SPECIMEN CULTURE: INDICATION AND

INTERPRETATION BY CLINICIAN
I K Agus Somia
Division of Tropical and Infectious Disease
Departement of Internal Medicine
Sanglah Hospital/Udayana University
BALI
The definitive diagnosis of bacterial infections is most commonly accomplished by
the the cultural recovery of the causative agent from body surfaces, fluids, tissue or excreta of
the affected patient. Bellow will be discussing about indication and interpretation of specimen
culture.
Blood culture
Blood culture (BC) testing before initiation of antimicrobial therapy is recommended
as a standard of care in international sepsis guidelines. Indication for BC testing including
are:
- clinical feature of sepsis
- suspicious of infective endocarditis
- fever of unknown origin
- unexplained leucocytosis or leucopenia
- systemic and localized infectin including: suspected meningitis, osteomyelitis, septic
arthritis, acute untreated bacterial pneumonia or other possible bacterial infection.
Interpretation of blood culture
True infection is almost always present if the culture is positive for one of the
following organisms: streptococci (non-viridans), aerobic and facultative-gram negative rods,
anaerobic cocci, anaerobic gram-negative rods and yeast. Negative growth does not rule out
infection. Suspect contamination if only one of several cultures is positive, if detection
bacterial growth is delayed (5 days), or if multiple organisms are isolated from one culture.
Common contaminations include the following: S epidermidis, Bacillus species,
proionibacterium acnes, Corynebacteium species, Viridans streptococcus and Candida
tropicalis.
Sputum culture
When are sputum Gram stains and cultures indicated? - There is considerable
controversy about the utility of sputum specimens in community-acquired pneumonia (CAP).
The value in nosocomial pneumonia, especially ventilator associated pneumonia (VAP), is
more universally acknowledged. Special stains of respiratory secretions may be performed as
clinically indicated. These include:
Acid fast stains for mycobacteria and nocardia.
Fluorescent antibody stains for Legionella and respiratory syncytial virus.
Quellung stains for streptococcus pneumoniae (in laboratories whose technologists
are trained in this technique).
Routine media used for the isolation and identification of respiratory pathogens
include blood agar, chocolate agar, and McConkey agar. Blood agar supports the growth of
Gram positive cocci and most Gram negative rods, and is especially useful for evaluation of
the colony morphology and hemolysis of streptococci. Chocolate agar permits recovery o
Haemophilus influenzae and other fastidious organisms that may grow less well on blood

agar. McConkey agar is selective for Gram negative bacteria and allows further classification
into lactose positive or negative organisms, based upon their ability to ferment lactose.
Interpretation: culture results are reported in a semiquantatative manner (1+ to 4+ in
some laboratories, rare-few-moderate-abundant in others). Most true pathogens are present in
at least 3+ (moderate) amounts. Quantitative thresholds for BAL and PSB cultures have been
extrapolated from quantitative cultures of infected lung tissue5. The generally accepted
breakpoints for bronchoalveolar lavage (BAL) and protected specimen brush (PSB) are 10 3
and 104 colony forming units (CFU)/mL, respectively.
Urine culture
Urine culture should be ordered for patients with symptoms and risk factors for
urinary tract infection. Clinical judgement should exercised in ordering urine cultures for
aymptomatic individuals with one or mor risk factor. The risk factors including:
- Previous leukocyte esterase and or nitrates in urine
- Recurrent urinary tract infections
- Pregnancy
- Less than 3 years of age
- Diabetes mellitus
- Recent urological syrgery/cystocopy
- Neurogenic bladder
- Renal disease, renal transplant.
- Genitourinary problem
- Treatment failure for uncomplicated UTI
Interpretation of urine culture
A positive of rine culture is based on the growth of bacteria at high number of colony
forming unit (CFUs). Urine culture results should be interpreted in conjunction with clinical
symptoms of urinary tract infection, such as dysuria, urinary frequency, suprapubic pain,
flank pain and fever. For clean-catch urine samples, a positive urine culture as indicated by
the growth of bacteria greater than 100.000 CFUs/ml is suggestive of UTI; growth of 1.000
100.000 CFUs/ml may still indicate UTI, especially for specimen taken at cystoscopy or
other invasive procedurs. Growth of 2 or more different bacteria or polymicrobial growth is
likely to the result of contamination
References
1. Vanchawng L, e al. 2013. Urine Culture. Available in.hhtp/www.
emedicine.medscape.com/article/20932272-overview.
2. Schmitz RP, Keller PM, Baier M, Hagel S, Pletz MW, Brunkhorst FM. Quality of
blood culture testing - a survey in intensive care units and microbiological
laboratories across four European countries. Critical Care. 2013; 17(R248): 2-9.
3. Ntusi N, Aubin L, Oliver S, Whitelaw A, Mendelson M. Guideline for the optimal use
of blood cultures. S Afr Med J. December 2010; 100(12): 839-843.
4. Bhattacharya AK. Role Of Sputum Cultures In Diagnosis Of Respiratory Tract
Infections. Clinical Medicine: Lung India. 2006;23;20-24.
5. Pallin DJ, Ronan C, Montazeri K, Wai K, Gold A, Parmar S, et al. Urinalysis in Acute
Care of Adults: Pitfalls in Testing and Interpreting Results. 2014. Downloaded from
http://ofid.oxfordjournals.org/. Accessed 10 April 2014.