Pediatric patient data collected in 2004 from three continents (North America, South America, and Europe) indicated that Klebsiella spp. Incubation time of mycobacterial cultures: how long is long enough to issue a final negative report to the clinician? Time course of fetal tissue invasion by Listeria monocytogenes following an oral inoculation in pregnant guinea pigs. In the clinical laboratory, infrequency and lack of familiarity with Brucella species is a risk factor, especially if relevant clinical information does not accompany the sample. In addition, taxonomy and phylogeny describe interactions between the organisms themselves, whereas epidemiology describes interactions between the organisms, their hosts, and the surrounding environment. With iodophors, the bactericidal effect depends on the content of available iodine as well as on the presence of organic matter. Limited numbers of bacteria were examined, and in nondiseased subjects, aerobic and anaerobic Grampositive organisms predominated. Both taxa are minimally reactive biochemically, are motile only if the hanging drop method is used, and are catalase positive but oxidase negative. Severe hepatotoxicity following ingestion of Herbalife nutritional supplements contaminated with Bacillus subtilis. While the test has not been evaluated lately, an older study confirmed its high sensitivity and specificity (109). The protein responsible for hemolysis, named pyolysin, is also an important virulence factor in vivo. Females (69%) and the elderly (median age, 70 years) were at the highest risk of infection, and the most common specimen sources were urine (86%), soft tissues (7%), blood (3%), miscellaneous fluids (2%), and the respiratory tract (2%). Detection of antibodies directed against any of the bacteria discussed in this chapter has been tried on a small scale only and does not seem to offer much value. Bipolar staining, however, is not a unique feature of Yersinia species and may not always be evident. The medium contains tryptose, digest of soybean meal, yeast extract, ferric ammonium citrate, sodium sulfite, egg yolk emulsion, kanamycin, and polymyxin sulfate. The higher sensitivity (>98 to 100%) of the third-generation tests has reduced their specificity (72 to 99%). Aerial Hyphae Aerial hyphae project away from the surface of the colony into the air but may not be apparent until 7 to 14 days for some species that form such hyphae. Screening for Staphylococcus aureus carriage in pregnancy: usefulness of novel sampling and culture strategies. In comparison, alcoholic sprays have little antimicrobial effect and produce potentially explosive vapors (106). The early form is presumably caused by intrauterine infection and manifests as granulomatosis infantisepticum. Decontamination, Disinfection, and Sterilization n tive efficacy of alternative hand-washing agents in reducing nosocomial infections in intensive care units. Molecular characterization of carbapenem-resistant Acinetobacter species in an Irish university hospital: predominance of Acinetobacter genomic species 3. Two cases of Chromobacterium violaceum infection after injury in a subtropical region. The emergence and increased use of a plethora of cultureindependent diagnostic tests (250, 251) in clinical laboratories in the last few years has resulted in decreased availability of cultures for further characterization in public health laboratories. For steam sterilization, muslin as the only wrapper has limitations and handling of items made of muslin leads to contamination (299). The substrate mycelium fragments into coccal forms, and the aerial hyphae fragment into variously sized spores (17). Misidentification of Yersinia pestis by automated systems, resulting in delayed diagnoses of human plague infections-Oregon and New Mexico, 20102011. Further, the presence of other commensals or use of antimicrobials prior to screening may result in false-positive reactions, thus contributing to a lack of assay specificity.
