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Bacteriology > Diagnostic process > Flashcards

Diagnostic process Flashcards

1
Q

Steps of diagnostic process

A
  1. Patient assessment
  2. Pre-analytical
  3. Analytical
  4. Post-analytical
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2
Q

Patient assessment

A

-Problem oriented approach
-integration of history, presentation, physical exam findings and lab data

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3
Q

Pre analytical

A
  1. specimens selected and collected
  2. Lab provided with all relevant info
  3. sampled shipped to lab
  4. Lab decides on appropriate tests
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4
Q

Analytical

A

1.Direct exam of specimens
2.Preliminary report which can be compared with patient info
3. Sample processing
4. Primary set of results (ex. culture) recorded
5.Secondary tests selected and conducted

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5
Q

Post-analytical

A
  1. Final lab results and report by diagnostician
    2.Interpretation of report by vet

**leads back to patient assessment and DIAGNOSIS

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6
Q

Principles of sampling

A
  1. Obtain sample from site of infection; minimize contamination
    >culture margins of abscess and collect urine by cystocentesis
  2. Collect sample at correct time
    >shedding stage of pathogen
  3. Collect a sufficient quantity of sample
    >Ask the lab what they need!
  4. Use appropriate collection device
    >sample must be sterile
    >use contained designed for sampling
  5. Handle/store sample appropriately
    >can sample be frozen? Special transport media needed?
  6. Obtain cultures before administering antibiotics
    >otherwise cannot interpret a negative test

7.Make smears in addition to cultures
>can be done in house; gram stains!

  1. Label everything!!
  2. Dont put anyone in danger! Is it a zoonosis?
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7
Q

Most common injury during diagnostic process

A

Needlestick injuries
-can lead to tendon sheath infections=amputations or other infections

*dont recap needles, dispose sharps after use in sharps container,

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8
Q

What would lab use to detect bacteria?

A

culture

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9
Q

What would lab use to detect parasite related structures?

A

microscopy

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10
Q

What would lab use to detect DNA/RNA?

A

PCR

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11
Q

What would lab use to detect antibody or antigen?

A

ELISA

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12
Q

What would lab use to detect tissue structures?

A

-histological examination

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13
Q

What would lab use to detect differential cell counts?

A

Blood

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14
Q

What would lab need for biochemical analysis?

A

blood or urine

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15
Q

To freeze or not to freeze?

A

**Always check with lab

-for bacteriological/mycological culture= don’t freeze
- non-propagative tests= freezing possible
-can freeze milk
-can freeze samples to be tested for L. monocytogenes

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16
Q

Common labs in Western canada

A
  1. Diagnostic services in UCVM calgary
  2. True North Vet diagnostics- Langley; private
    3.Animal Health Branch Abbotsford
  3. Prairie Diagnostic services in Sask
  4. Veterinary Diagnostic Services
  5. IDEXX
17
Q

Shipping samples safely

A

-shipping regulations depend on what you’re sending
-In general:
>water tight primary container
>Absorbant material
>watertight secondary container
>sturdy outer packaging

18
Q

Sample processing conducted by the lab

A

1.Sample received
2.Sample processed in biosafety cabinet (where sample smears can be made/stained to provide preliminary report)
3. Incubation 18-24 hrs
4. Any bacteria grown identified
5. Antimicrobial susceptibility testing (AST)
6. AST incubation
7.Final report

19
Q

Susceptibility testing

A

-conducted to determine the therapeutic guidance required for veterinarian to treat patient

**basically help determine the most appropriate antimicrobial for the issue at hand

20
Q

Susceptible vs. resistant

A

Susceptible: high likelihood of clinical success if an organism is susceptible to drug

Resistant: clinical failure is predicted if an organism is resistant to drug

21
Q

Divisions of resistance

A
  1. Intrinsic resistance
  2. Acquired resistance
22
Q

Intrinsic resistance

A

-constitutive
-naturally resistant to a drug. No acquisition to the drug, but instead it is natural for the bacterial species

23
Q

Acquired resistance

A

-not inherent to the organism
-“superbugs”; have a gene or mutation which differentiates from the wild-type making a drug that is normally used no longer effective

24
Q

SPICE organisms

A

Serratia
Providentia
Indole positive Proteae
Citrobacter
Enterobacter

25
Q

What resistance do SPICE organisms have?

A

They produce AmpC beta-lactamases resulting in cephalosporin resistance

26
Q

Types of susceptibility test methods

A

1.Categorical methods- tells you whether organism is susceptible or resistant

  1. Quantitative methods- yields a minimum inhibitory concentration describing exactly how susceptible or resistant an organism is
27
Q

Minimum inhibitory concentration

A

the lowest concentration of a drug inhibiting bacterial growth

*represented as a number on a doubling scale

28
Q

Categorical susceptibility test example

A

Kirby-Bauer (disks)

29
Q

Quantitative susceptibility tests

A

-Gradient strips (E-tests)

-Agar dilution

-Broth dilution

30
Q

Interpretation of susceptibility tests

A

-use standardized interpretive criteria
>Will say “less than # = resistance”

31
Q

What factors are used to make up interpretations for susceptibility tests?

A

-Definitions based on species, indication (issue), drug, dosing regimen.

Changing the typical use of a drug (adjusting any factors) will reduce the interpretation power of the susceptibility tests

32
Q

Sensitivity vs. specificity

A

Sensitivity: Few false negatives so less cases of disease missed

Specificity: Few false positives. Ability to ensure that negative individuals are considered negative for disease

33
Q

Postive vs. negative predictive value

A

Positive predictive value: reflects the proportion of subjects that are positive for disease who actually have the disease

Negative predictive value: reflects the proportion of subjects with negative test result who truly do not have outcome of interest/disease

Bacteriology (20 decks)

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