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									                                                                                   Policy #MI\BA\v16                  Page 1 of 15
                       Department of Microbiology
Laboratory Policy & Procedure Manual
Section: Bacteria and Yeast Work-up                                                Subject Title: Table of Contents
Issued by: Laboratory Manager                                                      Original Date: October 08, 2002
Approved by: Laboratory Director                                                   Revision Date: January 11, 2011
                                                                                   Review Date: May 31, 2011


                                          BACTERIA and YEAST WORK-UP

                                                    TABLE OF CONTENTS
AEROBIC BACTERIA .................................................................................................................. 2
   GRAM POSITIVE BACTERIA ................................................................................................. 2
    GRAM POSITIVE COCCI - Catalase-Positive ..................................................................... 2
    GRAM POSITIVE COCCI – Catalase-Negative ................................................................... 3
         Identification tests for Group B streptococcus ............................................................... 4
    GRAM POSITIVE BACILLI ................................................................................................. 5
   GRAM NEGATIVE BACTERIA .............................................................................................. 6
    GRAM NEGATIVE COCCI / DIPLOCOCCI ....................................................................... 6
         Identification of Neisseria gonorrhoeae ......................................................................... 6
         Identification of Neisseria meningitidis .......................................................................... 7
    GRAM NEGATIVE BACILLI - Oxidase-Negative, Fermenter ............................................ 8
    GRAM NEGATIVE BACILLI – Oxidase-Negative, Non-Fermenter ................................... 8
    GRAM NEGATIVE BACILLI – Oxidase-Negative or Weak Positive ?Haemophilus
    species ..................................................................................................................................... 8
    GRAM NEGATIVE BACILLI – Oxidase-Positive ............................................................... 9
         Identification of H. pylori ............................................................................................... 9
Identification and Susceptibility Testing Methods for Common Urinary Tract Isolates.............. 10

ANAEROBIC BACTERIA .......................................................................................................... 12

YEAST IDENTIFICATION ......................................................................................................... 13

REFERENCES ............................................................................................................................. 14

Record of Edited Revisions .......................................................................................................... 15




                                       PROCEDURE MANUAL
          UNIVERSITY HEALTH NETWORK / MOUNT SINAI HOSPITAL DEPARTMENT OF MICROBIOLOGY
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                                                                     Page 1
                                                                          Policy #MI\BA\v16              Page 2 of 15
                      Department of Microbiology
Laboratory Policy & Procedure Manual
Section: Bacteria and Yeast Work-up



                                                 AEROBIC BACTERIA

                                          GRAM POSITIVE BACTERIA


GRAM POSITIVE COCCI - Catalase-Positive

Tests                    S. aureus        CNST         S. saprophyticus        S. lugdunensis        Micrococcus         Stomatococcus
                                                                                                      species6              species7
T-DNase1                      +              -                   -                      -                    -                     -
Staph-Slide                   +              -                   -                       -                    -                     -
Agglutination1,2,4
Tube                          +              -                   -                      -                    -                     -
coagulase1,4
Novobiocin                  N/A              S                  R                      S                   N/A                    N/A
susceptibility3
GenProbe5                 >1,500         <1,200               N/A                    N/A                   N/A                    N/A
                           PLU            PLU
Oxidase                      -              -                   -                      -                     +                     -
Growth in 6.5%              +              +                    +                      +                     +                     -
NaCl
Bacitracin                  N/A            N/A                N/A                    N/A                    S                     N/A
PYR8                         -              V                  -                      +                    N/A                     +
LAP                         N/A            N/A                N/A                    N/A                   N/A                     +
Ornithine                   N/A             -                 N/A                     +                    N/A                    N/A
decarboxylase

1 compulsory test for Blood Cultures
2 compulsory test for all specimens other than Blood Cultures
3 test on urines from female of childbearing age
4 compulsory test for Infection Control MRSA screens
5 confirmatory test if needed
6 obligately aerobic
7 catalase variable
8 compulsory test for CNST isolated from Blood Cultures and sterile sites; set up ornithine decarboxylase if PYR is
   positive to rule out S. lugdunensis
   Intrepretation:
           PYR                Ornithine       Report
             -                                CNST
             +                    +           S. lugdunensis
      Indeterminant               -           CNST
      Indeterminant               +           Send to PHL for ID