Specimens for culture should be placed in transport medium (a medium such as brucella broth containing 20% glycerol is best for transport and storage) and transported to the laboratory immediately, or refrigerated during delays (263). In all cases where infection with an aerobic actinomycete is suspected, it is of utmost importance that the laboratory be notified of the suspected diagnosis. The glucose and agar concentrations are lower than in the original formulation, which improves growth. Relative importance of nasopharyngeal versus oropharyngeal sampling for isolation of Streptococcus pneumoniae and Haemophilus influenzae from healthy and sick individuals varies with age. Class 3 cabinets provide the most suitable containment for working with exotic pathogens. These infections range from uncomplicated cases of cellulitis to myonecrotic infections with a poor prognosis (38, 39). In case of respiratory diphtheria, material for culture should be obtained on a swab (either a cotton- or a polyester-tipped swab) from the inflamed areas in the nasopharynx. QacA multidrug efflux pump from Staphylococcus aureus: comparative analysis of resistance to diamidines, biguanidines, and guanylhydrazones. In 1890, Robert Koch published a set of postulates in an attempt to standardize the evidence needed to demonstrate a causal role for a microbe in a disease (98). Multiple mechanisms of antimicrobial resistance in Pseudomonas aeruginosa: our worst nightmare? Polyphasic classification is empirical and contains elements from both phenetic and phylogenetic classifications. Centrifuge the specimen at 3,000 Ч g for 15 min, decant the supernatant, and add a few drops of phenol red indicator to the sediment. Quality Control Procedures Although it is not necessary with each transfer, the status of the specimen should be assessed periodically. Ahlinder J, Цhrman C, Svensson K, Lindgren P, Johansson A, Forsman M, Larsson P, Sjцdin A. Additionally, as some species have been described on the basis of only a single isolate, and for others only a few reports exist, little if any meaningful clinical information can be associated with many species names. The widely accepted practice of confirming positive fluorochrome stains may be challenged in the future. Characterization of some groups of gram-negative nonfermentative bacteria by the carbon source alkalinization technique. Most Corynebacterium xerosis strains identified in the routine clinical laboratory correspond to Corynebacterium amycolatum. The clinical picture of posttraumatic-wound infection ranges from localized cellulitis or abscesses to osteomyelitis (1). For serum samples, separation from blood should take place as soon as possible, preferably within 24 h. When grown on carbohydrate-rich media, such as glucose nutrient agar, the large cells of B. The classical biotype caused the sixth pandemic, while the El Tor biotype, which was first isolated in 1905, is the cause of the ongoing seventh pandemic that began in 1961 (8). Chapin and Tsai-Ling Lauderdale in chapter 21 of the ninth edition of this Manual. Partial purification and characterization of an Escherichia coli toxic factor that induces morphological cell alterations. A much broader range of taxonomic studies of bacteria has gradually replaced the former reliance on morphological, physiological, and biochemical characterization. Aseptically remove catheter and clip 5 cm of distal tip directly into a sterile tube. Shiga toxinnegative attaching and effacing Escherichia coli: distinct clinical associations with bacterial phylogeny and virulence traits and inferred in-host pathogen evolution. More recently, an emended description of the genus Rhizobium (Rhizobiaceae, Alphaproteobacteria) was proposed to include all species of Agrobacterium (143), of which only R. Because of low sensitivity and lack of effect on the care and management of patients (in the developed world), and because the cost of antigen testing is much higher than the cost of the Gram stain, direct antigen tests should be considered only when direct communication with the clinical service documents a specific need, such as prior antimicrobial therapy (114). Tween 80 can be added to liquid media and acts as a surfactant that allows the dispersal of clumps of mycobacteria, resulting in a more homogeneous growth. The vancomycin-susceptible species formerly named Pediococcus halophilus was reclassified in the genus Tetragenococcus (14).
