Comparison of four methodologies for rapid and cost-effective identification of Candida glabrata.

To improve turnaround time and decrease the cost of the identification of Candida glabrata, we evaluated four methods for the detection of trehalose assimilation or fermentation. These methods were compared with the API 20C method (bioMERIEUX, Hazelwood, Mo.) to determine accuracy. We recommend the use of Remel Rapid Trehalose Assimilation Broth because of its rapid, 3-h results, reasonable sensitivity, and low number of false positives.

A cooperative MLT program between a community college and a university.

In 1991 the University of Utah collaborated with Salt Lake Community College to establish a jointly sponsored Medical Laboratory Technician (MLT) program. With documented need for MLTs in Utah and surrounding states, both institutions combined their resources to create an associate degree program that neither institution could offer alone. The first academic year of prerequisite science and liberal education courses are completed at the Community College followed by a second year of professional didactic and laboratory courses taught by faculty of the Medical Technology (MT) Program at the University of Utah, Department of Pathology. Following the second year of professional courses, MLT students complete 15 weeks of clinical rotations in the Salt Lake Metropolitan area. MLT students as well as MT students benefit from their shared experiences in combined courses that are taught on the university campus.

CLS advanced degrees and career enhancement. Part 1--Comparison of career data.

OBJECTIVE: Determine whether recipients of clinical laboratory science (CLS) advanced degrees (MS) experience greater career achievements than their baccalaureate level (BS) colleagues. DESIGN: Two similar questionnaires were used-one for certified or licensed CLS professionals who had earned advanced CLS degrees (MS); the other for matched BS CLS colleagues. SETTING: Five academic programs that conduct both National Accrediting Agency for Clinical Laboratory Sciences accredited CLS education and CLS MS degree programs participated. PARTICIPANTS: The number of survey respondents was 220, 117 with advanced CLS degrees and 103 BS level controls. There were 99 matched pairs, i.e., 198 individuals were matched for gender, residence region, and years of experience. MAIN OUTCOME MEASURES: Careers of BS vs. MS respondents were statistically compared, e.g., fractions with managerial level jobs, relative earnings increases per year, numbers of publications and reports, and other professional contributions. RESULTS: Compared to their BS degree controls, MS degree respondents had more managerial level jobs (62% MS; 36% BS), a higher frequency of job change (once per 4.3 years MS; once per 5.9 years BS), and a higher increase per year of earnings (9.1% MS; 8.1% BS). A greater percentage of the MS degree graduates (77%) than the BS level controls (33%) had authored external publications; the responses related to authorship of institutional reports and procedures were less different-84% MS and 64% BS. Professional contributions to their institutions or profession were cited slightly more frequently by the MS graduates (65%) than by the BS level controls (55%). CONCLUSION: Compared to their matched BS level CLS colleagues, CLS MS degree recipients had greater job mobility, greater management authority, higher salary, and more numerous professional contributions.

CLS advanced degrees and career enhancement. Part 2--A comparison of perceptions.

OBJECTIVE: To determine whether recipients of clinical laboratory science (CLS) advanced degrees (MS) perceive greater career enhancement value related to earning an advanced degree than is perceived by their baccalaureate level (BS) colleagues. DESIGN: Two questionnaires were used-one for certified or licensed CLS professionals who had earned MS CLS degrees; the other for matched BS CLS colleagues. SETTING: Five academic programs that conduct both National Accrediting Agency for Clinical Laboratory Sciences accredited CLS education and CLS MS degree programs participated. PARTICIPANTS: The number of survey respondents was 220 (117-MS; 103-BS level controls). The groups were matched for gender, residence region, and years of experience. MAIN OUTCOME MEASURES: The primary outcome measurements were the perceived benefits of having a CLS MS degree, the reasons for and against obtaining a CLS MS degree, and the overall evaluation of CLS degree programs at both levels. RESULTS: The highest perceived benefit of having a CLS MS degree was the same in both groups, "enhanced self esteem and confidence". The highest priority motivation of MS degree recipients for obtaining a CLS advanced degree was "personal satisfaction". The highest priority reason of the BS group for not obtaining a CLS advanced degree was "family obligation". In both levels of degree programs the subject most commonly cited as needing modification was laboratory management. CONCLUSION: The results indicate that CLS professionals who have CLS MS degrees perceive a greater career enhancement value of advanced CLS degrees than their BS level colleagues.

Comparison of the Murex Candida albicans CA50 test with germ tube production for identification of C. albicans.

A total of 502 yeast isolates were tested with the 30-min MUREX Candida albicans CA50 (Norcross, GA) test for presumptive identification of C. albicans. The results were compared with the standard 2-h germ tube test, which was the reference standard. Of the 502 isolates, 316 were C. albicans and 186 were non-C. albicans. Identifications were based on germ tube reactions; the API20C and chlamydospore agars were used when discrepant results persisted between the germ tube and MUREX test after repeat testing of the MUREX method. A total of 16 C. albicans gave negative results on initial testing with the MUREX test but were interpreted as positive when repeated. Three germ tube negative yeasts initially tested positive with the MUREX but were negative when repeated. Two additional yeast isolates gave incorrect results with the MUREX, even with repeat testing: C. albicans and C. lusitaniae. The initial sensitivity and specificity for the MUREX C. albicans CA50 test were 94.6% and 97.8%, respectively. As an addition to the study, two fetal bovine sera were compared for production of germ tubes; fetal bovine serum and Fetal Clone II. The testing found them to be in 100% agreement.