                                      PROCEDURE MANUAL
         UNIVERSITY HEALTH NETWORK / MOUNT SINAI HOSPITAL DEPARTMENT OF MICROBIOLOGY
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                                                             Page 2
                                                                          Policy #MI\BA\v16              Page 3 of 15
                      Department of Microbiology
Laboratory Policy & Procedure Manual
Section: Bacteria and Yeast Work-up

GRAM POSITIVE COCCI – Catalase-Negative

1.       beta-hemolytic large colonies on Blood Agar:

Test                                                            Group A, B, C or G streptococcus
Gram Stain                                                                      g+c
Catalase                                                                         -
BE                                                                               -
Streptococcus Latex Agglutination                            Agglutination with Group A, B, C or G

2.       beta-hemolytic small colonies on Blood Agar:

Test                                                              Streptococcus anginosus group
Gram Stain                                                                      g+c
Catalase                                                                         -
BE                                                                               -
Streptococcus Latex Agglutination                            Agglutination with Group A, C, F, G or
                                                             non-groupable
VP                                                                               +

3.       Non-hemolytic or -hemolytic on Blood Agar:

Test                Streptococcus          viridans         Aerococcus         Enterococci1,4         Leuconostoc/                Others
                     pneumoniae          Streptococci          uriae                                  Pediococcus
Gram Stain               g+dc                  g+c               g+c                  g+c                   g+c                    g+c
                                                              clusters,
                                                               tetrads
Catalase                    -                   -                  -                   -                    -                       -
BE                          -                   -                  -                  +1                    -                       V
Vancomycin                  S                   S                                   S / R3                  R                       S
Bile                        +                   -                  -                N/A                    N/A                     N/A
Solubility
Optochin                  S                     R                  R                 N/A                   N/A                     N/A
PYR                      N/A                    -                  -                  +                     -                      N/A
LAP                      N/A                                       +
Vitek id-gp              ID if            Some ID;                                    ID2              Not in data          ID – will ID
card                 questionable         report as                                                    base, set up           Gemella,
                    identification         viridans                                                     API Strep              Strep.
                       by Bile           Strep group                                                      strip              anginosus
                      solubility                                                                                            group5, non-
                        and/or                                                                                               haemolytic
                      Optochin                                                                                             group B strep
                                      PROCEDURE MANUAL
         UNIVERSITY HEALTH NETWORK / MOUNT SINAI HOSPITAL DEPARTMENT OF MICROBIOLOGY
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                                                                          Policy #MI\BA\v16              Page 4 of 15
                      Department of Microbiology
Laboratory Policy & Procedure Manual
Section: Bacteria and Yeast Work-up
1.
     For urine, wounds and superficial specimens, report as Enterococcus species based on Bile
     Esculin result (do not need to further speciate).
2.
     If Vitek ID as E. faecium and Amp-S, or other Enterococcus other than E. faecalis, set up
     sugars: Xylose, Arabinose, MGP, PYR
3.
     Enterococci species that are I or R to Vancomycin must be checked for yellow pigment. For
     isolates negative for pigment, set up rapid xylose test. Positive xylose (within 2 hours)
     isolates are E. gallinarum. For non-yellow pigmented isolates and negative rapid xylose
     isolates, set up Enterococcus MIC panel. Unidentified isolates are to be sent to the Provincial
     Health Lab for identification.
4.
     Enterococcus identification:
      Test                     Enterococcus                  Enterococcus          Enterococcus          Enterococcus
                                  faecalis                     faecium              gallinarum           casseliflavus
      BE                             +                            +                      +                     +
      Yellow pigment                 -                             -                      -                    +
      Pyruvate                       +                             -                      -                    -
      Rapid xylose (2hrs.)           -                             -                     +                     +
      Arabinose                      -                            +                      +                     +
      MGP                            -                             -                     +                     +
      Sorbose                        -                             -                      -                    -
      Sorbitol                       +                            V                      V                    V
      Raffinose                      -                            V                      V                    V
      Ampicillin                     S                            R                      S                     S
5.
     Streptococcus anginosus group – VP+

Identification tests for Group B streptococcus

                                                  Hemolysis


                                     β                                             α or γ
                             Catalase                                              Catalase


                    +                                 -                        +                    -
                 discard                           Strep                    discard        Bile esculin (1 hour)
                                                  grouping
                                                                                         +                    -
                                                                                     discard                Strep grouping
                                      PROCEDURE MANUAL
         UNIVERSITY HEALTH NETWORK / MOUNT SINAI HOSPITAL DEPARTMENT OF MICROBIOLOGY
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                                                             Page 4
                                                                          Policy #MI\BA\v16              Page 5 of 15
                      Department of Microbiology
Laboratory Policy & Procedure Manual
Section: Bacteria and Yeast Work-up