Placement of an endotracheal tube or a tracheostomy for mechanical ventilation allows upper respiratory tract microbes to gain access to the lower respiratory tract, where infection can be established. The use of this technology is still limited, but the advantages of using it for genotyping enterococcal isolates and the consequent impact on our understanding on the epidemiology of enterococcal infections have already been reported (136, 137). All species show a fermentative glucose metabolism, with succinic and lactic acids as their major end products. After the introduction of molecular methods for studying these microorganisms, however, the enterococci have undergone considerable changes in taxonomy, which started with the splitting of the genus Streptococcus and the recognition of Enterococcus as a separate genus in 1984 (2). The medium contains beef serum, eggs, infusion from heart muscle, glucose, and digest of animal tissue. Clinical and molecular epidemiology of sporadic and clustered cases of nosocomial Clostridium difficile diarrhea. To ensure accurate identification, at least 300 bp of quality sequence should be compared between the reference and query sequences and should cover at least one region of the gene where variations are to be expected. Clinical isolates have been recovered from blood, wounds, exudates, abscesses, genitourinary sites, continuous ambulatory peritoneal dialysis fluid, and bone (197200). Clinically relevant species include Balneatrix alpica, Bergeyella zoohelcum, Chryseobacterium species, E. Taxonomic variation in the Mycobacterium fortuitum third biovariant complex: description of Mycobacterium boenickei sp. It is unclear if these reports represent accurate species assignments, given the similarity of related species as described above. In the United States, an estimated 495,000 cases of shigellosis occur each year, with 38 deaths (47). Usefulness of multilocus polymerase chain reaction followed by electrospray ionization mass spectrometry to identify a diverse panel of bacterial isolates. Persons who are pregnant or immunocompromised should be discouraged from working in a mycobacteriology laboratory. Characterization of Aeromonas hydrophila wound pathotypes by comparative genomic and functional analyses of virulence genes. However, extreme variability of test results has been observed among laboratories testing identical products (203). Although the number of free-floating planktonic cells may be very low, the total number of P. Investigation of Disease Outbreaks n 129 (Berlin, Germany) and contains updated articles related to worldwide nosocomial outbreaks. Re-evaluation, optimization, and multilaboratory validation of the PulseNet-standardized pulsed-field gel electrophoresis protocol for Listeria monocytogenes. The Polyphasic Species Concept A wide variety of cellular components have been used to study relationships among bacteria and to design classifications (13). In August 1997, the Sterrad 100 system was approved to sterilize certain surgical instruments with long lumens, such as those used in urologic, laparoscopic, and arthroscopic procedures, including instruments with single stainless steel lumens of 3 and <400 mm in length. Klassevirus 1, a previously undescribed member of the family Picornaviridae, is globally widespread. The requisition must include the following information: patient name, age, sex, Personal Protective Equipment Workers should be allowed to wear gloves on the bench if they wish, and gloves should be changed often. With an optimum growth temperature of 45°C, it seems to frequently occur in hot water systems. Six cases of Aerococcus sanguinicola infection: clinical relevance and bacterial identification. Because of the nonspecific symptoms, infections may go undiagnosed or be treated with ineffective antibiotics. The role of the external environment is less important, except in certain areas, such as intensive care units and burn units. In addition, the laboratory must handle these specimens in a manner that will result in the greatest probability of success in establishing a diagnosis and minimizing the exposure of hospital personnel and patients to infectious agents. Molecular epidemiology is no longer a science for the elite; molecular biological devices and reagents are widely available, and almost any clinical or research laboratory has the expertise and the equipment required for performing molecular studies. Evaluation of the new GenoType Mycobacterium assay for identification of mycobacterial species. Phenotypic detection of methicillin resistance in Staphylococcus aureus by disk diffusion testing and Etest on MuellerHinton agar.
Thorough cleaning is essential before highlevel disinfection and sterilization because inorganic and organic materials that remain on the surfaces of instruments interfere with the effectiveness of these processes. The presence of small clusters of Gram-negative organisms surrounded by amorphous material is indicative of biofilm formation compatible with a chronic infection. Quantitative tracheal lavage versus bronchoscopic protected specimen brush for the diagnosis of nosocomial pneumonia in mechanically ventilated patients. This table does not include reagents or tests specifically intended for examination of food, water, or environmental specimens. Bacteria that produce proteolytic activity appear as colonies surrounded by a clear zone. They developed the Bowie-Dick test to determine whether steam penetration and air removal occurred successfully. Both schemes are based on the internal fragments of seven housekeeping genes, and they share three genes. Advances in microarrays and nucleic acid sequencing culminated in many discoveries of previously uncultured pathogens. There has been significant progress made in the performance of serologic tests for infectious