BD™ Trypticase™ Soy Agar II with 5% Sheep Blood

INSTRUCTIONS FOR USE – READY-TO-USE PLATED MEDIA PA-254053.07 Rev.: Mar 2013

BD Trypticase Soy Agar II with 5% Sheep Blood

INTENDED USE BD Trypticase Soy Agar II with 5% Sheep Blood is a nutritious general purpose medium for the isolation and cultivation of nonfastidious and fastidious micro-organisms from clinical specimens and the detection of hemolytic reactions.

PRINCIPLES AND EXPLANATION OF THE PROCEDURE Microbiological method. The nutritional composition of Trypticase Soy Agar (TSA) has made it a popular medium, both unsupplemented and as a base for media containing blood.1 BD Trypticase Soy Agar II is an improved version, providing clearer hemolytic zones than Trypticase Soy Agar (TSA) when supplemented with 5% sheep blood. It provides excellent growth and beta hemolysis of hemolytic streptococci and other organisms.2-4 It is suitable for performing the CAMP test (formation of a zone of complete, synergistic hemolysis at the junction of perpendicular streak inocula of Staphylococcus aureus and group B streptococci) for the presumptive identification of Streptococcus agalactiae, and for use with low concentration (0.04 unit) bacitracin discs (BD Taxo A discs) for presumptive identification of group A streptococci (S. pyogenes).2,3,5,6 BD Trypticase Soy Agar II with 5% Sheep Blood is not the appropriate medium for the primary isolation of fastidious anaerobes. The combination of casein and soy peptones in the Trypticase Soy Agar (TSA II) base render the medium highly nutritious by supplying organic nitrogen, particularly amino acids and larger-chained peptides. The sodium chloride maintains osmotic equilibrium. Proprietary growth factors improve the hemolytic reactions. Defibrinated sheep blood is the most widely used blood for enriching agar base media.1

REAGENTS BD Trypticase Soy Agar II with 5% Sheep Blood Formula* Per Liter Purified Water Pancreatic Digest of Casein 14.5 g Papaic Digest of Soybean Meal 5.0 Sodium Chloride 5.0 Growth Factors 1.5 Agar 14.0 Defibrinated Sheep Blood 5% pH 7.3 +/- 0.2 *Adjusted and/or supplemented as required to meet performance criteria.

PRECAUTIONS

. For professional use only. Do not use plates if they show evidence of microbial contamination, discoloration, drying, cracking or other signs of deterioration. Consult GENERAL INSTRUCTIONS FOR USE document for aseptic handling procedures, biohazards, and disposal of used product.

STORAGE AND SHELF LIFE On receipt, store plates in the dark at 2 to 8° C, in their original sleeve wrapping until just prior to use. Avoid freezing and overheating. The plates may be inoculated up to the expiration date (see package label) and incubated for the recommended incubation times. Plates from opened stacks of 10 plates can be used for one week when stored in a clean area at 2 to 8° C.

PA-254053.07 - 1 - USER QUALITY CONTROL Inoculate representative samples with the following strains (for details, see GENERAL INSTRUCTIONS FOR USE document). Incubate the inoculated plates at 35 ± 2°C in an aerobic atmosphere supplemented with carbon dioxide. Examine plates after 18 to 24 h for amount of growth, colony size and hemolytic reactions.

Strains Growth Results Escherichia coli ATCC 25922 Growth good to excellent; may be beta-hemolytic Enterococcus faecalis ATCC 29212 Growth good to excellent Shigella flexneri ATCC 12022 Growth good to excellent Staphylococcus aureus ATCC 25923 Growth good to excellent; beta hemolysis Streptococcus agalactiae ATCC 12386 Growth good to excellent; (weak) beta hemolysis Streptococcus pneumoniae ATCC 6305 Growth good to excellent green-grey colonies; alpha hemolysis Streptococcus pyogenes ATCC 19615 Growth good to excellent; beta hemolysis Uninoculated Red (blood color)

PROCEDURE Materials Provided BD Trypticase Soy Agar II with 5% Sheep Blood (90 mm Stacker plates). Microbiologically controlled.

Materials Not Provided Ancillary culture media, reagents and laboratory equipment as required.

Specimen Types This is a universal isolation medium in aerobic bacteriology that can be used for all types of clinical specimens (see also PERFORMANCE CHARACTERISTICS AND LIMITATIONS OF THE PROCEDURE).

Test Procedure Streak the specimen as soon as possible after it is received in the laboratory. The streak plate is used primarily to isolate pure cultures from specimens containing mixed flora. Alternatively, if material is being cultured directly from a swab, roll the swab over a small area of the surface at the edge; then streak from this inoculated area. In order to improve detection of all pathogens contained in the specimen, it must also be streaked onto appropriate selective media.1,4 Since many pathogens require carbon dioxide on primary isolation, plates should be incubated in an aerobic atmosphere containing approximately 3 to 10% CO2. Incubate plates at 35-37°C for 18 to 24 h or longer, if necessary.