GRAM POSITIVE BACILLI

Test                 Listeria        Arcanobacterium             Erysipelothrix              C.             C.              Lactobacilli
                                                                                         jeikeium       urealyticum
                                                                                            (JK)
Catalase                +                      -                         -                    +               +                    -
BE                      +                      -                         -                    -               -                    V
Penicillin             N/A                    N/A                       N/A                 Yes              N/A                  N/A
 Resistance
Motility                 +                      -                          -                  -             -                     N/A
Urease                                                                                                      +
Vancomycin             N/A                   N/A                 N/A                       N/A             N/A                  R/S
                      Set up                 Set up Vitek id-gp card                      Set up          Set up              Set up
                    Vitek id-                                                             Vitek            API              RapID ANA
                     gp card                                                               ani           CORYNE
                       and
                    rhamnose

Note:
 Catalase positive, Penicillin sensitive, Gram positive bacilli that are not Listeria or Bacillus
   species, report as “Corynebacterium species”; except in urine (rule out C. urealyticum).

   Catalase positive, Penicillin resistant, Gram positive bacilli that do not identify as
    Corynebacterium jeikeium, report as “Corynebacterium species”; except in urine (rule out C.
    urealyticum).

   For aerobic pigmented, Catalase positive, Gram positive bacilli, send isolate to PHL for ID.

   Aerobic spore-forming bacilli - observe for haemolysis and set up motility test (use motility
    medium). If motile, report as “Bacillus sp. not B. antracis.” If non-motile, non-haemolytic
    and large bacilli send isolate to PHL. Package the isolate in a SAFT PAK container, labeled
    “Bacillus species non-motile” and shipped as dangerous goods. Phone PHL at 416-235-5706
    to inform of bacillus species to rule out B anthracis.

   For faintly staining beaded gram positive bacilli, perform a modified Kinyoun (rule out
    Nocardia) and Kinyoun (rule out Mycobacterium)

   All gram positive bacilli isolated from tissues and sterile sites, perform a modified Kinyoun
    (rule out Nocardia) and Kinyoun (rule out Mycobacterium)



                                      PROCEDURE MANUAL
         UNIVERSITY HEALTH NETWORK / MOUNT SINAI HOSPITAL DEPARTMENT OF MICROBIOLOGY
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                                                                          Policy #MI\BA\v16              Page 6 of 15
                      Department of Microbiology
Laboratory Policy & Procedure Manual
Section: Bacteria and Yeast Work-up



                                         GRAM NEGATIVE BACTERIA

GRAM NEGATIVE COCCI / DIPLOCOCCI

Test                     M. catarrhalis           N. gonorrhoeae            N. meningitidis              N. species
Oxidase                        +                         +                        +                           +
Catalase                       +                         +                        +                           +
Tributyrin                     +                       N/A                       N/A                        N/A
apiNH                         N/A                       ID                       ID                      Some ID
Vitek nhi                     N/A                      N/A                       N/A                         ID
Gonogen                       N/A                       ID                       ID                      Some ID

Identification of Neisseria gonorrhoeae

                                                           Oxidase



                             Negative                                           Positive
                             (not Neisseria)

                                                                                Gram stain  gnb (not Neisseria)


                                                                                Gram negative diplococcus


                                                                                apiNH strip
                                                                                Gonogen




                                      PROCEDURE MANUAL
         UNIVERSITY HEALTH NETWORK / MOUNT SINAI HOSPITAL DEPARTMENT OF MICROBIOLOGY
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                                                                          Policy #MI\BA\v16              Page 7 of 15
                      Department of Microbiology
Laboratory Policy & Procedure Manual
Section: Bacteria and Yeast Work-up

Identification of Neisseria meningitidis

                                                           Oxidase



                             Negative                                           Positive
                             (not Neisseria)

                                                                                Gram stain  gnb (not Neisseria)


                                                                                Gram negative diplococcus


                                                                                apiNH strip




                                      PROCEDURE MANUAL
         UNIVERSITY HEALTH NETWORK / MOUNT SINAI HOSPITAL DEPARTMENT OF MICROBIOLOGY
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                                                                          Policy #MI\BA\v16              Page 8 of 15
                      Department of Microbiology
Laboratory Policy & Procedure Manual
Section: Bacteria and Yeast Work-up


GRAM NEGATIVE BACILLI - Oxidase-Negative, Fermenter

Test                                              E. coli                                Not E. coli
MUG*                                                 +                                        -
INDOLE*                                              +                                       +/-
Vitek id-gn                                         ID                                       ID
api20E                                    Use when not ID by id-gn                 Use when not ID by id-gn

* Use for urine isolates

Note:
Unidentified isolates are to be sent to the Provincial Health Lab for identification.