diseases, and automated platforms now allow testing laboratories to increase sample throughput. Classification of metal-resistant bacteria from industrial biotopes as Ralstonia campinensis sp. It is emphasized that unidentifiable, clinically significant coryneform bacteria should be sent to an established reference laboratory experienced in corynebacterial identification for characterization which includes sequence-based analyses. They grow well on complex media, including blood agar, nutrient agar, and mostly on MacConkey agar. It is best to confirm positive smears by having them reviewed by another experienced reader. Evaluation of the E test for antimicrobial susceptibility testing of Pseudomonas aeruginosa isolates from patients with long-term bladder catheterization. Actinobaculum schaalii causing urinary tract infections: report of four cases from Argentina. If there are sufficient quantities of cells, the smear may be prepared by direct contact with a tissue sample or by applying a drop of body fluid. Bacillus and Other Aerobic Endospore-Forming Bacteria n 447 2 to 3 weeks later) should be collected for serologic testing at a federal center. Unusual Pathogenic Gram-Negative Aerobic and Facultatively Anaerobic Bacteria, 2nd ed. Genotyping of measles virus in clinical specimens on the basis of oligonucleotide microarray hybridization patterns. The person preparing the skin should use pressure because friction increases the antibacterial effect of the antiseptic. Molecular Typing of Vibrios Pulsed-field gel electrophoresis using NotI and SfiI enzymes is a well-standardized approach to molecular typing of vibrios for surveillance purposes (79, 85, 86). Medical and neurosurgical management of Citrobacter koseri, a rare cause of neonatal meningitis. A multigene approach to phylogenetic analysis using the genus Mycobacterium as a model. Yeasts and dermatophytes are usually susceptible, although the fungicidal action varies with the species (35). Salmonella should not be reported as susceptible to first- and second-generation cephalosporins, cephamycins, and aminoglycosides because these drugs are not effective clinically. Stephan R, Cernela N, Ziegler D, Pflьger V, Tonolla M, Ravasi D, Fredriksson-Ahomaa M, Hдchler H. It may be beneficial to ask the assistance of a surgical pathologist when choosing the best portion of excised tissue for examination (43). Swabs collected through the nose for diagnosis of sinusitis are other specimens of dubious value. Reporting of enteropathogenic Yersinia is not nationally notifiable, so the actual incidence of disease may be underreported. Other respiratory samples, such as sputum samples or throat washes, are less suitable and have not been validated (3). Using a separate sterile pipette for each tube, add to the sediment 1 to 2 ml of sterile, 0.
They are resistant to piperacillin, amoxicillin, ampicillin, cefoperazone, cefuroxime, and cefazolin. It may, however, be easier to initially inoculate a chocolate agar plate to check for sterility overnight before a sample is processed for mycobacteria. When supplemented with 1 to 2% IsoVitaleX (which contains cysteine and other supplements), general bacteriological media (tryptic soy broth and Mueller-Hinton broth) can also support the growth of F. Tubed media should be incubated in a slanted position with the screw caps loose for at least a week until the inoculum has been absorbed; they can then be incubated upright if space is at a premium. All of these enteric pathogens grow on usual media, but detection is enhanced and simplified using specific selective media. Relabeling of a specimen is allowed only if another specimen cannot be collected, such as for tissue collected during a surgical procedure. Proper interpretation and reporting of species identification, even by molecular methods, should be checked against fundamentally established phenotypic characteristics, such as growth rate, colony morphology, and pigmentation. Most strains are resistant to penicillins, cephalosporins, aminoglycosides, aztreonam, and carbapenems (131). The in vitro methods for detecting antimicrobial resistance in enterococcal isolates were reviewed and summarized in reference 1 and are also discussed in chapters 71 and 73. Patients expect that any reusable instrument or device used for diagnosis or treatment has undergone a process to eliminate any risks for cross-infection. Species that have not been recovered from humans to date are also included in Table 2, as the possibility exists that they may be isolated from human sources in the future. Hidden beta-lactamases in the Enterobacteriaceae-dropping the extra disks for detection. Fluorometric deoxyribonucleic acid-deoxyribonucleic acid hybridization in microdilution wells as an alternative to membrane filter hybridization in which radioisotopes are used to determine genetic relatedness among bacterial strains. The Skin Microbiome the skin microbiome is the first line of defense against infection and plays a role in modulating the inflammatory response. Culture Culture is more effective than smearing since it can detect as few as 101 to 102 viable organisms/ml specimen. Tissue biopsy specimens collected during endoscopy are used for culture and urease detection. Establish background rate Provide data for use in ongoing surveillance, including baseline rates of disease; compare to for selected units and infection sites. Blood must be avoided, as erythrocytes produce catalase and can cause a false-positive reaction. Plasminogen activator (Pla), encoded by the 10-kb plasmid, is a surface protease that activates mammalian plasminogen and degrades complement; it is essential for dissemination after subcutaneous or intradermal inoculation (experimental proxies for flea bite transmission) in mouse models of bubonic disease (7, 24). These methods include agar