About Cultures

呂學重教授
感染醫學科

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 About Cultures
 Blood culture
 Bacterial identification and Antibiotic sensitivity test
 Urine culture
 Stool culture
 Stool for Salmonella and Shigella spp.
 Stool for Campylobacter spp.
 Stool for Clostridium difficile
 Sputum culture
 Body fluid culture
 Abscess culture
 Pus culture
 CVP tip culture

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 Blood
 Bacteremia
 Transient release
 Intermittent – present a focus of disease
(septicemia)
 Continuous – endocarditis, uncontrolled
disease (septicemia)

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 Blood Culture
 姓 名:蕭 X X 病歷號碼:2844983 性別/出生日期:F/1929/10/16(79.287)
 病患來源:急診 病 床 號:- 採檢日期 時間:2009/01/29 17:52
 醫囑醫師:謝承諴 科 別:急診內科 送檢日期 時間:2009/01/29 20:03
 檢驗組別:微生物 檢 體 別:B 報告日期 時間:2009/02/03 13:33
 白血球篩檢: 檢驗結果說明:Data informed!
 收件編號:M012904781 項目英文說明:Blood culture 醫檢師:----- P/T:
 ------------------------------------------------------------------------
 細菌名稱 生長狀態 抹片檢查
 =========================================================
 1 GPC 1/2
 2 GNB 2/2
 ------------------------------------------------------------------------
 藥敏試驗______________________ 1( 濃度 )

 檢驗結果說明:Data informed!

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 Blood Culture
 姓 名:林 X X 病歷號碼:2490509 性別/出生日期:M/1945/03/21(63.874)
 病患來源:急診 病 床 號:- 採檢日期 時間:2009/02/03 04:11
 醫囑醫師:吳孟桓 科 別:急診內科 送檢日期 時間:2009/02/03 04:52
 檢驗組別:微生物 檢 體 別:B 報告日期 時間:2009/02/05 13:30
 白血球篩檢: 檢驗結果說明:Data informed!
 收件編號:M020304622 項目英文說明:Blood culture 醫檢師:----- P/T:
 ------------------------------------------------------------------------
 細菌名稱 生長狀態 抹片檢查
 ========================================================================
 1 Kleb.pneumoniae 2/2 -
 ------------------------------------------------------------------------
 藥敏試驗__________________ 1( 濃度 )
 Amoxicillin/clavulanic acid . S ,
 Amikacin . S ,
 Aztreonam____ S ______,
 Ceftazidime . S ,
 Ciprofloxacin . S ,
 Ceftriaxone____________ S ______,
 Cefuroxime . S ,
 Cefazolin . S ,
 Ertapenem_________ S ______,
 Gentamicin S ,
 Piperacillin . S ,
 Piperacillin-tazobactam_______. S ______,

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 Blood Culture
 姓 名:蕭 X X 病歷號碼:2844983 性別/出生日期:F/1929/10/16(79.287)
 病患來源:急診 病 床 號:- 採檢日期 時間:2009/01/29 17:52
 醫囑醫師:謝承諴 科 別:急診內科 送檢日期 時間:2009/01/29 20:03
 檢驗組別:微生物 檢 體 別:B 報告日期 時間:2009/02/03 13:33
 白血球篩檢: 檢驗結果說明:Data informed!
 收件編號:M012904781 項目英文說明:Blood culture 醫檢師:----- P/T:
 ------------------------------------------------------------------------
 細菌名稱 生長狀態 抹片檢查
 =========================================================
 1 Coag(-) staphylococcus 1/2 -
 ------------------------------------------------------------------------
 藥敏試驗______________________ 1( 濃度 )

 檢驗結果說明:Data informed!

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 Blood
 Blood culture
 Time
 Site
 Volume 1:5~1:10
 Bottle
 Aerobic, anaerobic
 Children
 Resin bottles
 Mycolytic bottle for
Mycobacterium and Fungi

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Blood Culture

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 Blood
 Blood culture
 Dilution factor -
1:5~1:10
 Anticoagulase – SPS
(0.025~0.3% sodium
polyanethol sulfonate)
 Bactec 9240

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BACTEC 9240
 Methodology
1. Organisms metabolic activity release CO2
2. Reactive with dye in vial sensor
3. LED, activate fluorescent material sensor
1 H+ 4. Photo detector read fluorescent
H+ 5. Raw data send to microprocessor
6. Analysis
2
7. Test results

POSITIVE
VIAL

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7
4 6
5 10
Blood Culture

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 Blood Culture
 Preliminary report
 GPC (2/2)
 GNB (2/2)

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Bacterial Identification and
Antibiotic Sensitivity Test

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Bacterial Identification and
Antibiotic Sensitivity Test
 接種1-10μl 濃度0.5
McFarland的懸浮液
(含BaSO4)，在培養基
上劃開或點上（最終
濃度為105-106
CFU/ml）。

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Bacterial Identification and
Antibiotic Sensitivity Test

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Bacterial Identification and
Antibiotic Sensitivity Test