GRAM NEGATIVE BACILLI – Oxidase-Negative, Non-Fermenter

Test
Vitek id-gn                                           Some ID
api20E                                                Some ID
api20NE                                               Most ID

Note:
Unidentified isolates are to be sent to the Provincial Health Lab for identification.

GRAM NEGATIVE BACILLI – Oxidase-Negative or Weak Positive ?Haemophilus species

Test                                              H. influenzae1                        H. parainfluenzae
Gram                                                   g-cb                                   g-cb
Satellitism                                              +                                      +
ALA                                                      -                                      +
Catalase                                                 +                                      -

Note:
If isolated form blood and sterile sites and if required from other sites set up Vitek nhi card. If
identification from nhi is poor, send isolate to the Provincial Health Lab for identification.

If isolated from blood or sterile sites, send isolate to the Provincial Health Lab for Serogroup b
typing.



                                      PROCEDURE MANUAL
         UNIVERSITY HEALTH NETWORK / MOUNT SINAI HOSPITAL DEPARTMENT OF MICROBIOLOGY
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                                                                          Policy #MI\BA\v16              Page 9 of 15
                      Department of Microbiology
Laboratory Policy & Procedure Manual
Section: Bacteria and Yeast Work-up

GRAM NEGATIVE BACILLI – Oxidase-Positive

Test                                           Ps. aeruginosa                          Not Ps. aeruginosa
Cetrimide*                                            +                                         -
Vitek id-gn                                          ID                                     Some ID
api20E                                               ID                                     Some ID
api20NE                                  ID including mucoid strains                        Most ID
Growth at 42oC                                        +                                        +/-

* Growth AND green pigment

Note:
Unidentified isolates are to be sent to the Provincial Health Lab for identification.

Identification of H. pylori:

           Test                                                  H. pylori

           Gram stain                                            Small, gram negative gull-shaped or spiral
           Catalase                                              +
           Oxidase                                               +
           Urea slant (rapid)                                    +
           Cephalothin 30g                                      S (inhibition)
           Nalidixic acid 30g                                   R (no zone)




                                      PROCEDURE MANUAL
         UNIVERSITY HEALTH NETWORK / MOUNT SINAI HOSPITAL DEPARTMENT OF MICROBIOLOGY
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                                                             Page 9
                                                                          Policy #MI\BA\v16              Page 10 of 15
                      Department of Microbiology
Laboratory Policy & Procedure Manual
Section: Bacteria and Yeast Work-up



Identification and Susceptibility Testing Methods for Common Urinary Tract Isolates

Suspect Organism                 Tests to be performed and expected result                          Identification/Susceptibility
E.coli (Lactose                 Oxidase: Negative                                                  Vitek Susceptibility
        fermenter)              MUG: Positive + Indole: Positive
Enterobacteriaceae              Oxidase: Negative                                                  Vitek ID + Susceptibility
Pseudomonas                     Oxidase: Positive                                                  Vitek Susceptibility
aeruginosa                      Characteristic appearance + Cetrimide: Positive
Non-fermenters                  Oxidase: Negative/Positive                                         Vitek ID + Susceptibility or
                                                                                                   API NE + KB Sens if
                                                                                                   applicable
Yeast                            If isolated from aseptically collected urine:
                                  Wet mount
                                 Germ tube-positive : Report as C. albicans
                                             -negative : Identify to species                       Refer to Mycology

                                 If isolated from Voided Urine: Wet mount
                                              Do not identify. Report as yeast.
Group B                         Strep. Latex Agglutination: Group B Positive
  streptococcus                 Bile esculin: Negative
Staphylococcus
  species: aureus               Staph. Latex Agglutination: Positive                               Vitek Susceptibility
                                                                                                   Oxacillin screen
                                                                                                   Vancomycin screen
   S. saprophyticus             Staph. Latex Agglutination: Negative
                                Novobiocin: Resistant (set up on patients 12 -
                                60 yrs and females only)