CAMP-Test: Isolates suspected to be Streptococcus agalactiae may be tested by the CAMP test for presumptive identification. The inoculum may be picked from a blood agar plate. Make a single streak of Staphylococcus aureus ATCC 33862 across the center of the plate. If a loop is used, do not use it parallel to the agar surface, since the streak will be too wide and the results will not be satisfactory. The streptococcal test strains are inoculated by making a single streak perpendicular to the S. aureus line coming as close as possible (2-3 mm), but not touching it. Several isolates may be tested on the same plate. Perpendicular streptococcal streaks should be 5-8 mm apart. It is recommended that S. agalactiae ATCC 12386 be included along with patient isolates to verify satisfactory performance and S. pyogenes ATCC 19615 as a negative control. The procedure should be practised with known cultures before using it to identify unknown isolates. Note: Studies on the CAMP Test have shown that the reaction is most reliable early in the shelf life of some lots of the prepared plated medium. For the CAMP test, incubate plates in an aerobic atmosphere at 35 ± 2°C for 18 to 24 h. Do not incubate anaerobically or in a CO2 incubator since this may cause false-positive results with group A streptococci.2,3,5,6 PA-254053.07 - 2 - Results After incubation most plates will show an area of confluent growth. Because the streaking procedure is, in effect, a "dilution" technique, diminishing numbers of micro-organisms are deposited on the streaked areas. Consequently, one or more of these areas should exhibit isolated colonies of the organisms contained in the specimen. Further, growth of each organism may be semi-quantitatively scored on the basis of growth in each of the streaked areas. Further differentiation of the isolated organisms by biochemical and/or serological tests is necessary. Consult the appropriate references for the appearance and further differential tests of the organisms isolated. 2,3,7,8

CAMP Test: A positive CAMP reaction is indicated by arrowhead or triangular shaped area of increased hemolysis which forms around the end of the streptococcal streak line closest to the S. aureus growth. The streptococcal growth must be within the wide zone of partial hemolysis that surrounds the S. aureus growth. Isolates showing the described arrow-head hemolysis may be presumptively identified as Streptococcus agalactiae but should be confirmed as Lancefield group B streptococci with additional immunological or serological procedures. A negative reaction may appear as a bullet-shaped zone of slightly increased hemolysis or as no increased hemolysis.

PERFORMANCE CHARACTERISTICS AND LIMITATIONS OF THE PROCEDURE BD Trypticase Soy Agar II with 5% Sheep Blood is a standard medium for the isolation and cultivation of many aerobically growing micro-organisms, such as Enterobacteriaceae, Pseudomonas and other non-fermenting Gram negative rods, streptococci, staphylococci, coryneforms, Candida species, and many others.1,4 The medium lacks V factor (nicotinamide adenine dinucleotide, NAD) since sheep blood contains NADase which destroys the NAD. For this reason, Haemophilus influenzae which requires both the X and V factors, will not grow on this medium. Neisseria gonorrhoeae does not grow well on this medium. Instead, BD Chocolate Agar (GC II Agar with IsoVitaleX) should be used for the recovery of these species. Also, the medium is not suitable for the isolation and growth of Mycobacterium, Legionella, Bordetella and other organisms with highly specific nutritive requirements.

The number and types of bacterial species occurring as infectious agents is very large. Therefore, before the medium is routinely used for rarely isolated or newly described micro- organisms, its suitability must first be tested by the user by cultivating pure cultures of the organism in question. Although certain diagnostic tests may be performed directly on this medium, biochemical and, if indicated, immunological testing using pure cultures are recommended for complete identification. Consult appropriate references for further information.4-7 For details on the use of BD Taxo discs on this medium, consult the respective Instructions for Use. BD Trypticase Soy Agar II with 5% Sheep Blood is not the appropriate medium for the primary isolation of fastidious anaerobes.

REFERENCES 1. Vera, H.D., and D.A. Power. 1980. Culture media, p. 969. In: E.H. Lennette, A. Balows, W.J. Hausler, Jr., and J.P. Truant (ed.), Manual of clinical microbiology, 3rd ed. American Society for Microbiology, Washington, D.C. 2. Facklam, R.R., and J.A. Washington II. 1991. Streptococci and related catalase-negative gram-positive cocci, p. 238-257. In: A. Balows, W.J. Hausler, Jr., K.L. Herrmann, H.D. Isenberg, and H.J. Shadomy (ed.), Manual of clinical microbiology, 5th ed. American Society for Microbiology, Washington, D.C. 3. Ruoff, K.L., R.A. Whiley, and D. Beighton.2003. Streptococcus. In: Murray, P. R., E. J. Baron, J.H. Jorgensen, M. A. Pfaller, and R. H. Yolken (ed.). Manual of clinical microbiology, 8thed. American Society for Microbiology, Washington, D.C. 4. Thomson, R.B., 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

PA-254053.07 - 3 - (ed.). Manual of clinical microbiology, 8th ed. American Society for Microbiology, Washington, D.C. 5. Bernheimer, A.W., R. Linder, and L.S. Avigad. 1979. Nature and mechanism of action of the CAMP protein of group B streptococci. Infect. Immun. 23:838-844. 6. Darling, C.L. 1975. Standardization and evaluation of CAMP reaction for prompt, presumptive identification of Streptococcus agalactiae (Lancefield group B) in clinical material. J. Clin. Microbiol. 1:171-174. 7. Isenberg, H. D. (ed.). 1992. Interpretation of aerobic bacterial growth on primary culture media, Clinical microbiology procedures handbook, vol.1, p. 1.6.1-1.6.7. American Society for Microbiology, Washington, D.C. 8. Baron, E. J, L. R. Peterson, and S. M. Finegold. 1994. Bailey & Scott’s diagnostic microbiology, 9th ed., p. 415. Mosby-Year Book, Inc. St. Louis, MO.

PACKAGING/AVAILABILITY BD Trypticase Soy Agar II with 5% Sheep Blood Cat. No. 254053 Ready-to-use plated media, 20 plates Cat. No. 254087 Ready-to-use plated media, 120 plates

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

Becton Dickinson GmbH Tullastrasse 8 – 12 D-69126 Heidelberg/Germany Phone: +49-62 21-30 50 Fax: +49-62 21-30 52 16 [email protected] http://www.bd.com http://www.bd.com/europe/regulatory/

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