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 Urine Culture
 姓 名:林 X X 病歷號碼:2490509 性別/出生日期:M/1945/03/21(63.874)
 病患來源:急診 病 床 號:- 採檢日期 時間:2009/02/03 07:04
 醫囑醫師:吳孟桓 科 別:急診內科 送檢日期 時間:2009/02/03 09:09
 檢驗組別:微生物 檢 體 別:U 報告日期 時間:2009/02/05 11:23
 白血球篩檢:n- 檢驗結果說明:

 收件編號:M020300061 項目英文說明:Urine culture (quantitative) 醫檢師:---

-- P/T:
 ------------------------------------------------------------------------
 細菌名稱 生長狀態 抹片檢查
 =========================================================
===============
 1 Colony count < 1000 -
 ------------------------------------------------------------------------
 藥敏試驗______________________ 1( 濃度 )

 檢驗結果說明:
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 Urine Culture
 姓 名:蕭 X X 病歷號碼:2844983 性別/出生日期:F/1929/10/16(79.287)
 病患來源:急診 病 床 號:- 採檢日期 時間:2009/01/29 18:09
 醫囑醫師:謝承諴 科 別:急診內科 送檢日期 時間:2009/01/29 22:55
 檢驗組別:微生物 檢 體 別:U 報告日期 時間:2009/01/31 14:37
 白血球篩檢:2+ 檢驗結果說明:

 收件編號:M012900171 項目英文說明:Urine culture (quantitative) 醫檢師:----- P/T:

 ------------------------------------------------------------------------
 細菌名稱 生長狀態 抹片檢查
 ========================================================================
 1 Proteus mirabilis >100000 -
 2 E.coli >100000 -
 ------------------------------------------------------------------------
 藥敏試驗______________________ 1( 濃度 ) 2( 濃度 )
 Ampicillin . R , R ,
 Amikacin . S , S ,
 Ceftazidime_________ S ______, S ______,
 Ciprofloxacin . S , S ,
 Ceftriaxone . S , S ,
 Cefuroxime_________ S ______, S ______,
 Cefazolin . S , S ,
 Ertapenem . S , S ,
 Gentamicin____________ S ______, S ______,
 Piperacillin . S , I ,
 Sufamethoxazole-Trimethoprim . S , I ,
 Piperacillin-tazobactam_______. S ______, S ______,
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 Urine Culture
 Mid-stream urine  Clean catch urine
 Catheterized urine  Foley indwelling urine

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 Urine Culture
 Middle stream urine
 Cathetered urine
 Clean catch urine
 Bag urine
 Foley indwelling urine; Foley tip - unacceptable
 @ suprapubic bladder aspiration
 @ cystoscopy, nephrostomy
 @ PCN

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Urine Culture

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Urine Culture

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 Urine Culture result
 29 CFU / 10 -3 cc (a loop) = 2.9 X 104
CFU/cc
 >100 CFU / 10 -3 cc (a loop) = > 105
CFU/cc
 < 1 CFU / 10 -3 cc (a loop) = <1000
CFU/cc
 <1 CFU / 10 -2 cc (a loop) = <100 CFU/cc

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 Urine Culture
 Bacterial Identification and Antibiotic
Sensitivity Test

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 Urine Culture

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105 CFU/ml
Stool Culture Result

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 Gastro-intestinal tract
 Rectal swab
 Stool for Salmonella and Shigella – buffer
glycerol saline
 Stool for Camylobacter – Cary-Blair
transport medium
 Stool for Vibrio – sterile tube or bottle
 Stool for Clost.difficile – AN swab

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Stool Culture

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 Stool Culture
 Bacterial Identification and Antibiotic
Sensitivity Test

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 Body Fluid Culture
 CSF, pericardial fluid, pleural effusion,
acites, peritoneal dialysis fluid, joint fluid
 Sterile tubes, sterile syringe
 Anaerobic vial
 Swab – unacceptable
 Anticoagulase - unacceptable

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Body Fluid Culture Result

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Body fluid Culture

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Body Fluid Culture
Rare light Moderate

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Heavy
Body Fluid Culture

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Enriched
 Abscess Culture Result
 姓 名:梁 X X 病歷號碼:1979487 性別/出生日期:F/1952/10/13(56.274)
 病患來源:住院 病 床 號:P13K1313A 採檢日期 時間:2009/01/21 22:30
 醫囑醫師:楊仕安 科 別:感染醫學科 送檢日期 時間:2009/01/21 22:30
 檢驗組別:微生物 檢 體 別:AB 報告日期 時間:2009/01/24 14:06
 白血球篩檢: 檢驗結果說明:

 收件編號:M012200105 項目英文說明:Abscess culture 醫檢師:----- P/T:

 ------------------------------------------------------------------------
 細菌名稱 生長狀態 抹片檢查
 ========================================================================
 1 Kleb.pneumoniae Rare -
 ------------------------------------------------------------------------
 藥敏試驗______________________ 1( 濃度 )
 Amoxicillin/clavulanic acid . S ,
 Amikacin .S ,
 Aztreonam_____________________. S ______,
 Ceftazidime .S ,
 Ciprofloxacin .S ,
 Ceftriaxone___________________. S ______,
 Cefuroxime .S ,
 Cefazolin .S ,
 Ertapenem_____________________. S ______,
 Gentamicin .S ,
 Piperacillin .S ,
 Piperacillin-tazobactam_______. S ______,
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 檢驗結果說明:
Abscess Culture

？
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Abscess Culture
Rare light Moderate

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Heavy
Abscess Culture

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Enriched
 Wound or Pus Culture Result
 姓 名:張 X X 病歷號碼:3249598 性別/出生日期:M/1968/04/13(40.803)
 病患來源:住院 病 床 號:P13K1318C 採檢日期 時間:2009/01/31 22:35
 醫囑醫師:張鴻鈞 科 別:感染醫學科 送檢日期 時間:2009/01/31 22:35
 檢驗組別:微生物 檢 體 別:WD 報告日期 時間:2009/02/03 15:11
 白血球篩檢: 檢驗結果說明:

 收件編號:M020100107 項目英文說明:Wound culture 醫檢師:----- P/T:

 ------------------------------------------------------------------------
 細菌名稱 生長狀態 抹片檢查
 ========================================================================
 1 Proteus vulgaris Light -
 2 Viridans streptococcus Moderate -
 ------------------------------------------------------------------------
 藥敏試驗______________________ 1( 濃度 ) 2( 濃度 )
 Ampicillin . ,S ,
 Amoxicillin/clavulanic acid . S , ,
 Amikacin______________________. S ______, ______,
 Aztreonam .S , ,
 Ceftazidime .S , ,
 Clindamycin___________________. ______, S ______,
 Ciprofloxacin .S , ,
 Ceftriaxone .S ,S ,
 Cefuroxime____________________. R ______, ______,
 Cefazolin .R , ,
 Erythromycin . ,S ,
 Ertapenem_____________________. S ______, ______,
 Gentamicin .S , ,
 Penicillin . ,S ,
 Piperacillin__________________. S ______, ______,
 Teicoplanin . ,S ,
 Piperacillin-tazobactam .S , ,
 Vancomycin____________________. ______, S ______, 39

 檢驗結果說明:
Pus Culture

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Pus Culture

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Pus Culture
Rare light Moderate

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Heavy
Pus Culture

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Enriched
 Sputum Culture Result
 姓 名:黃 X X 病歷號碼:2625445 性別/出生日期:F/1941/04/03(67.778)
 病患來源:住院 病 床 號:P13K1315C 採檢日期 時間:2009/01/12 19:14
 醫囑醫師:蔡之祐 科 別:肺感染及免疫 送檢日期 時間:2009/01/12 19:14
 檢驗組別:微生物 檢 體 別:SP 報告日期 時間:2009/01/14 15:03
 白血球篩檢:2+ 檢驗結果說明:

 收件編號:M011200268 項目英文說明:Sputum culture 醫檢師:----- P/T:

 ------------------------------------------------------------------------
 細菌名稱 生長狀態 抹片檢查
 ========================================================================
 1 Staph.aureus Moderate -
 ------------------------------------------------------------------------
 藥敏試驗______________________ 1( 濃度 )
 Clindamycin .R ,
 Erythromycin .R ,
 Fusidic acid__________________. S ______,
 Linezolid .S ,
 Oxacillin .R ,
 Penicillin____________________. R ______,
 Sufamethoxazole-Trimethoprim . R ,
 Teicoplanin .S ,
 Tigecycline___________________. S ______,
 Vancomycin .S ,

 檢驗結果說明:
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Sputum Culture

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 CVP tip

15 colony / plate

means clinical
significant

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CVP Tip Culture Result

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 Gram stain
 Bacteria and Fungus  Neutrophil (WBC)
 R : <1 /OPF  R : <25 / LPF
 + : 1~5 / OPF  + : >25 / LPF
 2+ : 5~100 / OPF  2+ : 20~60 /OPF
 3+ : >100 / OPF  3+ : >60 /OPF

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 Acid fast stain
 Acid fast stain
 actual no. : 1~3 AFB / 300 OPF
 + : 1~9 AFB /100 OPF
 2+ : 1~9 AFB / 10 OPF
 3+ : 1~9 AFB / OPF

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 Respiratory tract
 Specimen
 Deep cough sputum – the first cough in the
morning, smear
 Brochial washing
 @ Transtracheal aspiration
 @ Double sheath - >1000
 @ Brochoalveolar lavarge - > 10000
 @ open lung biopsy
 @ suitable for anaerobic culture

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Thank You
For Your
Attention!

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Abscess Culture

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Abscess Culture

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 Blood
 Blood culture
 Time
 Site
 Volume 1:5~1:10
 Bottle
 Aerobic, anaerobic
 Children
 Resin bottles
 Mycolytic bottle for
Mycobacterium and Fungi

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