Respiratory Culture/Eye Cultures

Question 1

What bacterial agents cause eye infections?

Answer 1

H. flu
S. aureus
S. pnuemoniea
P. aeruginosa
B. cereus
Newborns: N. gonorrhoea, Chlamydia

Question 2

What are the three most likely specimen collections you will do for an eye?

Answer 2

1. purulent conjunctivitis
2. corneal infections
3. intraocular fluid

Question 3

What do you want to do to the skin around the eye before you culture it?

Answer 3

mild antiseptic

Question 4

specimen collection: purulent conjunctivitis

Answer 4

1. collect purulent material with cultuerette

2. place swab into sleeve and transport at ambient temp

Question 5

specimen collection: corneal infections

Answer 5

1. swab and collect MULTIPLE corneal scrapings
2. place onto agar
3. transport at ambient temp, or 2-8 degrees viral cultures

Question 6

specimen collection: intraocular fluid

Answer 6

1. collect fluid by needle aspiration

2. transport at ambient temp, or 2-8 degrees viral cultures

Question 7

Lab processing

Answer 7

if specimen allows, direct specimen gram stain performed

routine bacterial culture (examine at 24-48 hours)
susceptibility

Question 8

What are the LRTI we worry about?

Answer 8

Bronchitis/Bronchiolitis
Pneumonia
Empyema

Question 9

What are the routes of infections for LRTI?

Answer 9

inhaled, aspiration of oral or gastric contents, hematogenous spread, hand to mouth, viral illness

Question 10

What is the function of the normal respiratory flora?

Answer 10

It is isolated from the host in the absence of the disease.

1. protects from infection, 2. prevents the proliferation of organisms 3. balance of organisms maintained

Question 11

What are anatomy examples of normal flora?

Answer 11

nasal hairs, mucociliary hairs, coughing

Question 12

what are abnormal host defense mechanisms

Answer 12

1. immunocompromised 2. reduced clearance of secretions 3. structural abnormalities 4. smoking 5. empirical antibacterial therapy that reduces normal flora

Question 13

What are the main lower respiratory tract specimens?

Answer 13

1. sputum (expectorated through the mouth, contaminated)
2. tracheal aspirate (suctioned from ET tube or tracheostomy)
3. bronchial aveolar lavage (bronchial brushings and washings are collected, limited contamination)

Question 14

Describe the sputum collection procedure

Answer 14

1. have patient rinse out mouth
2. have patient take slow deep breaths to expectorate a sputum sample into container
3. It needs to be examined to make sure it contains at least 1 mL of THICK MUCUOUS (ohhh how lovely)
4. send to lab. if suspect >1hr delay, then refrigde.

Question 15

Describe tracheal aspirate collection

Answer 15

1. hyperventilate the patient and gently insert the catheter into trachea
2. apply suction for about 5-10 seconds, collecting 2-10mL
3. send to lab. if suspect >1hr delay, then refrigerate.

Question 16

What is the eval for respiratory tract specimen?

Answer 16

1. gram stain first
2. sputum : if there are too many squamous epithelial cells that means there is too much saliva)
3. tracheal aspirate: if no organisms seen on gram stain, culture not warranted.

Question 17

How can you tell if your sputum has bee containminated?

Answer 17

> 25 epithelial cells/LPF

If there are less than 25 cells then you can proceed to a culture set up.

Question 18

How can you tell if you have a good sputum sample?

Answer 18

it will contain many PMNs in a person with a usually “normal” immune system.