PC154

Shipped 15 February 2016

HISTORY

The challenge was sent to category A, B, C, and C1 laboratories. The following scenario was presented to participants:

In the morning, you discover Neisseria gonorrhoeae culture plates, inoculated at a physician’s office, emergency ward (ER), or Sexually-Transmitted Disease (STD) clinic, on the bench at room temperature from the previous evening. The Neisseria gonorrhoeae culture plates were not incubated. All appropriate specimen and requisition identifiers were present and correct. How would you proceed?

Please select the one option that best describes your lab’s protocol.

A. Start incubation as soon as possible and report routinely

B. Discard culture plates and contact physician, ER or STD clinic to resubmit specimen

C. Start incubation as soon as possible and contact physician, ER or STD clinic to re-submit specimens

D. Refer plates for molecular testing

E. N/A, sample not normally processed

MAIN EDUCATIONAL POINTS from PC154

  1. Delayed placement of inoculated culture media into a CO2 environment by 24 hours may result in a statistically significant decrease in the recovery of N. gonorrhoeae.
  2. Delayed placement of inoculated culture media into a CO2 environment can also result in delayed recovery of those organisms which manage to survive, as well as reduced colonial size and numbers.
  3. Recovery rates of N. gonorrhoeae may not be as severely impacted by delayed incubation if those plates have been held in a CO2 enriched environment – however the organisms’ rate of growth, numbers and colony size will show a negative impact.
  4. Despite the higher sensitivity and specificity of commercial NAATs, Health Canada strongly recommends culture in several situations, including as a test of cure for suspected treatment failures.
  5. There are situations where the current Health Canada recommendations call for treatment without waiting for test results.

Full critique (PDF)

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