Microbiology for Clinicians:

Interpreting Culture Results

 Course content

Course roadmap
Basic concepts

Common infections

1
 “The future of antibiotics
World Antibiotic depends on all of us.”
Awareness Week
2019

2
 Core Competencies
Core competencies for
antimicrobial prescribing
C1: Understands the patient and the patient’s clinical needs
C2: Understands treatment options and how they support the
patient’s clinical needs
C3: Works in partnership with the patient and other healthcare
professionals to develop and implement a treatment plan
C4: Communicates the treatment plan and its rationale clearly to
the patient and other health professionals
C5: Monitors and reviews the patient’s response to treatment

3
 Objectives
• Recognize the importance of appropriate specimen
collection in the interpretation of microbiologic data
• Utilize clinical data to appropriately interpret
microbiologic data in order to distinguish colonization
or and contamination from infection
• Accurately interpret antimicrobial susceptibility data

4
5
 Number of bacterial cells
in and on a human body is
equal to or exceeds the
number of human cells!

6
Does the microbiologic data make sense?

Review Evaluate
Check for
micro- Assess route &
adverse
biologic spectrum duration of
effects
data therapy

Positive cultures could mean:

• Contamination
• Colonization
• Infection
7
We must all be
antimicrobial
stewards

WHO/A. Kristensen

8
Inappropriate use of antimicrobials can
lead to considerable harm.

9
Culture results could represent….

Colonization

Contamination

Infection

10
Culture results could represent….

Colonization Commensal microorganisms

11
Culture results could represent….

Exogenous microorganisms
Contamination introduced into a specimen

12
Culture results could represent….

Infection Disease

13
 Core Competencies 1, 2, 3, 4

Case 1

Diagnostic
work-up
Clinical
Clinical Therapeutic re-assessment Modify
assessment decisions antimicrobials
Data
Patient review
education
Initial evaluation Subsequent evaluation

14
65 year-old female patient who:

Presented with dysuria and fever

Admitted for non-infectious reason

1 of 4 sets of blood cultures are

positive for Staphylococcus epidermidis

15
16
 Diagnostic challenge

Contaminant Infection

17
 Diagnostic challenge

Contaminant Infection

18
 Diagnostic challenge

Contaminant Infection

19
Methodology is critical to the interpretation
of blood culture results

Technique
Methodology is critical to the interpretation
of blood culture results

Separate
Blood veni-
Technique Timing
volume puncture
sites
 Chance of pathogen recovery in blood
culture
+30% +13% +7%
Blood
volume

10 mL 20 mL 30 mL 40 mL
Volume of blood
Cockerill et al, CID 2004
Methodology is critical to the interpretation
of blood culture results

Separate
Blood veni-
Technique Timing
volume puncture
sites
Methodology is critical to the interpretation
of blood culture results

Separate
Blood veni-
Technique Timing
volume puncture
sites
Interpreting blood culture results

Genus/species of the organism

Number of individual bottles that are positive

Number of species isolated

25
Interpreting blood culture results

Genus/species of the organism

Number of individual bottles that are positive

Number of species isolated

26
Interpreting blood culture results

Genus/species of the organism

Number of individual bottles that are positive

Number of species isolated

27
Interpreting blood culture results

Genus/species of the organism

Number of individual bottles that are positive

Number of species isolated

28
 Core Competencies 1, 2, 4, 5

An informed re-evaluation

Review Evaluate
Check for
micro- Assess route &
adverse
biologic spectrum duration of
effects
data therapy

Optimal antibiotics

29
Does the microbiologic data make sense?

Review Evaluate
Check for
micro- Assess route &
adverse
biologic spectrum duration of
effects
data therapy

1 out of 4 bottle positive for CoNS

30
Does the microbiologic data make sense?

Review Evaluate
Most Check for
likely skin contamination ofroute &
micro- Assess
adverse
biologic spectrum blood culture duration of
effects
data therapy

31
Key points
• Obtain blood from culture from
separate venipuncture sites to
assist in distinguishing
contaminant from true infection.

32
 Core Competencies 1, 2, 3, 4

Case 2

Diagnostic
work-up
Clinical
Clinical Therapeutic re-assessment Modify
assessment decisions antimicrobials
Data
Patient review
education
Initial evaluation Subsequent evaluation

33
62 year-old male patient with:
Diabetes mellitus

Painless ulcer on right foot

Present for 1 month

4 cm plantar ulcer over 1st metatarsal

head with purulent discharge

34
 Microbiologic data
• Superficial foot swab
without debridement

• Culture grew:
• MSSA
• Anaerobes
• Pseudomonas
aeruginosa
WHO/A. Kristensen

35
36
 Diagnostic challenge

Colonization Infection

37
 Diagnostic challenge

Key point: Obtain Superficial swabs of an

appropriate specimen open wound are likely to
always yield bacteria

38
 Core Competencies 1, 2, 3, 4

Case 2

Diagnostic
work-up
Clinical
Clinical Therapeutic re-assessment Modify
assessment decisions antimicrobials
Data
Patient review
education
Initial evaluation Subsequent evaluation

39
 Core Competencies 3

Case 2
• MRI: osteomyelitis

• Day 3: Diagnostic
tobramycin
work-up
discontinued due to Clinical
Clinical acute renal injury
Therapeutic re-assessment Modify
assessment decisions antimicrobials
• Underwent surgical Data
debridement
Patient review
education
Initial evaluation Subsequent evaluation

40
Does the microbiologic data make sense?

Review Evaluate
Check for
micro- Assess route &
adverse
biologic spectrum duration of
effects
data therapy

Deep specimen cultures yielded

only MSSA on culture

41
Verify the spectrum of therapy

Review Evaluate
Check for
micro- Assess route &
adverse
biologic spectrum duration of
effects
data therapy

Antibiotics changed to 1st generation

cephalosporin alone

42
Unintended consequences?

Review Evaluate
Check for
micro- Assess route &
adverse
biologic spectrum duration of
effects
data therapy

Adverse event: acute

renal injury

43
Key points
• Skin ulcers are colonized with
bacteria.
• If no clinical features of
infection, no antibiotic therapy
is necessary
• If osteomyelitis suspected,
pursue appropriate cultures

44
Minimum inhibitory concentration (MIC)
• Lowest concentration of an
antimicrobial that inhibits
visible growth in vitro
• Reference microbiology
organizations provide
interpretive guidelines
WHO/O. Karatuna

45
 Core Competencies 3

Case 2

Diagnostic
work-up
Clinical
Clinical Therapeutic re-assessment Modify
assessment decisions antimicrobials
Data
Patient review
education
Initial evaluation Subsequent evaluation

46
 MSSA
Measured EUCAST
zone interpretation
diameter
Cefoxitin (FOX30) 26 mm susceptible
Erythromycin (E15) 27 mm susceptible
Clindamycin (DA2) 27 mm susceptible
Fusidic acid (FD10) 31 mm susceptible
WHO/O. Karatuna

47
Review: Microbiology for Clinicians
Drug

prescription
Dose .............
.............
Route
.............

Duration

48
 Quiz time!
Please click
“Next” to
proceed.