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Blood Cultures Flashcards

1
Q

Obj. 1: Define the following terms: bacteremia, fungemia, viremia, pseudobacteremia

A

Bacteremia: presence of bacteria in the blood
Fungemia: presence of fungi in the blood
Viremia: presence of a virus in the blood
Pseudobacteremia: presence of bacteria in the blood from contamination during collection

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2
Q

Obj. 1: Define the following terms: septicemia

A

Septicemia: multiplying organisms in the bloodstream plus the presence of symptoms

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3
Q

Obj. 1: Define the following terms: SIRS (Systemic Inflammatory Response Syndrome)

A

SIRS (Systemic Inflammatory Response Syndrome): criteria for the designation of SIRS requires at least two (2) of these —
- Temperature
- Heart Rate
- Respiratory rate
- WBC count

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4
Q

Obj. 1: Define the following terms: sepsis

A

Sepsis: dysregulation of the host response to an infection accompanied by organ dysfunction

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5
Q

Obj. 1: Define the following terms: septic shock

A

Septic shock: sepsis plus cardiovascular dysfunction

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6
Q

Obj. 1: Define the following terms: endocarditis

A

Endocarditis: inflammation of the heart due to a bacterial infection

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7
Q

Obj. 1: Define the following terms: Disseminated intravascular coagulation (DIC)

A

Disseminated intravascular coagulation (DIC): abnormal blood clotting throughout the body’s blood vessels

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8
Q

Obj. 2: List common symptoms associated with possible septicemia

A
  • Fever
  • Chills
  • Tachycardia
  • Hyperventilation
  • Toxicity
  • Prostration
  • Mental confusion
  • Dizziness
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9
Q

Obj. 3: List five (5) risk factors associated with bacteremia

A
  1. Age of the patient
  2. Increased use of invasive procedures
  3. Antimicrobial resistance
  4. Diagnostic criteria and coding practices
  5. Decreased immune competency of certain patient
    populations
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10
Q

Obj. 4: Classify bacteremia by its site of origin (primary and secondary bacteremia)

A

Primary bacteremia: intravascular
Secondary bacteremia: extravascular

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11
Q

Obj. 5: Classify bacteremia by the duration of the bacteremic episode (transient, intermittent, continuous)

A

Transient: “passing through,” occurs when bacteria enter the blood after manipulation of tissue with normal flora

Intermittent: infected site sporadically releasing bacteria into the blood (“seeding”)

Continuous: intravascular source and are consistently present in the bloodstream

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12
Q

Obj. 6: Discuss situations that may result in transient, intermittent, continuous, primary, and secondary bacteremia

A

Transient: dental work, endoscopy
Intermittent: abscess
Continuous: biofilm on infected IV catheter

Primary: infected cardiac valve, infected IV catheter
Secondary: abscess, pneumonia patients, UTI

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13
Q

Obj. 7: Discuss the expected lab test results for patients with septicemia for the following tests: Platelet count, coagulation tests, WBC count, lactate, blood glucose, CRP, and PCT (Procalcitonin)

A

Plt. count: decreased
Coag tests: High PTT and PT
WBC count: increased (can be decreased)
Lactate: increased
Glucose: increased or decreased
CRP: increased
PCT: increased

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14
Q

Obj. 8: Recognize that one blood culture “set” consists of two (2) blood culture bottles (aerobic and anaerobic)

A

Recognize that one blood culture “set” consists of two (2) blood culture bottles (aerobic and anaerobic)

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15
Q

Obj. 9: Describe the purpose of sodium polyanetholsulfonate (SPS) and resins (ARD antimicrobial removal devices)

A

Sodium Polyanetholsulfonate (SPS): anticoagulant
Resins: binds antimicrobials

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16
Q

Obj. 10: Discuss the proper method of collecting (including sterile collection, recommended maximum number of sets, timing of collection, amount of blood, and what to do if an IV is present, patient is receiving antimicrobials, or spiking a fever) a blood specimen for bacteriologic culture