disk diffusion, broth microdilution, agar disk elution and E-test. Surveillance Cultures from Patients, Hospital Personnel, and the Environment the clinical microbiology laboratory is often called upon to detect potential pathogens that may be colonizers of patients, health care workers, and the hospital environment. The choice of approach is often determined by the workload and prevalence of gonorrhea in the service area of the laboratory. Alp E, Yildiz O, Aygen B, Sumerkan B, Sari I, Koc K, Couble A, Laurent F, Boiron P, Doganay M. There are four subgroups of Shigella that historically have been treated as species: subgroup A as S. For research laboratories where the microorganism load is known, the process of matching risk and containment is straightforward. Rod forms are best visualized by growing isolates in a liquid medium, and under such conditions, some branching of individual cells may be found. Aerosolized contaminated dust particles are the source of human infection, and the infectious dose is very low. Evidence-based biosafety: a review of the principles and effectiveness of microbiological containment measures. In addition, the detection of organisms directly in the specimen may assist in the interpretation of culture results; smears of such specimens may show more-characteristic diagnostic morphologies of organisms than smears from colonial growth. Two or all three conformations may be present at the same time in significant amounts and be visible as two or three bands in the gel, and since they have different migration properties in agarose, interpretation of the profiles may be difficult. Misidentification of unusual Aeromonas species as members of the genus Vibrio: a continuing problem.
The strains are catalase and oxidase positive (the latter is an untypical feature for coryneform bacteria), always motile, and oxidizers. It is not possible to estimate the variability of the phenotype in the case of a species with one strain or in the case of a genus with one species and one strain, for which many recent examples exist. Infection control recommendations for patients with cystic fibrosis: microbiology, important pathogens, and infection control practices to prevent patient-to-patient transmission. Using biochemical and molecular methods, these authors were able to separate the isolates into four distinct groups. In France, aldehydes are no longer used for endoscope reprocessing, despite evidence that peracetic acid may stain prions as well (328). However, this method is labor-intensive, has lower specificity, and has a slower turnaround time (minimum of 2 days for negative specimens; longer for positive specimens). In vitro and in vivo activities of newer fluoroquinolones against Vibrio vulnificus. Vandamme P, Goris J, Coenye T, Hoste B, Janssens D, Kersters K, De Vos P, Falsen E. Taxonomy and Classification of Bacteria n method compared with the initial renaturation method. Finally, multilocus enzyme electrophoresis has been shown to provide a wider range of polymorphisms than serotyping (149). Globicatella sanguinis, initially named Globicatella sanguis, was described in 1992 (29). It is good practice to maintain backup copies of written or electronic data linked to the stored organisms. Bacteria that produce ammonia from the hydrolysis of urea appear as golden to dark brown colonies. Hippurate Hydrolysis Test the ability to hydrolyze hippurate is an alternative test for the presumptive identification of S. Higher rates should be investigated and corrected by educational efforts (83, 85). Francisella n 855 chills, fever, headache, and generalized malaise characterize the onset of illness. Most of them are potentially applicable to all enterococcal species, and others are species specific. Most of the genera described here are catalase-negative facultative anaerobes, but A. Based on the staining reaction, bacteria are classified as Gram-positive bacteria, which retain the primary crystal violet dye and appear deep blue or purple; and Gram negative bacteria, which can be decolorized, thereby losing the primary stain and subsequently taking up the counterstain safranin and appearing red or pink. If the organism is bile soluble, the tube containing the deoxycholate will exhibit reduced turbidity within 15 min and show an increase in viscosity along with clearing of the solution. Specimen contamination in mycobacteriology laboratory detected by pseudo-outbreak of multidrug-resistant tuberculosis: analysis by routine epidemiology and confirmation by molecular technique. Prevention of Health Care-Associated Infections n resistant Acinetobacter baumannii resulting from false susceptibility testing by a rapid automated system. Reagents, Stains, and Media: Bacteriology n 337 It can be supplemented with 5-fluorouracil to render it selective. Shiga toxin-mediated hemolytic uremic syndrome: time to change the diagnostic paradigm? Microbial Genomics and Pathogen Discovery n drives immune effector responses in atopic disease. The latter represents a catch for the inexperienced microbiologist, since Ashdown medium normally contains gentamicin and thus fails to support the growth of B. The medium contains cephalothin, vancomycin, trimethoprim, amphotericin B, and polymyxin B as selective factors. Both species have been isolated in the rice-growing regions of northeast Thailand, western Cambodia, Laos, and southern and central Vietnam (5456). Some institutions resterilize items that have not been used on patients but that, for instance, were dropped and/ or whose package was damaged. Dogs are most often resistant to clinical infection and develop antibody titers upon exposure. DetectiV: visualization, normalization and significance testing for pathogen-detection microarray data. Typhoid fever typically presents with a sustained debilitating high fever and headache.
