HOW TO REPORT BETTER AND FASTER IN DIAGNOSTIC BACTERIOLOGY ? The question has many limitations than answers, The great problem remain with humans have ten times more commensals bacteria occupying our body than our own cells, it just means we have occasion of useful and commensal bacteria, however sometimes few pathogens enter the humans and try to win the system, it we call as infection . however our own system of immunity saves from succumbing to the harmful effects and invasions, My teacher who has dedication to bench Dr Joga Lakshmi MD and emeritus professor from Andhra Medical colleges used to teach me the difficulty is understanding Medical Microbiology is what is harmful and which is not , it continues to be the challenge when we are reporting, not to forget much of our work is in in bacteriology which revolves around few bacteria and many others are discarded as insignificant, commensals to the clinical situation,.However we find many discussion and unnecessary conflicts and egoistic clashes in the departments continue to hamper the good relations in the departments, however much corrections can be brought with healthy understanding reading to basic books in diagnostic microbiology, If we look into the Matters with wisdom Microbiology including all the divisions it is truly difficult we can never become perfect with even many decades working in the laboratory However what is important for clinicians is a little communication at the end of our exhaustive work we do in laboratory, after culturing it really takes a minimum of 3 days to deliver a minimal report on Antibiograms let us be realistic let us not waste the time

Acute Pharyngitis - And specimen of throat swab routinely sent rarely in a suspected case of Diphtheria which we get rarely and higher clinical application needed to treat the patients with antitoxin even overruling the laboratory reports
At least in few cases every week we get isolates of Streptococcus group A and beta hemolytic Performing susceptibilities on beta-haemolytic streptococci: Beta-haemolytic streptococci are invariably susceptible to penicillin s, everywhere, and you can send the reports on the 2nd day and effective penicillin can be started ,If the patient has anaphylaxis to penicillin documented on the request form then fair enough. To test with better alternatives as Erythromycin Otherwise, it is all a bit academic and testing many drugs with Gram positives is unfair and causes confusion loss of times, DEALING WITH MIXED FLORA ON CULTURE PLATES Working up individual organisms where the culture plates clearly show”enteric flora”: For superficial swabs, this is a no-brainer. But even in sterile sites, the work up of each individual organism when they clearly represent enteric flora is of little clinical value. We get specimens from perforated intestines or Appendix certainly we isolate Enteric flora and dominance of E.coli truly it will not be useful to process for antibiograms, and much of the care will be taken by clinicians with combination of higher grade antibiotics with their own experience, proving only E.coli is difficult Anaerobic culturing - We have few facilities to culture anaerobes in our laboratories and very few have a practical experience Culturing for anaerobes in areas of the body where anaerobes live peri-anal area, vagina, oral, gastrointestinal This is not very wise because if you manage to grow anaerobes from such sites then it may well represent normal colonising flora. If we look at the anaerobes in the gut and oral cavity dominated by anaerobes and certainly routine microbiology laboratories do not point the true nature of infection, certain it needs the most advanced microbiology facilities whatever many times we report will not serve the matters, and truly it is better to explain to the clinicians limitations of our laboratory system
Sputum to be cultured and not Saliva - Never proceed to take up culturing of sputum unless it is truly sputum and not salivary secretions collected by inexperienced staff where there are lots of epithelial cells on microscopy: Because if you do so, you will simply be culturing a sample originating from the mouth or prophylaxis which will bear little relation to what is happening down in the lungs. However the laboratory reports misguide the clinicians with commensals isolated and tried with every new generation of antibiotics leading to reporting of MDR strains. Be hold to reject the specimens or else we will be delivering reports which are more harmful than useful
Culturing for bacteria in vaginal swabs: Vaginal flora contains lots of different colonizing bacteria, most of which very rarely causes problems. It is probably only worthwhile looking for staphylococci and streptococci when there has been instrumentation or trauma (e.g. post-natal). The vast majority of vaginal swabs do not need cultured for bacteria. Unless we suspect a infections with Gonorrhea bacterial vaginosis or matters related to pelvic inflammatory diseases
Let’s not waste time and be truly scientific
Try learn more at “Time Wasters ”Michael Microbiology matters concepts of clinical Microbiology
Dr.T.V.Rao MD free lance reporter on Infectious diseases