medium depends on the type slide used: BBL UROTUBE: Growth on Cetrimide Agar should be interpreted as follows: green to yellow, fluorescing colonies indicate the presence of Pseudomonas aeruginosa. The diagnosis may be confirmed by a positive oxidase test (see Materials Not Provided). Non- fluorescing growth on this medium must be further tested for complete identification. BBL UROTUBE M: Growth on Malt Agar indicates the presence of yeasts, e.g. Candida albicans or other fungi. Note that certain yeast strains need 42 to 48 hours for full development of growth on the media. Rarely, certain bacteria, such as lactobacilli, might grow on this medium. Therefore, a Gram stain from the growth on this medium might be useful. Further testing is required for complete identification. BBL UROTUBE E: Brown to black colonies on Enterococcus Agar indicate the presence of Enterococcus species, e.g. Enterococcus faecalis. Growth of colorless to gray colonies may indicate the presence of streptococci, but confirmation is needed. BBL UROTUBE E. coli: If the BGLU medium turns yellow, Escherichia coli or other beta- glucuronidase positive bacteria are present. Perform an indole test from yellow growth on this medium. A positive indole reaction indicates the presence of E. coli. If there is colorless to beige growth on this medium, perform a TDA test. A positive TDA test indicates presence of organisms from the Proteus-Morganella-Providencia group. For the availability of indole and TDA reagents, see Materials not Provided. For performing these supplemental tests, follow the instructions provided with the reagents. BBL UROTUBE SXT: This medium is used to determine the susceptibility (or resistance) of the isolated bacteria against Trimethoprim/Sulfamethoxazole (SXT). No growth on this medium indicates sensitivity, strong growth indicates resistance against SXT. A reduced growth on this medium, when compared to CLED Agar (Medium 1) may indicate the presence of a mixed culture containing at least one SXT resistant organism.

After use and prior to discarding, all used tubes and other contaminated material must be autoclaved or incinerated. For details, see GENERAL INSTRUCTIONS FOR USE document.

PERFORMANCE CHARACTERISTICS AND LIMITATIONS OF THE PROCEDURE BBL UROTUBE, BBL UROTUBE M, BBL UROTUBE E, BBL UROTUBE E. coli, and BBL UROTUBE SXT are suitable for the diagnosis of common urinary tract infections from urine specimens. The dipslide method with CLED and MacConkey Agars has been proven to be an effective and simple means for counting common bacteria (e.g., Enterobacteriaceae, other Gram negative rods (such as Pseudomonas), enterococci, staphylococci and others present in urine.1-8 Use of a third medium (if available), in addition to these standard media, is helpful if special groups of organisms are suspected to be present as infectious agents.9-12

It is mandatory that urine specimens used with these or other systems and media have been collected aseptically and are fresh (not older than 2 hours) or have been stored refrigerated (for not longer than 24 hours).1,13

DA-212115.03 Page 7 of 10 Improper collection of the urine, storage of the specimens for a time exceeding the periods indicated above, long transportation periods before the processing of the inoculated slides, and exposure of the inoculated slides to extreme temperatures may result in a wrong diagnosis or even make a diagnosis impossible.1,13

The most precise diagnosis of urinary tract infections is obtained if urine obtained by bladder puncture is used since microorganisms present in the normal urethral flora may contaminate urine obtained by other collection techniques.

Fastidious bacteria such as mycoplasmas, chlamydiae, Neissseria gonorrhoeae, mycobacteria, or Gardnerella vaginalis will not grow on the media of these dipslide products. If these organisms are suspected to be involved in an urinary tract infection, the appropriate techniques must be applied for their detection.1,13 Certain strains of streptococci, esp. of Streptococcus agalactiae (group B) will not grow sufficiently on medium 1 (CLED Agar). If they are suspected to be involved in a urinary tract infection, a cultivation of the urine on a blood agar plate (e.g., BD Columbia Agar with 5% Sheep Blood) is recommended.

Media on dipslides must not be used for performing susceptibility tests by the disc diffusion method.

Although certain diagnostic tests may be performed directly on the media, biochemical and, if indicated, immunological testing using pure cultures is necessary for complete identification. Exceptions are E. coli and the Proteus-Morganella-Providencia groups, which can be identified on medium 3 (BGLU Agar) of BBL UROTUBE E. coli if the recommended supplemental tests (indole, TDA) have been performed. Also, Pseudomonas aeruginosa may be directly identified on medium 3 (Cetrimide Agar) of BBL UROTUBE if greenish fluorescent colonies are found which produce a positive oxidase reaction.

For appropriate therapy, susceptibility tests of the isolated organisms may be necessary. Growth of any bacteria on medium 3 (PDM Medium with trimethoprim/ sulfamethoxazole) of BBL UROTUBE SXT must be interpreted as resistance of the organisms to this antimicrobial agent (SXT).