          CNST                  Novobiocin: Sensitive
                                Staph. Latex Agglutination: Negative


Enterococcus species Bile esculin: Positive                                                        Vitek Susceptibility
                                                                                                   Vancomycin screen




                                      PROCEDURE MANUAL
         UNIVERSITY HEALTH NETWORK / MOUNT SINAI HOSPITAL DEPARTMENT OF MICROBIOLOGY
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                                                                          Policy #MI\BA\v16              Page 11 of 15
                      Department of Microbiology
Laboratory Policy & Procedure Manual
Section: Bacteria and Yeast Work-up

Suspect Organism        Tests to be performed and expected result                                   Identification/Susceptibility
Corynebacterium        Non-haemolytic colonies on Blood Agar
species                Gram positive bacilli, small, palisade
                       arrangement.
                       Catalase: Positive
                       Urea: Negative
Corynebacterium        Non-haemolytic colonies on Blood Agar                                       API CORYNE for ID
urealyticum            Gram positive bacilli, small, palisade
                       arrangement.
                       Catalase: Positive
                       Urea (rapid): Positive
viridans streptococcus Alpha-haemolytic colonies on Blood Agar
                       Gram positive cocci in chains
                       Catalase: Negative
Aerococcus urinae      Alpha-haemolytic colonies on Blood Agar
                       Gram positive cocci in tetrads or clusters
                       Catalase: Negative
                       LAP: Positive + PYR: Negative
Lactobacillus species Alpha-haemolytic or non-haemolytic colonies
                       on Blood Agar
                       Gram positive thin bacilli
                       Catalase: Negative
Bacillus species       Gram positive large bacilli with square ends
                       Motility: Positive




                                      PROCEDURE MANUAL
         UNIVERSITY HEALTH NETWORK / MOUNT SINAI HOSPITAL DEPARTMENT OF MICROBIOLOGY
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                                                                          Policy #MI\BA\v16              Page 12 of 15
                      Department of Microbiology
Laboratory Policy & Procedure Manual
Section: Bacteria and Yeast Work-up



                                             ANAEROBIC BACTERIA

Test                   Peptostrepto-          Propioni-          Anaerobic          Clostridium          B. fragilis         Anaerobic
                       coccus                 bacterium          non-spore            species                                  Gram
                       species                 species            forming                                                     negative
                                                                   Gram                                                        bacilli
                                                                  positive
                                                                   bacilli
Gram                           g+c            g+b small,         g+b small           g+b, large               g-b                  g-b
                                              branching
Catalase                    N/A                   +                  -                 N/A                 N/A                 N/A
Subculture BA             No growth           No growth          No growth          No growth*           No growth           No growth
CO2
Subculture                No growth           No growth          No growth          No growth*           No growth           No growth
CHOC CO2
Subculture                  Growth              Growth             Growth              Growth              Growth                 Growth
BRUC AnO2
BBE                           N/A                 N/A                  N/A              N/A                   +                     -
RapID ANA**                   N/A                 N/A                                 Some ID                N/A                   ID
Vitek ani**                   N/A                 N/A                                                                              N/A


*        Some Clostridium species can grow aerobically
**       Usually not done – report as anaerobic gram positive or gram negative bacilli

    Anaerobic, small Gram positive bacilli resembling diphtheroids that are catalase positive
     should be reported as “Propionibacterium species”.

    Anaerobic, small Gram positive bacilli that are catalase negative should be reported as
     “Anaerobic non-spore forming Gram positive bacilli”.




                                      PROCEDURE MANUAL
         UNIVERSITY HEALTH NETWORK / MOUNT SINAI HOSPITAL DEPARTMENT OF MICROBIOLOGY
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                                                                          Policy #MI\BA\v16              Page 13 of 15
                      Department of Microbiology
Laboratory Policy & Procedure Manual
Section: Bacteria and Yeast Work-up



                                            YEAST IDENTIFICATION

     Identify yeast as per site of isolation:

1)       Sterile sites and biopsy specimens:

                   a) Germ tube: Positive - Report as "Candida albicans" “isolated”.
                   b) Germ tube: Negative - Report as “Yeast” “isolated” “identification to follow”
                                            and send the isolate to Mycology for identification.

