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*** LAB NEWS ***
5/10/99
BACTERIAL CULTURES FOR "R/O ALL"
Many specimens submitted for bacterial culture are accompanied by
a
request for "r/o all" (or similar statement) in the field
reserved for
special instructions. Specimens such as sputum, urine, or
wounds/drainage fluid often contain resident flora from skin or
mucosal surfaces and the request for "r/o all" leads to
expensive and
time-consuming identification and susceptibility testing that is
usually not clinically useful and may in fact be misleading.
Effective 5/12/99, the request "r/o all" will not be interpreted
literally. Specimens collected from nonsterile sites will be worked
up
according to the following guidelines:
- Traditional pathogens (e.g. S. aureus, beta-hemolytic
streptococci, S. pneumoniae, enterococci, Enterobacteriaceae,
Pseudomonas and other nonfermenters) will be worked up. This will
include identification and susceptibility testing (when technically
feasible).
- Organisms that are part of the normal skin or mucosal flora
(viridans group streptococci, coagulase-negative staphylococci,
diphtheroids, and lactobacilli) will not be extensively worked up.
In
general, a descriptive identification, eg diphtheroid or
coagulase-negative staphylococci will be provided but susceptibility
tests will not be routinely performed.
- The workup of any specific specimen will depend on the type of
specimen, number and quantity of organisms isolated, and Gram stain
findings.
- After reviewing the preliminary culture report, clinicians may
call the laboratory and request additional workup of a specific
organism. In addition, the plates will be held for 3-5 days after
the
culture is finalled.
Identification and susceptibility testing (when technically
feasible) will continue to be attempted on all organisms isolated
from
normally sterile specimens (however, the above guidelines may be
applied to polymicrobial infections e.g. abscesses).
Eric D. Spitzer, MD,
PhD
Chief, Microbiology Laboratory
x4-2382
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