Antimicrobial Susceptibilities Antimicrobial therapy is not recommended for uncomplicated Salmonella gastroenteritis, and routine susceptibility testing of fecal isolates is not warranted for treatment purposes. A precise reconstruction of the emergence and constrained radiations of Escherichia coli O157 portrayed by backbone concatenomic analysis. Dyes and Indicators n Phosphate-buffered saline Phosphate-buffered saline solutions are made by mixing varying amounts of 0. Workshop on treatment of and postexposure prophylaxis for Burkholderia pseudomallei and B. In addition to plasmids, bacteriophages play a major role in generating genome diversity by promoting homologous recombination and horizontal gene transfer between bacteria (18, 19). In spite of published reports documenting the occasional use of direct staining of blood, the likelihood of results affecting patient management does not warrant use as a routine laboratory procedure. The opportunistic human pathogen Acinetobacter baumannii senses and responds to light. Coagulase-positive staphylococci grow as dark blue colonies on a clear background. Mycobacterium kansasii pericarditis in a kidney transplant recipient: a case report and comprehensive review of the literature. Initially, cases from the same clinic were investigated, including those that received methylprednisolone injections. Epidemiologic background of hand hygiene and evaluation of the most important agents for scrubs and rubs. Everyone should know what to do in the event of a spill or accidental release in the laboratory, and drills should be conducted periodically to reinforce proper responses (38). Contamination rates above 5% often indicate a too-weak decontamination, which could compromise mycobacterial cultures due to overgrowth of contaminants. Frequently, plasmids encoding these enzymes also carry resistance genes for aminoglycosides, quinolones, and other antimicrobials (140). In food-borne illness investigations, qualitative isolation tests are insufficient because low-level contamination of 26. Nevertheless, confirmatory tests themselves can introduce shortcomings, as shown for the poorly specific target cppB (encoding cryptic plasmid protein B) (61, 62) and the insufficiently sensitive porA pseudogene (61). Enterococci are not able to synthesize porphyrins and therefore do not produce cytochrome enzymes (4, 8). Genomic species 5 is weakly oxidase positive and pyrrolidonyl aminopeptidase negative. Phylogeny and species identification of the family Enterobacteriaceae based on dnaJ sequences. Important clinical features of pulmonary tuberculosis are cough, weight loss, night sweat, low-grade fever, dyspnea, and chest pain. In outbreak investigations, the precautionary principle is relatively often used when deciding on public health actions, since the aim of an outbreak investigation is to stop the outbreak from spreading as soon as possible. Inoculate the resuspended sediment to appropriate culture media, and prepare a smear. The wrapper should be a barrier against recontamination after sterilization, but it also can prevent ethylene oxide from reaching the item. Acidification of mannitol p, of ethylene glycol p Sphingobacterium spiritivorum (chapter 44) 45b. Comparison of multiple-locus variable-number tandem repeat analysis, pulsed-field gel electrophoresis, and phage typing for subtype analysis of Salmonella enterica serotype Enteritidis. Antimicrobial susceptibility of Gemella haemolysans isolated from patients with subacute endocarditis. Strains may have reduced the nitrate to nitrite and then reduced the nitrite completely to nitrogenous gases that are not detected when nitrate reagents A and B are added to the medium. One of the broadest applications of this technique has been the design of primers to *This chapter contains information presented by Anne M. The MicroTrak culture confirmation test (Trinity Biotech, County Wicklow, Ireland) uses fluorescein isothiocyanatelabeled antibodies for confirmation of N.
