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Thread: Culture and Sensitivity Report (HOW TO INTERPRET)

  1. #1
    Senior Member ResonantEcho's Avatar
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    Culture and Sensitivity Report (HOW TO INTERPRET)

    According to the following information, what medication should be prescribed? And can someone explain how to read the report and the meaning on what is reported?:

    Release D/T: >100,000 CFU/ML GRAM NEGATIVE RODS
    >100,000 CFU/ML ESCHERICHIA COLI

    E COLI
    Antimicrobial MIC mcg/ml Int
    --------------------------------------------------------
    AMPICILLIN 4 S
    AMOX/CLAV ACID <=8/4 S
    AMP/SULBACT <=8/4 S
    AMIKACIN <=16 S
    CEFAZOLIN <=8 S
    CEFOTAXIME <=8 S
    CEFUROXIME <=4 S
    CIPROFLOXACIN <=1 S
    NITROFURANTOIN <=32 S
    GENTAMICIN >8 R
    IMIPENEM <=4 S
    LEVOFLOXACIN <=2 S
    PIPERACILL/TAZO <=16 S
    TRIMETH/SULFA <=2/38 S
    TETRACYCLINE <=4 S
    TOBRAMYCIN 4 S
    CEFEPIME <=8 S
    AZETREONAM <=8 S
    CEFTRIAXONE <=8 S
    TRIMETHOPRIM <=8 S

    Guessing I would say I should have been prescribed TRIMETH/SULFA. Was prescribed LEVOFLOXACIN.
    -ResonantEcho - T6/T7 Complete - October 31st, 1986

  2. #2
    Senior Member alan's Avatar
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    Do a search for the number 100,000 - I believe the nurses have said on numerous occasions that if the count is above 100,000, you should be prescribed an antibiotic. My memory isn't the greatest, so see what the search shows you.
    Alan

    Proofread carefully to see if you any words out.

  3. #3
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    It was Sensitive to everything but gentamicin anyway, the doc picked levofloxacin because he feels comfortable with it and is probably avoiding TMP-SMX because of frequent adverse events like skin rash. As I said it often, in vitro sensitivity is not the whole portrait. I hope you get better on levofloxacin.
    Pharmacist, C4-5 injury but functional C6 (no triceps/flexors)

  4. #4
    Senior Member ResonantEcho's Avatar
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    Quote Originally Posted by JGNI
    It was Sensitive to everything but gentamicin anyway, the doc picked levofloxacin because he feels comfortable with it and is probably avoiding TMP-SMX because of frequent adverse events like skin rash. As I said it often, in vitro sensitivity is not the whole portrait. I hope you get better on levofloxacin.
    So what do the numbers mean?

    He originally prescribed me Levofloxacin before knowing what bacteria was present. A few days after taking final pill (7 days, 1 a day), I started noticing strings of something or another coming out of my bladder (some here have described it as looking like egg whites). However, I wasn't running a fever. Now the egg whites have subsided but urine is VERY cloudy but I am still not running a fever. I just have some discomfort in my stomach.

    He prescribed me Trimeth/Sulfa (2 a day for 10 days). I noticed a few messages here in the past said if fever wasn't present anti-biotics should not be taken. Should I hold off and see if the cloudiness eventually subsides?

    From report, am I correct by saying Trimeth/Sulfa did show to be the most sensitive to bacteria? Then Amox/Clav Acide and Amp/Sulbact? Then Ciprofloxacin? Levofloxacin being 5th sensitive?
    -ResonantEcho - T6/T7 Complete - October 31st, 1986

  5. #5
    The report shows >100,000 bacterial colonies of the bug e.coli.
    A UTI is present when the colony count is >100,000 though infections are usually only treated when the colony count is present along with a fever or a rise in the wbc count. Most people with catheters will show >100,000
    counts all the time, called colonization.

    The sensitivities show the drugs that your laboratory has tested against this e coli germ. If it is "S" sensitive, it can work effectively with e coli. The MIC (minimum inhibatory concentration) is the dilution of this drug at which the germ can no longer grow. All of the "S" meds usually work but some clinicians use the MIC to guide them in more complex situations.

    AS mentioned above, the urine culture results are valuable but the choice of antibiotic is also determined by allergies, ease of dosing and pts compliance history.

    AAD

  6. #6
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    ResonantEcho,

    You are right by understanding that the lower the MIC the better, meaning that you will not need to reach very high concentrations of the antibiotic to kill the bacteria, that's the concept. Those in vitro analysis are telling you just that. BUT, all antibiotics are not reaching the same concentrations everywhere in your body. So if the antibiotic is mainly excreted in the urine, no matter if the MIC of this antibiotic is high, it will probably exceed it there in the urine and it will work. On the other hand, even if an antibiotic had a low MIC (it's all theory here), if none of it was to reach your bladder it would be of no use. Determination of susceptibility for most antibiotics (don't put nitrofurantoin among these) is established on the expected concentration you will be able to reach in your blood so that if the bacteria gets there (that's where it can become life threatening) it will be killed, R if it will not, S if it will. So you understand it can be different for urine.