Obj. 11: Correlate the number, timing, ratio of patient blood to culture broth, and volume of specimens with optimal recovery of organisms for meaningful clinical use

A

Sterile collection
- Clean skin w/ isopropyl alcohol
- Follow with iodine/Chlorhexidine in circles
- Remove residue with alcohol pad
Recommended maximum number of sets
- 3 culture sets within 24 hours
Timing of collection
- Acute: multiple cultures in the first 6-12 hours
- Chronic: 2-3 cultures per day for 3-4 days
Amount of blood
- Blood to medium ratio: 1:10
- Pediatric venipuncture: 2-6 mL (BLC: 1-3 mL)
- Adult venipuncture: 16-20 mL (BLC: 8-10 mL)
What to do if an IV is present
- If both arms have IV sites, draw below IV
Patient is receiving antimicrobials
- Collect cultures before antimicrobial therapy
Spiking a fever
- Collect before fever spike

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17
Q

Obj. 12: Discuss the proper method for transporting and incubating a blood specimen for bacteriologic culture

A

Transport to lab at room temperature ASAP; if delayed, can be held at room temp for 48 hours
Incubate 35 +/- 2 deg. C for 5-7 days ambient air

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18
Q

Obj. 13: Describe the proper blood culture procedure for possible brucellosis [include the Bactec FX and manual biphasic media (Ruiz Casteneda) in your answer]

A

Bactec FX
- Incubate for 14 days
Manual biphasic media (Ruiz Casteneda)
- Incubate 35 +/- 2 deg. C for 6 weeks and terminally subculture

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19
Q

Obj. 14: Discuss the basic principles of the Wampole (DuPont Isolator) Lysis Centrifugation Method

A

RBCs and WBCs are lysed to release fungi and intracellular pathogens — centrifuge and plate sediment/pellet

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20
Q

Obj. 30: Evaluate a Gram stained smear of a blood culture bottle to determine the likely organism(s)

A

Actinomyces

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21
Q

Obj. 31: Correlate the image with a clinical scenario(s)

Recognize which is a common contaminant

A

Actinomyces

  • Tissue necrosis and dissemination to brain
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22
Q

Obj. 30: Evaluate a Gram stained smear of a blood culture bottle to determine the likely organism(s)

A

Actinomyces

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23
Q

Obj. 31: Correlate the image with a clinical scenario(s)

Recognize which is a common contaminant

A

Actinomyces

  • Tissue necrosis and dissemination to brain
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24
Q

Obj. 30: Evaluate a Gram stained smear of a blood culture bottle to determine the likely organism(s)

A

Actinomyces

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25
Q

Obj. 31: Correlate the image with a clinical scenario(s)

Recognize which is a common contaminant

A

Actinomyces

  • Tissue necrosis and dissemination to brain
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26
Q

Obj. 30: Evaluate a Gram stained smear of a blood culture bottle to determine the likely organism(s)

A

Bacillus (GP and decolorized)

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27
Q

Obj. 31: Correlate the image with a clinical scenario(s)

Recognize which is a common contaminant

A

Bacillus (GP and decolorized)
COMMON CONTAMINANT!

  • Anthrax
  • Food poisoning (meat, chicken, fried rice, etc.)
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28
Q

Obj. 30: Evaluate a Gram stained smear of a blood culture bottle to determine the likely organism(s)

A

Bacillus

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29
Q

Obj. 31: Correlate the image with a clinical scenario(s)

Recognize which is a common contaminant

A

Bacillus
COMMON CONTAMINANT!

