Clinical Laboratory Information
Message from Dr. Henry D. Slosser on Testing of Uncommon Organisms (updated 3-9-2015)
To ensure quality patient care, uncommon organisms which are not routinely identified and tested for susceptibility will be sent immediately to a referral lab. The ordering physician will be notified of the isolate being sent out along with an expected turn-around time for results.
We describe here a recent case which supports our hospital’s laboratory policy on the testing of uncommon organisms.
SV is a morbidly obese 62 year old female who presented with sepsis secondary to possible community-acquired pneumonia and left lower extremity cellulitis. Two sets of blood cultures grew gram positive bacilli which was later identified as Corynebacteriumamycolatum/striatum and initially reported to be sensitive to penicillin but subsequently changed to resistant to penicillin upon further evaluation of results. Concerns regarding the penicillin susceptibility results prompted a request for repeat speciation and susceptibility testing to be performed at a referral laboratory. Results were available after 3 and 5 days respectively. In contrast to in-house results, the species identified at the referral laboratory was Corynebacterium striatum/simulans with a higher level of resistance to penicillin and ceftriaxone than was reported in-house.
Corynebacterium spp. is a common colonizer of the skin and mucous membranes and rarely causes invasive infection. Thus, speciation of the organism and susceptibility testing is not routinely performed in house. The discrepancy in speciation and susceptibility results between the in-house laboratory and the referral laboratory illustrated in this case has the potential to negatively affect treatment outcome. Thus, our current policy of sending test requests for uncommon organisms immediately to a referral laboratory helps to ensure timely reporting of reliable results to guide appropriate treatment decisions.
Message from Dr. Henry D. Slosser on ordering Ketones (updated 1-15-2013)
Due to the continuing nation-wide production problems with the Acetest tablets used for ketone body testing, we are again unable to perform the test. In order to provide a test that measures ketones, we will temporarily send the specimens to ARUP for quantitative beta-hydroxybutyric acid testing.
What will not change:
- Specimen requirements
- How you place the order for ketones
What will change:
- The order for ketones will be mapped to beta-hydroxybutyric acid, and sent to ARUP.
- Turn-around time will be 1-3 days.
- To view results in EMR, you’ll need to access the Chemistry group of Laboratory Tests, and select Beta-Hydroxybutyric Acid. The reports will include an explanatory comment.
You also have to option of ordering beta-hydroxybutyric acid directly.
If you have any questions or concerns, please contact Karen Watkins (Manager, Clinical Laboratory, x5780), or Kiem Injo (Hematology Lead CLS, x5720).
Bone Marrow Microbiology Culture (Updated 11-28-2011)
For consideration of bacterial, fungal or mycobacterial cultures, bone marrow will be processed as “blood” and placed into the Bactec blood culture vials. The blood cultures vials will support the growth and detection of most entities that could be associated with infection in bone marrow (Brucella, Cryptococcus neoformans, Histoplasma capsulatum, and mycobacteria.)
Requesting a bone marrow culture without specific indication is discouraged.