    Here are some factors influencing the choice of the antibiotic:

    - Susceptibility patterns
    - Safe achievable serum levels
    - Distribution of antibiotic in tissues
    - Route of excretion
    - Toxic side effects
    - Existing or developing renal or hepatic failure
    - Absorption characteristics
    - Existing or developing allergic reactions
    - Antibiotic interactions with other drugs
    - Cost

    You usually treat infections when symptomatic, which means anything causing you problems, not just fever. If you are nauseous, even without fever, it can be a good reason to treat it etc. Many factors are involved, the PERSON is treated, not just lab results or symptoms, so it is hard to give a clear answer to when to treat or not.

    By the way, in my experience, levofloxacin once a day has never been a very good choice in complicated UTI's (ours).
    Last edited by JGNI; 08-14-2006 at 11:30 PM.
    Pharmacist, C4-5 injury but functional C6 (no triceps/flexors)

  7. #7
    Hi there.
    I have a question.
    So from his list above seeing Ampicillin as a MIC of 4, Cipro as a less than 1, Cefazolin as less than 8, and macrobid less than 32, does that mean Ampicillin since it is positive 4 would not work at well as Cipro which is less than 1? Also, would Cefazolin being less than 8 be better than Cipro which is less than one or does it just have to have an S?
    I am asking because I just got results for having Enterococcus Faecalis and was told Ampiclin is less than 2, Penicillin is 2 and Nitrofutantoin is less than 32 but I had a bad reaction to Nicrotfutantion once so I am scared to go on that one. Do I have to go on Nitrofutation since it has the lowest number or should Ampicillin being less than 2 be an ok choice as well? How about Penicillin being a 2 (not greater or less than, just says 2)
    Your help in understading this would be most appreciated

  8. #8
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    As long as it is susceptible (S), you should be fine. If possible, avoid what you did not tolerate well in the past.
    Pharmacist, C4-5 injury but functional C6 (no triceps/flexors)

  9. #9

    If amount of Enterococcus Faecalis is less than 100,000cfu/ml

    Thanks for the quick reply
    A few more questions if I may...

    Question #1. The amount of bacteria in my urine wasnt the 100,000+ cfu/ml mentioned by someone above to be considered a full blown UTI, it was between 10,000 - 20,000 cfu/ml so they said it is mild low level UTI but I feel like I have to pee every half hour, even after I pee I feel a few minutes later like I have to pee so even though the count is low, you can still go on antibiotic right? Ampicillin came back as an "S" with less than 2 and Penicillin as an "S" and positive 2, so I think I will try the Ampicillin. Only other two that came back with "S" as well were Cipro less than 1 and Nitrofurontoin less than 32 but I have had bad experiences on both Cipro and Nitro (Macrobid) so I think I will try the Ampicillin. It says usually you take 500 mg 3 - 4 times a day for 7-14 days. Any thoughts on how long to stay on to be sure to kick it? 7 days, 10 days, 14 days?

    I think I got the UTI from taking a hot bath and not showering before. I showered after.
    I hadnt showered since two days before and I pee'd in the bath when I was laying in it. Dont know if that let some bacteria maybe from hot bath tub water get into my urethra.
    I layed in the hot bath to relax for 20 minutes then showered after but dont think I pee'd again for a few hours.
    I also remember laying on the couch later that night and having to pee but holding it for a while cause I was tired and didnt feel like getting up.
    Next morning, boom, constant pee feeling
    My nitrites and leukocytes came back negative as well but the pee feeling I have had for days and it isnt subsiding.

    Question #2. I have been taking D'mannonse as well, 1000 mg every 3-4 hours for the past 2 days but i read on internet it is only good for ecoli bacteria. I have Entercoccus Faecalis. Do you know if D'mannonse could help with that one as well?

    Question #3. Lastly, could this possibly clear up without antibiotics or probably not and I should go on them?

    Again thank you in advance for any help you can give me with this topic. This is my first UTI...ever and hopefully will go away as quickly as it came!!!

  10. #10
    Feelbetter, what you your disability that causes your neurogenic bladder? Or are you able bodied? UTIs are diagnosed differently in people with SCI or other causes of neurogenic bladder, and treated differently also. These forums are designed for those who have these conditions, and are not set up to answer general health questions for people who do not have a SCI or spinal cord disease.

    (KLD)

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