Indian Journal of Medical Microbiology, (2011) 29(4): 443-9. Correspondence. Comment on: Yeast identification in routine clinical microbiology laboratory and ...
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October-December 2011 Microbiology, (2011) 29(4): 443-9 Correspondence Indian Journal of Medical
443
Correspondence
Comment on: Yeast identification in routine clinical microbiology laboratory and its clinical relevance Dear Editor,
References
I read the recent publication on yeast identification in routine clinical microbiology laboratory and its clinical relevance with great interest.[1] The authors conclude that the use of chromogenic medium with morphology on CMA provides rapid and accurate identification of commonly isolated single or multispecies yeast. However, we have the following concern.
1. Agarwal S, Manchanda V, Verma N, Bhalla P. Yeast identification in routine clinical microbiology laboratory and its clinical relevance. Indian J Med Microbiol 2011;29:172-7. 2. Baradkar VP, Mathur M, Kumar S. Hichrom Candida Agar for identification of Candida species. Indian J Pathol Microbiol 2010;53:93-5.
In the present study, the yeast isolates were identified on the basis of growth on Cornmeal Agar through slide culture. The slide culture technique in mycology is used to study the undisturbed morphological details of the mycelial fungi. The advantage of using slide culture for yeast identification is not understandable when similar results can be achieved on CMA on a petri dish. The authors have included chromogenic media for confirmation of yeast identification. In the present study, the striking similar results on the chromogenic media and CMA can be an observer bias. In a recent publication by Baradkar et al, sensitivity and specificity for different Candida species have been reported to be variable.[2] Also, absent from this study was estimation of the sensitivity and specificity of yeast identification by various methods. For yeast identification, biochemical tests like sugar fermentation and assimilation are of immense importance and cannot be overlooked.
*Juhi Taneja, Jagdish Chander Consultant Microbiologist (JT), Dr Dang’s Laboratory, Hauz Khaz, New Delhi, Department of Microbiology (JC), Government Medical College, Hospital, Chandigarh, India. *Corresponding author (email: ) Received: 20-09-2011 Accepted: 19-10-2011
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Omission of extended spectrum β lactamases detection: Are the new Clinical Laboratory Standards Institute guidelines misleading? Dear Editor, Emerging bacterial resistance is the most serious problem being faced in the clinical practice today. Antibiotic susceptibility testing (AST) is the most valuable tool at the disposal of microbiology laboratory to offer assistance to the clinicians to arrive at an appropriate therapeutic conclusion. Many laboratories engaged in AST are following the guidelines defined by the Clinical Laboratory Standards Institute (CLSI) for testing and interpretation of results. As per the latest (2010) guidelines of CLSI,[1] new interpretive criteria for cephalosporins including cefazolin, cefotaxime, ceftazidime, ceftizoxime ceftriaxone and aztreonam are suggested and extended spectrum β lactamase
(ESBL) detection is no longer necessary to edit results for cephalosporins, aztreonam or penicillins to resistant. The bacteriology section of Microbiology department in the Grant Medical College and Sir J J Group of Hospitals, Mumbai, started implementing the new criteria since August 2010 but also continued ESBL testing as per the CLSI 2009[2] guidelines. In the past six months we have observed that many strains of gram negative bacilli which are resistant to third generation cephalosporins have produced zones in the susceptible range for piperacillin. All these strains were also ESBL producers, hence as per 2009 criteria, fall in the category of resistant strains and should be reported as such. However with the new criteria, in the absence of ESBL testing, such strains might erroneously be reported
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