REFERENCES 1. Gallien, R.1988. Mikrobiologische Diagnostik in der ärztlichen Praxis, G. Fischer Verlag , Stuttgart. 2. Ellner, P.D., and M.S. Papachristos. 1975. Detection of bacteriuria by dip-slide. Am. J. Clin. Pathol. 63: 516-521. 3. Guttmann, D. 1967. Dip-slide: an aid to quantitative urine culture in general practice. Br. Med. J. 3: 343-345. 4. McAllister, T.A., et al. 1973. Assessment of plane dipslide quantitation of bacteriuria. Nephron 11: 111-122. 5. Van Dorsten, J.P., and E.R. Bannister. 1986. Office diagnosis of asymptomatic bacteriuria in pregnant women. Am. J. Obstet. Gynecol. 155: 777-780. 6. Sandys, G.H. 1960. A new method of preventing swarming of Proteus sp. with a description of a new medium suitable for use in routine laboratory practice. J. Med. Lab. Technol. 17:224-233. 7. Mackey, J.P., and G.H. Sandys. 1965. Laboratory diagnosis of infection of the urinary tract in general practice by means of a dip-inoculum transport medium. Br. Med. J. 2:1286-1288. 8. Farmer III, J.J. 2003. Enterobacteriaceae: introduction and identification. In: Murray, P.R., E.J. Baron, J.H. Jorgensen, M.A. Pfaller, and R.H. Yolken (ed.). Manual of clinical microbiology, 8th ed. American Society for Microbiology, Washington, D.C. 9. Murray, P. R., E. J. Baron, J.H. Jorgensen, M. A. Pfaller, and R.H. Yolken (ed.). 2003. Manual of clinical microbiology, 8th ed. American Society for Microbiology, Washington, D.C. 10. King, E.O., M.K. Ward, and E.E. Raney. 1954. Two simple media for the demonstration of pyocyanin and fluorescein. J. Lab. Clin. Med. 44: 301. 11. MacFaddin, J.F. 1985. Media for the isolation – cultivation – maintenance of medical bacteria. Volume 1. Williams and Wilkins, Baltimore, London. 12. Chapin, K.C., and T.-L. Lauderdale. 2003. Reagents, stains, an media: bacteriology. In: Murray, P. R., E. J. Baron, J.H. Jorgensen, M. A. Pfaller, and R. H. Yolken (ed.). Manual of clinical microbiology, 8th ed. American Society for Microbiology, Washington, D.C. DA-212115.03 Page 8 of 10 13. Thomson, R.B. jr., and J.M. Miller. 2003. Specimen collection, transport, and processing: bacteriology. In: Murray, P. R., E. J. Baron, J.H. Jorgensen, M. A. Pfaller, and R. H. Yolken (ed.). Manual of clinical microbiology, 8th ed. American Society for Microbiology, Washington, D.C.

AVAILABILITY Cat. No. Product Name Package Size 212115 BBL UROTUBE E. coli 10 slides 272805 BBL UROTUBE E 10 slides 273007 BBL UROTUBE 10 slides 273357 BBL UROTUBE 50 slides 273008 BBL UROTUBE SXT 10 slides 273171 BBL UROTUBE M 10 slides

FURTHER INFORMATION For further information, please contact your local BD representative.

Becton Dickinson GmbH BD Diagnostic Systems Tullastrasse 8 – 12 D-69126 Heidelberg/Germany Phone: +49-62 21-30 50, Fax: +49-62 21-30 52 16 [email protected]

BD Diagnostic Systems Europe Becton Dickinson France SA 11 rue Aristide Bergès 38800 Le Pont de Claix/France Tel: +33-476 68 3636 Fax: +33-476 68 3292 http://www.bd.com

BD, BD logo and BBL are trademarks of Becton, Dickinson and Company. Urotube is a trademark of Becton Dickinson GmbH. ATCC is a trademark of the American Type Culture Collection © 2003 Becton, Dickinson and Company

INTERPRETATION GUIDE (CLED Agar, Medium 1 only!)

Contamination: Doubtful: Infection: DA-212115.031 000 - 10 000 >10Page 000 9 of- <100 10 000 100 000 - 1 000 000 (=103 -104) CFU/ml (=104-105) CFU/ml (=105-106) CFU/ml

1 000 10 000 100 000 1 000 000 (=103)/ml (=104)/ml (=105)/ml (=106)/ml

Contamination: Doubtful: Infection: 1 000 – 10.000 >10 000 - <100.000 100.000 – 1.000.000 (=10 3 -104) (=104-105) CFU/mL (=105-106) CFU/mL CFU/ L

DA-212115.03 Page 10 of 10