  • Anthrax
  • Food poisoning (meat, chicken, fried rice, etc.)
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30
Q

Obj. 30: Evaluate a Gram stained smear of a blood culture bottle to determine the likely organism(s)

A

Bacteroides fragilis (pleomorphic)

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31
Q

Obj. 30: Evaluate a Gram stained smear of a blood culture bottle to determine the likely organism(s)

A

Bacteroides fragilis (vacoulated)

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32
Q

Obj. 30: Evaluate a Gram stained smear of a blood culture bottle to determine the likely organism(s)

A

Campylobacter

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33
Q

Obj. 30: Evaluate a Gram stained smear of a blood culture bottle to determine the likely organism(s)

A

Campylobacter

  • Diarrhea
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34
Q

Obj. 30: Evaluate a Gram stained smear of a blood culture bottle to determine the likely organism(s)

A

Clostridium clostridioforme (GNR) [top]
Clostridium perfringens (GPR) [bottom]

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35
Q

Obj. 31: Correlate the image with a clinical scenario(s)

Recognize which is a common contaminant

A

Clostridium clostridioforme (GNR) [top]
Clostridium perfringens (GPR) [bottom]

  • C. perfringens
    • Gas gangrene
36
Q

Obj. 30: Evaluate a Gram stained smear of a blood culture bottle to determine the likely organism(s)

A

Corynebacterium spp.

37
Q

Obj. 31: Correlate the image with a clinical scenario(s)

Recognize which is a common contaminant

A

Corynebacterium spp.
COMMON CONTAMINANT!
- Diphtheria

38
Q

Obj. 30: Evaluate a Gram stained smear of a blood culture bottle to determine the likely organism(s)

A

Enterococcus

39
Q

Obj. 31: Correlate the image with a clinical scenario(s)

Recognize which is a common contaminant

A

Enterococcus

  • Acute endocarditis
  • GI perforation
  • Infected IV catheter
40
Q

Obj. 30: Evaluate a Gram stained smear of a blood culture bottle to determine the likely organism(s)

A

Streptococcus mitis

41
Q

Obj. 30: Evaluate a Gram stained smear of a blood culture bottle to determine the likely organism(s)

A

Fusobacterium nucleatum

42
Q

Obj. 31: Correlate the image with a clinical scenario(s)

Recognize which is a common contaminant

A

Fusobacterium nucleatum

  • Assoc. with infections of mouth (human bites, lung abscesses, pleural cavity, brain abscess)
43
Q

Obj. 30: Evaluate a Gram stained smear of a blood culture bottle to determine the likely organism(s)

A

Fusobacterium mortiferum

44
Q

Obj. 31: Correlate the image with a clinical scenario(s)

Recognize which is a common contaminant

A

Fusobacterium mortiferum

  • Assoc. with infections of mouth (human bites, lung abscesses, pleural cavity, brain abscess)
45
Q

Obj. 15: Discuss the organisms that are best isolated from the lysis centrifugation

A
  • Bartonella
  • Yeast/fungi
  • Mycobacteria
46
Q

Obj. 16: Define continuous monitoring blood culture systems

A

Blood culture systems that continuously monitor blood culture bottles for growth of organisms

47
Q

Obj.17: Discuss the basic principles of the BACTEC systems

A
  • As organisms grow in the blood culture bottles, they release CO2
  • A dye in the sensor of the bottom of the bottle reacts with the increased CO2 and releases a fluorescent signal
  • A photo detector measures the fluorescence and will alarm if it surpasses a certain parameter
48
Q

Obj. 18: Briefly discuss the principles of the VersaTREK and BacT/ALERT systems

A

VersaTREK: Detects changes in the air pressure above the blood culture bottle
BacT/ALERT: Detects changes in pH due to release of CO2

49
Q

Obj. 19: What steps should be taken after the BACTEC indicates a blood culture bottle is positive

A
  1. Prepare and exam gram stain from blood culture bottle
  2. CALL THE PHYSICIAN!
  3. Based on GS, set up appropriate culture media, biochemicals, rapid testing
50
Q

Obj. 20: Discuss the advantages of methanol fixation vs. heat fixation for direct smear GS

A

Methanol fixation keeps the cell morphology intact

51
Q

Obj. 21: Determine which media should be set up on ALL positive blood cultures

A
  • BAP, CHOC, AnaBAP
52
Q

Obj. 30: Evaluate a Gram stained smear of a blood culture bottle to determine the likely organism(s)