Comparison of updated Vitek Yeast Biochemical Card and API 20C yeast identification systems.

The updated Vitek Yeast Biochemical Card (YBC) was compared with the API 20C by using 409 germ tube-negative yeasts and Geotrichum spp. that were either clinical or proficiency sample isolates. The API 20C was the reference standard. The 409 isolates represented nine genera and 21 species. Morphology agars were inoculated and interpreted for each isolate. The API 20C identified 406 isolates (99.3%), while the Vitek YBC identified 367 (89.7%). Both systems identified the majority of yeasts after 24 h of incubation--73.4% were identified by the API 20C and 77.4% were identified by the Vitek YBC. The Vitek 24-h reading had some incorrect identifications. These included 14 isolates of Candida tropicalis that were identified as Candida parapsilosis (91 to 97% reliability) and 3 isolates of Candida krusei that were called Blastoschizomyces capitatus (Geotrichum capitatum), Candida rugosa, and Candida zeylanoides. In total, the Vitek YBC misidentified 30 isolates, while the API 20C misidentified 3 isolates. In addition, results for 14 isolates with the Vitek YBC were listed under the category "no identification." Morphology agars were required for identification with 89 isolates (21.9%) when the API 20C was used and with 50 isolates (12.6%) when the Vitek YBC was used. Apart from the price of the Vitek instrument, the API 20C costs $1.28 more per test than the Vitek YBC. Overall, the updated Vitek YBC compares favorably with the API 20C in the identification of common yeasts such as Torulopsis glabrata, C. parapsilosis, and Cryptococcus neoformans. However, problems were encountered with the Vitek system in the identification of C. tropicalis, C. krusei, Trichosporon spp., and some Cryptococcus spp. The routine use of morphology agars with either method is recommended.

Review of urine microscopy for bacteriuria.

Urine microscopy for bacteriuria remains a useful and valid technique for the evaluation of urinary tract infection; however, established interpretive criteria are not agreed on. Our own data and a review of the literature demonstrate that reliable data can be obtained by enumerating the organisms observed in stained or unstained centrifuged and stained uncentrifuged urine specimens. Criteria are given for the interpretation of urine microscopy for maximum sensitivity and specificity for each method reviewed. For clinicians desiring to perform urine microscopy, we recommend the use of oil-immersion microscopy of Gram-stained centrifuged urine sediment and suggest that observing at least one organism per oil-immersion field corresponds with 95% sensitivity and that observing more than five organisms corresponds with 95% specificity for bacteriuria at a level of 10(5) or more colony-forming units per milliliter. Further testing will be required on any negative specimen from a symptomatic patient.

Packaged commercial bacterial identification systems.

The authors attempt to provide a useful and current guide for clinical microbiologists who are seeking a review of the available packaged commercial systems for bacterial identification. Each system is outlined according to test principle, laboratory procedures, turn-around time, and limitations. Selected peer evaluations and references for many of the systems are also cited.

A five-year analysis of antimicrobial susceptibility testing profiles for beta-lactam antimicrobials, with inter-hospital and susceptibility method comparisons within a medical school affiliated hospital system.

A comparative study of antimicrobial susceptibility patterns was performed for a five-year period in four hospitals affiliated with the University of Utah School of Medicine due to concern that susceptibility testing method and results differences between hospital units might complicate training and comprise initial antimicrobial therapy. Few significant pattern changes were detected within or between the individual hospitals during the five-year period, and variances between hospitals were in general no greater than variances demonstrated within individual service units within the University Hospital.

Use of and cost savings with morphologic criteria and the spot indole test as a routine means of identification of Escherichia coli.

The use of primary isolation plate colonial morphologic criteria (CMC) of a flat, nonmucoid, lactose-fermenting, gram-negative rod on MacConkey agar and the spot indole (SI) test from the sheep blood agar plate was evaluated as a means for identification of Escherichia coli in comparison to kit (Micro-ID, API-20E) and conventional biochemical testing. In this preliminary phase of comparison of accuracy, 427 isolates of E. coli (69.8%) from a total of 612 isolates of lactose-fermenting gram-negative rods were evaluated. Of these E. coli isolates, 357 (83.6%) fit the CMC and were SI positive; 3 (less than 1% error rate) were not E. coli. In the second phase of the evaluation, using CMC and SI alone as a means for identification of E. coli, 472 (57.6%) E. coli isolates from a total of 820 Enterobacteriaceae isolates were assessed. Of these E. coli isolates, 326 could be identified using only CMC and SI (69.1% of the E. coli isolates and 39.8% of all Enterobacteriaceae isolates); 146 (30.9%) required additional biochemical testing because of atypical colonial morphology, because of the investigator's inability to differentiate colony types on both media or lack of isolated colonies on either of the two required media, or because as isolates from sterile body sites they were processed directly to Micro-ID kits. A minimum of 40% savings on Enterobacteriaceae identification schemes without compromising accuracy was calculated. As of November 1983, a direct (labor and materials) cost savings of approximately +200.80 per 100 Enterobacteriaceae identifications was projected.