Evaluation of an improved rapid coagglutination method for the serological grouping of beta-hemolytic streptococci

Reduction of morbidity and mortality rates for neonatal group B streptococcal disease through early diagnosis and chemoprophylaxis

Pregnant women, part of the term service population at Orlando Regional Medical Center, were screened for group B streptococci (GBS), using Lim Group B Strep Broth (GIBCO Laboratories, Madison, Wis.) and the Phadebact Strep B Test (Pharmacia Diagnostics, Piscataway, N.J.). Of the 803 women screened, 173 were confirmed as colonized with GBS at the time of admission in labor. Eighty of these women were treated with ampicillin at least 6 h prior to delivery. The remaining 93 women received no ampicillin. None of the infants born to the treated women was colonized with GBS at surface culture sites. Forty-three of the infants born to untreated women were colonized. Rapid identification of GBS colonization in women, combined with ampicillin chemoprophylaxis, significantly reduced vertical transmission of GBS.

Determination of the O-serovars of Pseudomonas aeruginosa by slide coagglutination

Determination of the somatic (O-) antigens of Pseudomonas aeruginosa by conventional slide agglutination is frequently complicated by the barely discernible, slow reaction of native cells. For diagnostic purposes a more practical procedure, a coagglutination test, has been developed in which protein A bearing Staphylococcus aureus (ATCC 12598) cells are added to the agglutination process occurring between specific anti-O serum and native Pseudomonas aeruginosa. Compared to the conventional method, slide O-coagglutination yields larger agglutinates in a shorter mean reaction time, i.e. one minute vs four minutes. Moreover, strains not reacting in the O-agglutination method or reacting only with polyvalent anti-O serum can be grouped by O-coagglutination, and cross reactions between reference strains of different O-groups do not occur. This method facilitates O-grouping of Pseudomonas aeruginosa in epidemiological investigations.

Elimination of multiple reactions of the Phadebact Streptococcus coagglutination test

Strong multiple reactions often occur with the Phadebact Streptococcus test when the culture contains blood. These reactions interfere with the identification of the Lancefield groups of streptococci. Group B streptococci from the vagina of pregnant women are difficult to identify by slide coagglutination because of the frequent presence of blood on culture swabs. Elimination of these multiple reactions caused by blood would permit rapid identification of group B streptococci in pregnant women. Vaginal broth cultures were examined to determine the cause of multiple reactions with slide coagglutination and to eliminate them from the testing procedure. Of 245 maternal broth cultures, 135 (55%) yielded multiple reactions when tested by coagglutination. Such reactions were either eliminated or greatly diminished by heating the broth sample to 90 degrees C for 10 min. It was also found that globulins in the serum may be responsible for multiple reactions with blood. This heating protocol will permit vaginal broth cultures to be rapidly tested for group B streptococci by slide coagglutination.

Rapid identification of pregnant women heavily colonized with group B streptococci

Pregnant women admitted to Tampa General Hospital, Tampa, Fla., were cultured for group B streptococci (GBS). Culture swabs were placed into enriched, selective Todd-Hewitt medium and were quantitated for GBS. The broth cultures were tested by slide coagglutination before incubation and after 5 and 20 h of incubation. Fifty-four (27%) of the 201 maternity patients cultured were positive for GBS and were identified as such by slide coagglutination. A strong correlation was found between the magnitudes of colonization and the times required to identify the broth cultures as GBS positive. Cultures from mothers heavily colonized (mean concentrations of 3 X 10(4) GBS per culture swab or greater) were identified after 5 h or less of incubation. Mothers lightly colonized with GBS (mean concentrations of 2 X 10(2) GBS per culture swab) were identified only after their broth cultures had been incubated for 20 h.

Evaluation of Phadebact and Streptex Kits for rapid grouping of streptococci directly from blood cultures

The Phadebact Streptococcus Test and the Streptex Test kits were evaluated for grouping streptococci directly from blood cultures. Pellets of bacteria obtained from centrifuged samples of positive blood cultures were inoculated into Todd-Hewitt broth for 2- and 4-h Phadebact tests and into pronase for Streptex tests. Hemolysis was determined after pipetting a portion of each pellet into cuts made in blood agar plates incubated anaerobically for 2 to 6 h. Serological groups were also determined from colonies of the 137 strains of streptococci used in the study by the Lancefield precipitin method. Of the 126 strains tested by the 4-h Phadebact method, 120 (95.2%) agreed with Lancefield groupings, and 133 (97.1%) of the 137 strains tested by Streptex were in agreement. In contrast, only 31 of 55 strains (56.4%) were correctly identified by the 2-h Phadebact method. Misidentifications were related to multiple agglutinations and weak agglutinations in homologous antisera. Group A isolates were most frequently misidentified by all of the test methods. Hemolysis was determined within 4 h for 92.7% of the isolates and within 6 h for the remaining strains. Although the 4-h Phadebact procedure and the Streptex procedure were comparable in overall accuracy, cost, and technologist time, Streptex was the method of choice for direct groups. Results were available within 75 min for the Streptex procedure compared with 4 h for the Phadebact method. Because few cross-reactions occurred, agglutination responses were clearer and easier to interpret. Results from 2-h Phadebact tests were not satisfactory, and this method is not recommended.

The systems approach to diagnostic microbiology

"Classical" and "conventional" methods for microbial identification are still utilized in clinical microbiology laboratories; however, significant advances in methodology have taken place in the last two decades. In the transition from classical to contemporary methodologies, the reference point has changed from multistep procedures to unitary procedures with marked emphasis on standardization, speed, reproducibility, and most recently, mechanization and automation. The most evident expression of this transition is the adaptation or streamlining of classical methods in the form of "miniaturized identification systems" and their commercial availability. This review analyzes the development of the underlining principles that make the systems approach to diagnostic microbiology possible.

Evaluation of three commercially available test products for serogrouping beta-hemolytic streptococci

Three beta-streptococci serogrouping kits, Phadebact, SeroSTAT, and Streptex, were evaluated as to their sensitivity, accuracy, and suitability as methods for serogrouping streptococci in a clinical microbiology laboratory. The majority of the primary isolates examined by the various methods associated with each of the three kits were correctly identified. The Streptex direct mixed-culture procedure was more often associated with the observation of cross-reactivity than with the direct procedures of the other two kits which did not employ mixed growth cultures. Furthermore, the Streptex kit was associated with more false-negative responses than those determined by the other two kits under evaluation. These results appeared to be due to the relatively poor sensitivity of the Streptex grouping reagents. The Streptex test procedures required more labor than the other kit procedures, requiring a 1-h enzymatic extraction step for the release of the group antigens. The SeroSTAT kit provided only a direct procedure and, thus, is limited in its application. The Phadebact procedures were the most versatile by providing not only a direct and a 24-h grouping procedure, but also by including a 4-h method that may be employed as required by the clinical microbiologist.