These and other data suggest that 20 min (at 20°C) is the minimum exposure time needed to reliably inactivate tuberculous and nontuberculous mycobacteria by 2% glutaraldehyde, provided that the contaminated item has been thoroughly cleaned before disinfection (20, 163). Before routine use, the performance of the machine should be validated with the most difficult load used at the institution to ensure safety of the process. Laboratory Detection of Enterobacteriaceae That Produce Carbapenemases the acquired carbapenemases that are present among Enterobacteriaceae can be divided into three classes (Table 13). Additionally, scientific advancements of pathogen discovery, genomics, and proteomics are supported by collecting and storing biological specimens such as human blood and urine, particularly from patients with noncultivable pathogens or ill-defined clinical syndromes. Aerococcus urinae and Aerococcus sanguinicola, two frequently misidentified uropathogens. Reading Schedule Since many mycobacteria are slowly growing organisms, cultures can be examined less frequently than routine bacteriologic cultures. Ordered restriction maps of Saccharomyces cerevisiae chromosomes constructed by optical mapping. Proteus organisms that do not fit the above-listed criteria must be fully identified by commercial or conventional biochemical methods (126). Aerobic Actinomycetes n 519 by the organism (reported as Corynebacterium equi) involved a patient on high-dose steroids with a pulmonary abscess; he had worked briefly in stockyards contaminated with animal feces shortly before the onset of his illness (139). The occurrence of enterococci as members of the intestinal microbiota of humans (20) and the relationship between the presence of enterococci in foods and human safety (25) have been extensively reviewed. For example, Stickler found chlorhexidine-resistant Proteus mirabilis after chlorhexidine was used extensively over a long period to prepare patients for bladder catheterization (38). Identification of other Yersinia species can be performed by biochemical analysis (Table 1) (40, 88). Antibacterial cleaning and hygiene products as an emerging risk factor for antibiotic resistance in the community. Use of matrix-assisted laser desorption ionization-time of flight mass spectrometry to resolve complex clinical cases of patients with recurrent bacteremias. Routine disinfection of environmental surfaces in patient care areas is recommended in the United States to add a step of additional safety in cases of unrecognized body fluids, but it is restricted to intensive care units and emergency rooms in Europe (148). The recent finding of the presence of a functional erm gene that induces macrolide resistance in many isolates of the M. Blood is added to support the growth of fastidious strains and also to permit differentiation based on hemolytic reactions. If the various copies of a particular gene are different, it is impossible to determine the identification of an unknown isolate using the sequence of this gene. Nevertheless, because peracetic acid has powerful germicidal activity and does not produce toxic residues, peracetic acid is very attractive for use in health care settings, most frequently in combination with hydrogen peroxide to disinfect hemodialyzers. In the environment, vibrios may enter a state referred to as viable but nonculturable, in which cells retain basic metabolic processes even though they fail to grow on standard laboratory media (6). Besides other applications, these compounds may be suitable for disinfecting laboratory equipment and workbenches. The organisms are ubiquitous and can be isolated from soil, water, and food as well as the intestinal tracts of humans and animals. Expression analysis of a highly adherent and cytotoxic small colony variant of Pseudomonas aeruginosa isolated from a lung of a patient with cystic fibrosis. Nakanaga K, Hoshino Y, Wakabayashi M, Fujimoto N, Tortoli E, Makino M, Tanaka T, Ishii N. Using nucleic acid microarrays to perform molecular epidemiology and detect novel beta-lactamases: a snapshot of extended-spectrum beta-lactamases throughout the world. In contrast, through inactivation of the O-antigen gene cluster and the pagP gene, as well as loss of the lpxL gene, Y. Congenital or acquired defects in host defense and the presence of foreign bodies may predispose patients to serious infections. Proposed minimal standards for the description of genera, species and subspecies of the Pasteurellaceae. However, inorganic anions and organic anions such as soaps are incompatible with chlorhexidine, and its activity is reduced at extreme acidic or alkaline pH and in the presence of anion- and non-ion-based moisturizers and detergents.