2)       Respiratory sites isolates:

                   Significant growth – For sputum (>2+ growth and predominant OR 1+ growth and
                   predominant and if pus cells are seen on gram stain) OR for BAL specimen (amount
                   greater than that of commensal flora):
                   a) Germ tube: Positive - Report as "Candida albicans"
                   b) Germ tube: Negative - Rule out Cryptococcus using Urease test. If Urease is
                                   negative, report as "Yeast, not Candida albicans or Cryptococcus". If
                                   Urease is positive, confirm purity, subculture isolate onto a SAB
                                   plate and send the SAB and original plate to Mycology for further
                                   identification ASAP.

                   Insignificant growth – i.e. any amount of yeast other than what has defined as
                   significant growth.
                   Rule out Cryptococcus using Urease test. If Urease is negative, report as part of
                   Commensal flora without specifically mentioning the presence of yeast. If Urease
                   is positive, confirm purity, subculture isolate onto a SAB plate and send the SAB
                   and original plate to Mycology for further identification ASAP.

3)       Voided urines, superficial sites, wounds and drainage fluids:
                No Germ tube performed. Report as "Yeast” with quantitation.

4)       Isolates from all other sites:
                 a)      Germ tube: Positive - Report as "Candida albicans".
                 b)      Germ tube: Negative - Report as "Yeast, not Candida albicans".




                                      PROCEDURE MANUAL
         UNIVERSITY HEALTH NETWORK / MOUNT SINAI HOSPITAL DEPARTMENT OF MICROBIOLOGY
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                                                                          Policy #MI\BA\v16              Page 14 of 15
                      Department of Microbiology
Laboratory Policy & Procedure Manual
Section: Bacteria and Yeast Work-up


                                                     REFERENCES

      H.D. Izenberg. 2003. Guildlines for Identification of Aerobic Bacteria, 3.16.1 in Clinical
      Microbiology Procedures Handbook, 2nd ed. Vol.1 ASM Press, Washington, D.C.

      H.D. Izenberg. 2003. Schemes for Identification of aerobic Bacteria, 3.18.1.1 – 3.18.2.1 in
      Clinical Microbiology Procedures Handbook, 2nd ed. Vol.1 ASM Press, Washington, D.C.




                                      PROCEDURE MANUAL
         UNIVERSITY HEALTH NETWORK / MOUNT SINAI HOSPITAL DEPARTMENT OF MICROBIOLOGY
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                                                                          Policy #MI\BA\v16              Page 15 of 15
                      Department of Microbiology
Laboratory Policy & Procedure Manual
Section: Bacteria and Yeast Work-up


Record of Edited Revisions

Manual Section Name: Bacteria and Yeast Work-up Manual

                        Page Number / Item                                         Date of Revision                Signature of
                                                                                                                      Approval
Annual Review                                                                   May 12, 2003                      Dr. T. Mazzulli
Annual Review                                                                   May 26, 2004                      Dr. T. Mazzulli
Annual Review                                                                   May 12, 2005                      Dr. T. Mazzulli
Yeast ID moved from Respiratory and Wounds Manuals                              April 6, 2005                     Dr. T. Mazzulli
Identification of Neiserria gonorrhoeae added                                   April 6, 2005                     Dr. T. Mazzulli
Identification of Neiserria meningitidis added                                  April 6, 2005                     Dr. T. Mazzulli
Identification of H. pylori moved from Respiratory                              April 6, 2005                     Dr. T. Mazzulli
Manual
Identification for S. lugduensis in blood and sterile sites                     Feb 14, 2006                      Dr. T. Mazzulli
Annual Review                                                                   July 12, 2006                     Dr. T. Mazzulli
Annual Review                                                                   August 13, 2007                   Dr. T. Mazzulli
Annual Review                                                                   October 9, 2008                   Dr. T. Mazzulli
Change reporting - If motile, report as “Bacillus sp. not                       March 04, 2009                    Dr. T. Mazzulli
B. antracis.”
Added Kinyoun and Modified Kinyoun for gram positive                            June 3, 2009                      Dr. T. Mazzulli
bacilli workup
Annual Review                                                                   October 10, 2009                  Dr. T. Mazzulli
Annual Review                                                                   October 10, 2010                  Dr. T. Mazzulli
Added shipping information for “Bacillus “ to PHL                               January 11, 2011                  Dr. T. Mazzulli
Annual review                                                                   May 31, 2011                      Dr. T. Mazzulli




                                      PROCEDURE MANUAL
         UNIVERSITY HEALTH NETWORK / MOUNT SINAI HOSPITAL DEPARTMENT OF MICROBIOLOGY
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