Quality assurance study of bacterial antigen testing of cerebrospinal fluid.

Bacterial antigen testing (BAT) of cerebrospinal fluid (CSF) by latex agglutination is a low-yield procedure in patients whose CSF specimens have normal laboratory parameters. Between August 1992 and August 1994, we evaluated 287 bacterial antigen (BA) test requests to determine whether yields could be improved and whether patient costs could be reduced by cancelling BAT for those patients with normal CSF parameters (cell count, protein, glucose) after consultation with physicians. A total of 171 (68%) BA tests were canceled by this approach. None of these CSF specimens was culture positive for an organism detectable by BAT. Of the remaining 116 CSF specimens tested, only 3 were positive by BAT, one each for Neisseria meningitidis, Streptococcus pneumoniae, and group B streptococcus. Only 43 of the CSF specimens tested had at least two abnormal parameters; the 3 positive CSF specimens were included in this group. In light of the low rate of positivity, the number of BA tests can be further reduced by establishing criteria that must be met before a CSF specimen is accepted for BAT. After review of our data and the literature concerning this topic, we concluded that only specimens with leukocyte counts of > or = 50 cells per mm3 should be tested. Of 287 specimens evaluated in our study, only 36 met this criterion, including the 3 BA-positive specimens. Enacting such a restriction would have reduced the total number of BA tests by 251 (87%) without compromising patient care. A laboratory cost savings of $6,500 per year would have been realized, with a substantial reduction in the cost per positive test. Patient charges would have been reduced by$12,500 per year

Genotype Prevalence and Risk Factors for Severe Clinical Adenovirus Infection, United States 2004-2006

Recently, epidemiological and clinical data have revealed important changes with regard to clinical adenovirus infection, including alterations in antigenic presentation, geographical distribution, and virulence of the virus

Identification of Medically Relevant Nocardia Species with an Abbreviated Battery of Tests

Identification of Nocardia to the species level is useful for predicting antimicrobial susceptibility patterns and defining the pathogenicity and geographic distribution of these organisms. We sought to develop an identification method which was accurate, timely, and employed tests which would be readily available in most clinical laboratories. We evaluated the API 20C AUX yeast identification system as well as several biochemical tests and Kirby-Bauer susceptibility patterns for the identification of 75 isolates encompassing the 8 medically relevant Nocardia species. There were few biochemical reactions that were sufficiently unique for species identification; of note, N. nova were positive for arylsulfatase, N. farcinica were positive for opacification of Middlebrook 7H11 agar, and N. brasiliensis and N. pseudobrasiliensis were the only species capable of liquefying gelatin. API 20C sugar assimilation patterns were unique for N. transvalensis, N. asteroides IV, and N. brevicatena. There was overlap among the assimilation patterns for the other species. Species-specific patterns of susceptibility to gentamicin, tobramycin, amikacin, and erythromycin were obtained for N. nova, N. farcinica, and N. brevicatena, while there was overlap among the susceptibility patterns for the other isolates. No single method could identify all Nocardia isolates to the species level; therefore, a combination of methods was necessary. An algorithm utilizing antibiotic susceptibility patterns, citrate utilization, acetamide utilization, and assimilation of inositol and adonitol accurately identified all isolates. The algorithm was expanded to include infrequent drug susceptibility patterns which have been reported in the literature but which were not seen in this study

Evaluation of the Q Score and Q234 Systems for Cost-Effective and Clinically Relevant Interpretation of Wound Cultures

The Q score and Q234 systems were compared to our current protocol for interpreting wound cultures. The Q score and Q234 systems were more cost effective than our current method, with the Q234 system being considered the most useful protocol for implementation by both the laboratory and our clinicians

First Case Report of Catheter-Related Bacteremia Due to “Mycobacterium lacticola”

This is the first report of infection caused by “Mycobacterium lacticola,” a rapidly growing, scotochromogenic mycobacterium that was isolated from the blood of an immunosuppressed child. The organism was identified by sequence analysis of >1,400 bp of the 16S rRNA gene. The clinical relevance of this isolate, coupled with its unique 16S rRNA gene sequence, should prompt further investigation to establish this organism as a valid mycobacterial species

Pseudomonas aeruginosa Acute Prostatitis and Urosepsis after Sexual Relations in a Hot Tub▿

We report a case of a previously healthy 38-year-old male with acute prostatitis and concurrent Pseudomonas aeruginosa urosepsis. Pulsed-field gel electrophoresis analysis confirmed that the source of the organism was the patient's newly purchased hot tub, which was filled with water from a stream