A

Klebsiella pneumoniae

53
Q

Obj. 31: Correlate the image with a clinical scenario(s)

Recognize which is a common contaminant

A

Klebsiella pneumoniae

  • Pneumonia
54
Q

Obj. 30: Evaluate a Gram stained smear of a blood culture bottle to determine the likely organism(s)

A

Lactobacillus

55
Q

Obj. 31: Correlate the image with a clinical scenario(s)

Recognize which is a common contaminant

A

Lactobacillus

  • Prevents colonization/overgrowth of pathogens/normal flora
56
Q

Obj. 30: Evaluate a Gram stained smear of a blood culture bottle to determine the likely organism(s)

A

Listeria monocytogenes

57
Q

Obj. 31: Correlate the image with a clinical scenario(s)

Recognize which is a common contaminant

A

Listeria monocytogenes

  • Listerosis: pkg. lunch meats, hot dogs, dairy products; pregnant women - stillborns, spontaneous abortions
58
Q

Obj. 30: Evaluate a Gram stained smear of a blood culture bottle to determine the likely organism(s)

A

Propionibacterium acnes

59
Q

Obj. 31: Correlate the image with a clinical scenario(s)

Recognize which is a common contaminant

A

Propionibacterium acnes
COMMON CONTAMINANT!
- CNS shunt infection
- Prosthetic joint infection

60
Q

Obj. 30: Evaluate a Gram stained smear of a blood culture bottle to determine the likely organism(s)

A

Staphylococcus aureus

61
Q

Obj. 31: Correlate the image with a clinical scenario(s)

Recognize which is a common contaminant

A

Staphylococcus aureus

  • Pneumonia
  • Acute endocarditis
  • Infected IV Catheters
62
Q

Obj. 30: Evaluate a Gram stained smear of a blood culture bottle to determine the likely organism(s)

A

Streptococcus pneumoniae (GP)

63
Q

Obj. 31: Correlate the image with a clinical scenario(s)

Recognize which is a common contaminant

A

Streptococcus pneumoniae (GP)

  • Community acquired pneumonia
  • Acute endocarditis
  • Meningitis
64
Q

Obj. 30: Evaluate a Gram stained smear of a blood culture bottle to determine the likely organism(s)

A

Streptococcus pneumoniae (GP and decolorized)

65
Q

Obj. 31: Correlate the image with a clinical scenario(s)

Recognize which is a common contaminant

A

Streptococcus pneumoniae (GP and decolorized)

  • Community acquired pneumonia
  • Acute endocarditis
  • Meningitis
66
Q

Obj. 30: Evaluate a Gram stained smear of a blood culture bottle to determine the likely organism(s)

A

Vibrio vulnificus

67
Q

Obj. 31: Correlate the image with a clinical scenario(s)

Recognize which is a common contaminant

A

Vibrio vulnificus

Consumption of contaminated seafood (raw oysters)

68
Q

Obj. 22: Outline the algorithm for identifying organisms from a positive blood culture, including: GS specific preliminary testing (biochemicals/direct molecular techniques), confirmation testing, and susceptibility reporting

69
Q

Obj. 23: Summarize how the use of rapid molecular testing, such as the BioFire FilmArray BCID Panel can improve patient outcomes

A

Simultaneous detection and identification of bacteria and resistance markers allowing a decrease in TAT for targeted therapy

70
Q

Obj. 24: Briefly discuss the basic principles of PNA FISH, Verigene, MALDI-TOF with sepsityper, and GeneXpert MRSA testing

A

Verigene: PCR — gram stain dependent
PNA FISH: Fluorescent in-situ Hybridization — detection of yeast strains
MALDI-TOF w/ sepsityper: lysing, washing, and centrifugation steps to perform directly on sample for ID
GeneXpert MRSA: Real-time PCR for MRSA/SA

