PROFICIENCY TESTING SERVICE AMERICAN ASSOCIATION OF BIOANALYSTS 205 West Levee St. Brownsville, Texas 78520-5596 (956) 546-5315 - (800) 234-5315 - Fax (956) 542-4041 www.aab-pts.org - [email protected] PARTICIPANT STATISTICS THROAT/URINE CULTURE SECOND QUADRIMESTER 2014 Specimen 1 - Urine, 18 year old Female, flank pain epidermidis are likely skin contaminants. Send a negative report. All of the urine "dipstick Organisms Extent 1 2 3 4 5 tests" have one or more shortcomings, and lack the accuracy of the plating procedures 777 Corynebacterium sp.; NOS 1 done quantitatively. 798 Escherichia sp.; NOS 2 799 Escherichia coli 1811 943 Aerobe found; but referred for ID 16 1 Specimen 4 - Throat, 11 year old Female, acute pharyngitis 983 Organism is gram-negative 1 Organisms Extent 1 2 3 4 5 985 Organism is gram-positive 1 919 Neg for beta-hemolytic strep screen 1 987 E.coli; Citrobacter or Enterobacter 12 922 Neg for Grp A strep screen by culture 26 23 10 993 Growth of gram-negative organisms 4 1 927 Neg for strep; not screened for GC 1 TOTAL PARTICIPANTS 22 2 14 1 2 947 No aerobic growth on blood agar 2 Flagging appears for failure to report 798, 799, 943, 983, 987 or 993. 949 No aerobic growth 1 1 In addition to the required organism, participants in all extents may report 777, 985 975 Neg for strep Group A antigen 1 2 and 994. TOTAL PARTICIPANTS 30 28 10 Flagging appears in all extents for failure to report 798, 799, 919, 922, 927, 947, 975 or 983. This urine produced Escherichia coli and Corynebacterium sp. The high count E. coli indicated that it was indeed a urinary tract infection (UTI) caused by the E. coli, as it This throat specimen contained Escherichia coli and Neisseria sp. A patient with a high is most commonly found. It invades from the perianal skin up into the bladder. On EMB, fever may well need a sputum culture, not a throat culture. The high fever causes pneumonia to the colonies are easily recognized as flat, glossy blue-black colonies with an overlaid be probable. The wrong specimen, one that doesn't reveal the cause of the symptoms, rarely green sheen of ppt. eosin. ID comprises ONPG/lactose, indol positive and motile. It will be works by accident. E. coli is easily recognized and quickly ID'd on a BAP and spot-indol positive citrate, Voges-Porskauer and oxidase negative. Spot tests are good for ID but ONPG and oxidase negative, with a large hemolytic colony unlike beta strep, is not a nasopharyngeal must have a lactose plating medium and indol must have a tryptophane source. The pathogen. This organism must be reported, with a disclaimer as, "not a pathogen at this site; oxidase test rules out vibrio and aeromonas sp. that are lactose/indole positive. request a sputum specimen" and have your lab director send it out, and call it in to the physician. The Corynebacterium sp. is a normal skin contaminant. The Neisseria, once GC is ruled out, is normal throat flora.

Specimen 2 - Urine, 31 year old Male, frequency, pain Organisms Extent 1 2 3 4 5 Specimen 5 - Throat, 3 year old Female, sore throat 834 Proteus sp.; NOS 2 Organisms Extent 1 2 3 4 5 835 Proteus mirabilis 711 921 Pos for beta-hemolytic strep screen 3 943 Aerobe found; but referred for ID 12 1 922 Neg for Grp A strep screen by culture 1 948 No pathogens isolated 2 923 Pos for Grp A strep screen by culture 30 22 10 949 No aerobic growth 2 976 Pos for strep Group A antigen 1 2 983 Organism is gram-negative 1 TOTAL PARTICIPANTS 31 28 10 990 Proteus or Pseudomonas 12 Flagging in all extents appears for failure to report 881, 887, 921, 923, 943 or 976. 993 Growth of gram-negative organisms 4 2 TOTAL PARTICIPANTS 20 2 14 1 1 This specimen contained Streptococcus pyogenes, Gp. A. This young patient has a Flagging in all extents appears for failure to report 834, 835, 943, 983, 990 or 993. generalized sinusitis and needs rapid ID and treatment. The cause, group A Streptococcus pyogenes is a primary pathogen and is invading the sinuses, where it can cause otitis media and This urine had Proteus mirabilis only. Incontinence is more often being treated with possibly meningitis if left to its devices too long. disposable diapers than before, so fewer catheters are used. There are fewer cases of The instant ID with the Direct Antigen swab in the pediatric office is the quickest; the backup UTI thus, but when there are, cultures submitted may show this Proteus to be the high- BAP is a necessity in case the swab fails, but it is a day later but also the ultimate guard against count organism. Proteus mirabilis may be identified when the lab door is opened; or a false negative and no treatment. The Direct Antigen swab is its own ID. From the beta colonies when the incubator door is opened, by its pungent odor. The spreading mucoid growth on BAP, confirm with strep typing sera against ABCG strains. Report STAT, by slip and phone to on plates is equally prognostic. Confirmation is easy. The P. mirabilis, aka, "the indol- the physician. negative proteus", is urease and ornithine positive, and H2S positive. P. vulgaris is indol positive, but ornithine negative. P. penneri is negative for indol, ornithine and, usually, H2S. These three are the human pathogens.

Specimen 3 - Urine, 23 year old Female, flank pain, fever Organisms Extent 1 2 3 4 5 874 Staphylococcus sp.; coagulase-neg; NOS 1 2 873 Staphylococcus sp.; NOS 4 943 Aerobe found; but referred for ID 15 1 989 Klebsiella; Staphylococcus or Streptococcus 1 985 Organism is gram-positive 1 994 Growth of gram-positive organisms 5 1 3 878 Staphylococcus epidermidis 211 948 No pathogens isolated 1 949 No aerobic growth 1 TOTAL PARTICIPANTS 21 3 13 1 2 Flagging appears for failure to report In addition to the required organism, participants in all extents may report 873, 874, 878, 943, 948, 949, 985, 989 and 994.

This specimen contained no known pathogens, but had Staphylococcus epidermidis. Not all urinary symptoms necessarily indicate UTI. There are physiological explanations that are revealed only by urologic tests and chemical reactions, such as excessive analgesic use. Hematuria suggests different causes. Urines produce a high incidence of lab workload, but bacteriuria is still a minority of specimens examined. Staphylococcus