Gram-negative rods: Enterobacteriaceae Part I Karen Honeycutt, M.Ed., MT(ASCP)SM CLS 418 Clinical Microbiology I Student Laboratory Session Microbiology Differentiation of Major GNR Genera (there are many!) • Utilization of Glucose – Ferment “F”, oxidize “O” or inactive “I” or “N” • Oxidase – Positive or negative • Ability to grow on MacConkey agar – Some GNRs that grow on BAP are unable to grow on MacConkey agar Microbiology GNR: Enterobacteriaceae General Information • Most common GNR in clinical specimens • Widely dispersed in nature, soil, human GI tract • Certain Enterobacteriaceae are endemic to a particular hospital environment, for example: – Klebsiella sp., Enterobacter sp., Serratia sp. and other opportunistic pathogenic enterics Microbiology GNR: Enterobacteriaceae Host – Enteric Interactions • Normal flora of GI tract, skin of GU tract • Colonization of skin & mucous membranes: hospitalized patients – Potential source for nosocomial infections • Overt or primary pathogens: always considered pathogenic or source of infection, for example: Shigella, Salmonella, Yersinia, E. coli O157:H7 Microbiology GNR: Enterobacteriaceae Host – Enteric Interactions • Opportunistic pathogens – Immunosuppressed, debilitated – Can be passed from person to person – Endogenous strains for host can cause infection in normally sterile sites or if overgrown (normal flora bacterial balance disrupted….antibiotics) – Nosocomial infections – often after an invasive procedure Microbiology GNR: Enterobacteriaceae Host – Enteric Interactions • Endotoxic shock – Endotoxin – lipopolysaccharide contained within cell wall – Bacteria are lysed exposing endotoxin (antibiotics, immune system-complement, aging bacterial cells,) – “Septic shock” – fever, leukopenia, capillary hemorrhage, hypotension, circulatory collapse Microbiology GNR: Enterobacteriaceae Isolation • Growth on BAP at 24 hrs, ambient air, CO2 or anaerobically (facultative anaerobe) • In general colony morphology: large, gray, beta- or nonhemolytic (normally larger than Staph, Strep, & Enterococci) Microbiology GNR: Enterobacteriaceae Isolation – MacConkey Agar (Pink) • Selective (gnrs) & differential medium General purpose – Lactose F = pink Lactose NF = clear – pH indicator in agar Lactose F = pH = pink color Microbiology GNR: Enterobacteriaceae Isolation – EMB Agar (Pink) • Selective (gnrs) & differential medium General purpose – Lactose &/or sucrose F = pink E. coli = metallic green sheen NL & NSF = clear colonies Microbiology GNR: Enterobacteriaceae Isolation – SS Agar (Pink) • Selective (gnrs) & differential medium Stool cultures - Lactose “F”& H2S production Lactose F = pink colonies Lactose NF = colorless colonies H2S + = black ppt. Microbiology GNR: Enterobacteriaceae Isolation – HE Agar (Green) • Selective (gnrs) & differential medium Stool cultures - Lactose & sucrose “F” & H2S Lactose &/or sucrose F = yellow/orange colonies Lactose & sucrose NF = colorless or blue-green H2S + = black ppt. Microbiology GNR: Enterobacteriaceae Isolation – XLD Agar (Red) • Selective (gnrs) & differential medium Stool cultures – Lactose, sucrose & xylose “F”& H2S Lactose &/or sucrose &/or xylose F = yellow Lactose, sucrose & xylose NF = colorless/red H2S + = black ppt. Microbiology GNR: Enterobacteriaceae Other Isolation Media • MacConkey Sorbitol – E. coli O157:H7 • CIN or Yersinia selective • Gram-negative broth – enrichment medium selectively enriched to promote Salmonella & Shigella (cost effective?) • Phosphate bufferd saline – cold enrichment Yersinia entercolitica will grow in 4˚C Microbiology GNR: Enterobacteriaceae Main Characteristics GNR Glucose “F” Oxidase negative Reduce nitrate to nitrite NO3 to NO2 Facultative anaerobes Able to grow on MacConkey agar Catalase positive: most GNRs are +, therefore not routinely performed unless CAT (-) GNR is suspected Microbiology GNR: Enterobacteriaceae Biochemical Tests: CHO Utilization: Glucose “I” or “N” Microbiology “O” “F” GNR: Enterobacteriaceae Biochemical Tests: CHO Utilization: Lactose • Disaccharide: glucose +galactose Beta-galactoside permease Beta-galactosidase • LF: have both enzymes NLF: have neither Slow LF: have beta-galactosidase but lack the permease enzyme Microbiology GNR: Enterobacteriaceae Biochemical Tests: Kligler’s Iron Agar Contains CHOs: Glucose & Lactose (10x) Uninoculated Glucose & lactose nonfermenter Microbiology Glucose “F” Glucose “F” & Lactose “F” Glucose “F” H2S + Glucose “F” & Lactose “F” H2S + ONPG • Detects delayed lactose F Organisms that have beta-galactosidase but not the permease enzyme Negative Microbiology Positive GNR: Enterobacteriaceae Biochemical Tests: Other Carbohydrates Microbiology GNR: Enterobacteriaceae Biochemical Tests: Indole Production Positive Microbiology Negative GNR: Enterobacteriaceae Biochemical Tests: Spot Indole Positive Microbiology GNR: Enterobacteriaceae Biochemical Tests: Citrate Utilization Utilize citrate as a sole carbon source Negative Microbiology Positive GNR: Enterobacteriaceae Biochemical Tests: Urease Production Hydrolysis of Urea = increased pH Negative Microbiology Positive Strongly Positive GNR: Enterobacteriaceae Biochemical Tests: Decarboxylation of specific amino acid Media contains one of the following amino acids: arginine, lysine or ornithine Inoculate & overlay with oil Microbiology Decarboxylase + = alkaline product = dark purple GNR: Enterobacteriaceae Biochemical Tests: Ornithine Decarboxylase ODC & MIO agar: must be a glucose “F” Only Glucose “F” Negative Microbiology Positive GNR: Enterobacteriaceae Biochemical Tests: Lysine Iron Agar Organism must ferment glucose; detects deamination or decarboxylation of lysine & H2S production LDC (-), LDA (-) Only Glucose “F” Uninoculated Microbiology LDC (-), LDA (-) H2S + Only Glucose “F” LDA+ LDC+ LDC+ H2S + LDA+ & H2S +