71
Q

Obj. 25: Correlate the most common organism(s) involved in septicemia with associated underlying diseases:
- Bacterial pneumonia

A
  • Streptococcus pneumoniae
  • S. aureus
  • PSA
  • Klebsiella spp.
  • Enterobacter spp.
72
Q

Obj. 25: Correlate the most common organism(s) involved in septicemia with associated underlying diseases:
- Acute endocarditis

A
  • S. aureus
  • Enterococcus spp.
  • Streptococcus pneumoniae
73
Q

Obj. 25: Correlate the most common organism(s) involved in septicemia with associated underlying diseases:
- Subacute endocarditis

A
  • Coag. Neg. Staphylococcus
  • Viridans Streptococcus
  • Abiotrophia spp./Granulicatella
74
Q

Obj. 25: Correlate the most common organism(s) involved in septicemia with associated underlying diseases:
- GI cancer

A
  • Clostridium septicum
  • Group D Streptococcus (S. bovis)
75
Q

Obj. 25: Correlate the most common organism(s) involved in septicemia with associated underlying diseases:
- GI perforations

A
  • E. coli
  • Enterococcus spp.
  • Anaerobes
    • Bacteroides fragilis grp.
    • Fusobacterium spp.
    • Clostridium spp.
76
Q

Obj. 25: Correlate the most common organism(s) involved in septicemia with associated underlying diseases:
- UTI

77
Q

Obj. 25: Correlate the most common organism(s) involved in septicemia with associated underlying diseases:
- Tooth abscess

A
  • Mouth flora
78
Q

Obj. 25: Correlate the most common organism(s) involved in septicemia with associated underlying diseases:
- Meningitis

A
  • Neiseseria meningitis
  • Streptococcus pneumoniae
79
Q

Obj. 25: Correlate the most common organism(s) involved in septicemia with associated underlying diseases:
- Intravascular catheter

A
  • Skin flora (CoNS, P. acnes)
  • S. aureus
  • Enterococcus spp.
80
Q

Obj. 26: List Gram positive and Gram negative organisms that may be observed on a Gram stained smear from a blood culture bottle but would NOT grow on SBA and, with some organisms, not on CHOC

A
  • Haemophilus
  • Camplyobacter
  • Abiotrophia spp./Granulicatella
81
Q

Obj. 27: Identify (by image or name) the most common contaminants found in blood cultures

A
  • Coag Neg Staph
  • Corynebacterium spp.
  • P. acnes
  • Viridans Strep.
  • Micrococcus
  • Bacillus spp. (environmental contaminant)
82
Q

Obj. 28: Recommend approaches that could be used to determine whether an isolate is a skin contaminant or a pathogen

A
  • Is it skin flora?
  • Is it only in one bottle (requires multiple draws)?
  • Delayed growth?
83
Q

Review Question: Once the initial Gram stain is read, the technologist should call the doctor. Then, any further plates and tests should be set up. What media and additional biochemical should be set up based on the following Gram stains?
- GPC in clusters

A

SBA, CHOC, ABAP, BioFire, Coagulase tube

84
Q

Review Question: Once the initial Gram stain is read, the technologist should call the doctor. Then, any further plates and tests should be set up. What media and additional biochemical should be set up based on the following Gram stains?
- GPC in chains

A

SBA, CHOC, ABAP, BioFire, Bile Esculin, NaCl broth, Opt disk

85
Q

Review Question: Once the initial Gram stain is read, the technologist should call the doctor. Then, any further plates and tests should be set up. What media and additional biochemical should be set up based on the following Gram stains?
- GNR

A

SBA, CHOC, MAC, CNA, ABAP, BioFire

86
Q

Review Question: Once the initial Gram stain is read, the technologist should call the doctor. Then, any further plates and tests should be set up. What media and additional biochemical should be set up based on the following Gram stains?
- GPC

A

SBA, CHOC, ABAP, BioFire
(If resembles lactobacillus → TJ plate) (If resembles Bacillus → PEA)

IUMICRO (25 decks)

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