Evaluation of the Usefulness of MacConkey Agar and Colistin-Nalidixic Acid Blood Agar for Body Fluids, Peritoneal Fluid, and Wound/Abscess Specimens

Jayoung Kim; Sung-il Cho; Yong-Kyun Kim; Yeon-Joon Park

doi:10.5145/ACM.2015.18.1.1

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Kim, Cho, Kim, and Park: Evaluation of the Usefulness of MacConkey Agar and Colistin-Nalidixic Acid Blood Agar for Body Fluids, Peritoneal Fluid, and Wound/Abscess Specimens

Original Article

Ann Clin Microbiol 2015;18(1):1-6.

Published online: 5 March 2015

DOI: https://doi.org/10.5145/ACM.2015.18.1.1

Evaluation of the Usefulness of MacConkey Agar and Colistin-Nalidixic Acid Blood Agar for Body Fluids, Peritoneal Fluid, and Wound/Abscess Specimens

Jayoung Kim¹, Sung-il Cho², Yong-Kyun Kim³, Yeon-Joon Park⁴

¹Department of Laboratory Medicine, International St. Mary's Hospital, The Catholic Kwandong University of Korea, Incheon, Korea

²Department of Laboratory Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea

³Samkwang Medical Laboratories, Seoul, Korea

⁴Department of Laboratory Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea

Correspondence: Yeon-Joon Park, Department of Laboratory Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul 137-701, Korea. (Tel) 82-2-2258-1640, (Fax) 82-2-2258-1719, (E-mail) yjpk@catholic.ac.kr

Received 5 September 201426 November 2014 Accepted 15 December 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

Background

Most clinical microbiology laboratories in Korea have difficulty in following the recommendations of the clinical procedure handbook for culture of body fluid and wound/abscess specimens. We evaluated the usefulness of MacConkey (MAC) and coli-stin-nalidixic acid blood agar (CNA) for the isolation of pathogens from these specimens.

Methods

A total of 1,508 clinical specimens [144 peritoneal fluid, 241 body fluids (19 bile, 70 joint fluid, 6 pericardial fluid, 104 pleural fluid, and other fluids in 42 cases) and 1,123 wound/abscess] were inoculated onto basic media [Blood agar plate (BAP), chocolate agar or BAP with streaking of Staphylococcus aureus] and simultaneously inoculated onto MAC and CNA. The pathogens isolated by basic media and by additional use of MAC and/or CNA were compared.

Results

With basic media, 885 isolates from 588 specimens were detected, and by additional use of MAC and CNA, an additional 27 isolates from 24 specimens and an additional 128 isolates from 112 specimens were isolated, respectively. Compared to the basic media, by adding MAC, an additional 233.3%, 38.5% and 4.5% of gram-negative bacteria were isolated from peritoneal fluids, body fluid and wound/abscess, respectively, and by adding CNA, an additional 106.7%, 45.0%, and 20.7% of gram-positive bacteria/yeast were isolated, respectively. The isolates detected by additional use of MAC were mainly Enterobacteriaceae (77.0%), and those detected by CNA were S. aureus (21.1%), Coagulase-negative Staphylococcus spp. (20.3%), Enterococcus spp. (16.4%), Streptococcus spp. (10.2%) and yeasts (16.4%).

Conclusion

For peritoneal fluid and body fluid specimens, additional use of MAC plus CNA seems nec-essary for detection of pathogens. For wound/abscess, additional use of CNA will be cost effective.

Keywords: Body fluids, Colistin-nalidixic acid blood agar, McConkey agar, Peritoneal fluid, Wound/Abscess

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Table 1.

Number of positive specimens and isolates by basic media, only MAC plate and CNA plate

	Peritoneal fluid∗ (n=144)			Body fluids† (n=241)			Wound/Abscess (n=1,123)			Total (n=1,508)
	BM‡	Only MAC	Only CNA	BM‡	Only MAC	Only CNA	BM‡	Only MAC	Only CNA	BM‡	Only MAC	Only CNA
No of positive specimens	15	6	14	26	4	8	547	14	90	588	24	112
Single pathogen		5	13		3	8		5	14		13	35
Mixed pathogens		1	1		1	0		9	76		11	77
No of isolates	18	7	16	33	5	9	834	15	103	885	27	128
GPB	8		14	17		8	478		84	503		106
GNB	3	7		13	5		336	15		352	27
Fungi	7		2	3		1	20		18	30		21
Mycobacterium									1			1

^∗ Peritoneal fluid including ascites, abdominal fluid, paracentesis, and CAPD;

^† Body fluids including joint fluid, bile, pericardial fluid, pleural fluid and other body fluids;

^‡ Basic media including blood agar plate, (BAP), and chocolate agar or BAP with streaking of S.aureus.

Abbreviations: BM, basic media; MAC, MacConkey; CNA, Colistin-nalidixic acid blood agar.

Table 2.

Number of bacterial isolates by basic media, only by MAC plate or CNA plate according the specimen types

Microorganism	Peritoneal fluid∗ (n=144)			Body fluids† (n=241)			Wound/Abscess (n=1,123)			Total (n=1,508)
Microorganism	BM‡	Only MAC	Only CNA	BM‡	Only MAC	Only CNA	BM‡	Only MAC	Only CNA	BM‡	Only MAC	Only CNA
GP	8		14	17		8	478		84	503		106
S. aureus			2	9		4	229		22	238		28
CNS	4		2	3		3	105		20	112		25
Enterococcus spp.	4		7	5			69		14	78		21
Streptococcus spp.			3			1	25		9	25		13
S. pneumoniae							3			3
S. pyogenes						1	1		1	1		2
S. agalactiae							5		2	5		2
Group C							2		1	2		1
Group G			1				5			5		1
Viridans group			1				9		4	9		5
Others			1						1			2
Corynebacterium spp.							42		12	42		12
Other GP†							8		7	8		7
GN	3	7		13	5		336	15		352	27
Enterobacteriaceae	1	5		9	4		154	10		164	19
E. coli	1	1		2	2		49	4		52	7
K. pneumoniae		2		5	1		46	2		51	5
P. mirabilis							24			24
E. cloacae		1		2	1		11	2		13	3
S. marcescens							11			11
Other EN		1					13	2		13	4
NE	2	2		4	1		178	5		184	8
P. aeruginosa	2	2		3	1		89	3		94	6
Acinetobacter spp.				1			78	2		79	2
Other NE							11			11
Other GN							4			4
Fungi	7		2	3		1	20		18	30		21
Candida spp.§	7		2	3		1	20		15	30		18
Other fungi									3			3
Mycobacterium spp.									1			1
Total isolates	18	7	16	33	5	9	834	15	103	885	27	128

^∗ Peritoneal fluid including ascites, abdominal fluid, paracentesis, and CAPD;

^† Body fluids including joint fluid, bile, pericardial fluid, pleural fluid and other body fluids;

^‡ Basic media including Blood agar plate (BAP), and chocolate agar or BAP with streaking of S. aureus;

^§ Candida spp. including Candida albicans, C. parasillosis,, C. famata, C. tropicalis, C. lusitanie, C. glabrata, and Candida spp.

Abbreviations: BM, Basic media; MAC, MacConkey; CNA, Colistin-nalidixic acid blood agar; GP, Gram positive bacteria; GN, Gram negative bacteria; EN, Enterobacteriaceae; NE, Non-Enterobacteriaceae.

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