TMrg;karbec©keTs mnÞIrBiesaFn¾CamUldæan enAkñúgKøInik)ak;etrIsaRsþ

(1)

TMrg;karbec©keTs mnÞIrBiesaFn¾CamUldæan

enAkñúgKøInik)ak;etrIsaRsþ

kare)aHBumÖpSayelIkTI2

GgÁkarsuxPaBBiPBelak TIRkughSWENv

(2)

TMrg;karbec©keTs

mnÞIrBiesaFn¾CamUldæan

enAkñúgKøInik)ak;etrIsaRsþ

(3)

TMrg;karbec©keTs

mnÞIrBiesaFn¾CamUldæan enAkñúgKøInik)ak;etrIsaRsþ

kare)aHBumÖpSayelIkTI2

J. Vandepitte and J. Verhaegen Department of Microbiology

St Rafaël Academic Hospital Leuven, Belgium

K. Engbaek

Department of Clinical Microbiology University of Copenhagen

Herlev Hospital Herlev, Denmark P. Rohner

Department of Clinical Microbiology Cantonal University Hospital

Geneva, Switzerland P. Piot

Join United Nations Programme on HIV/AIDS Geneva, Switzerland

C. C. Heuck

World Health Organization Geneva, Switzerland

World Health Organization Geneva

2003

(4)

(5)

matika

GarmÖkfa 5 esckþIepþIm 6 karFanaKuNPaBenAkñúg)ak;etrIsa®sþ 7

esckþIepþIm 7 niymnn½y 7 kar®tYtBinitüKuNPaBépÞkñúg 13

karvaytMélKuNPaBBIxageRkA 29 PaK 1 karRsavRCav)ak;etrIsa®sþ 32

Qam 33 esckþIepþIm 33 etI Bacteraemia GacekIteLIgenAeBlNa nig TIkEnøgNa ? 33

karbUmykQam 34 fñalsRmab;bNþúHQam 36 dMeNIrkarénkarbNþúHQam 37

TwkxYrq¥wgxñg (Cerebrospinal fluid (CSF)) 40

esckþIepþIm 40

karbUmykvtßúviPaK nig karbBa¢Ún 40

karBinitüedayEPñkTeT 41 karBinitüedayeRbImIRkUTsSn_ 41

karviPaKCabzm 45

etsþedIm,Ivas;GMBIPaBsuaMnwgfñaM (Susceptibility testing) 46

Twkenam 47 esckþIepþIm 47 karykvtßúviPaK 48

karbNþúH nig karbkRsaylT§pl 50

karbkRsaylT§plkarbNþúH Quantitative rbs;Twkenam 54

(6)

karviPaK (Identification) 55

etsþrkPaBsuaMrbs;)ak;etrIeTAnwgfñaM (Susceptility Tests) 56

lamk 57 esckþIepþIm 57

Pñak;garbgáehtu nig sBaØaKøIniksMxan;² 58

kareRbIR)as;FnFanenAkñúgmnÞIrBiesaFn_RtwmRtUv 61

karyk nig kardwkCBa¢ÚnvtßúsMNaklamk 61

karBinitüsMNaklamkedayEPñkpÞal; 63 rebobbNþúHenAelIfñalbNþúHEdlsm,ÚredaycMNIGahar 64

fñalbNþúHsRmab;bNþúHBYk)ak;etrIbgáeraKkñúgeBaHevon 64

karbnSúT§bzm 66 karviPaKdMbUgénemeraKEdlbNþúH 68

karviPaKrkemeraKedaymIRkUTsSn¾CacugeRkay 77

karviPaKedayeRbIetsþesr:Umsa®sþ (Serological identification) 84

karlakpøÚvdegðImEpñkxagelI 92

esckþIepþIm 92

emeraKFmμtaenAkñúg ^Pharynx 92

)ak;etrIEdlbgá[rlak ^Pharynx 93

karyk nigkarbBa¢ÚnvtßúviPaK 96

karBinitüpÞal;edaymIRkUTsSn_ 96

karbNþúH nigkarviPaK 96

kareFIV ^Test Gg;TIb‘Íy:URkam 99

CMgWrlakpøÚvdegðImEpñkxageRkam (Lower Respiratory Tract Infection) 100

esckþIepþIm 100 karbgáeraKEdlCYbjwkjab;CageK 100

karykkMhak 102 dMeNIrkarénkarBinitükMhakenAkñúgmnÞIrBiesaFn_ ¬sMrab;karbgáeraKEdlminEmnCaeraKrebg¦ 103

karbNþúHrk Mycobacterium tuberculosis 108

karbkRsaylT§plénkarbNþúHrk M. tuberculosis 111

suvtßiPaBkñúgkarbMeBjkargar 112

(7)

Cm¶WkameraK 113 esckþIepIþm 113 rlakbgðÜrenamburs 114

vtßúviPaKykecjBIRbdab;ePTrbs;RsþI 118 vtßúviPaKEdlykecjBIdMe)ARbdab;bnþBUC 122

TwkrégmanxÞúH dMe)A nigbUs 127

esckþIepþIm 127 lkçN³KøIniksMxan;²EdlCYbRbTHjwkjab; nigPñak;garbgáeraKsMxan;² 128

karyk nigkardwkCBa¢ÚnvtßúviPaK 131

karviPaKelIsPaBxageRkA 133 karBinitüedaymIRkUTsSn_ 134

karbNþúH 136 karviPaK 138 etsþGg;TIb‘Íy:URkam 143

karsikSaBI)ak;etrIEdlminRtUvkarxül; (Anaerobic bacteriology) 144

esckþIepþIm 144

karBiBN’naBI)ak;etrI Tak;TgnwgtRmUvkarGuksIuEhSn 144

)ak;etrIsaRsþ 145

etsþGg;TIb‘Uy:URkam (Antimicrobial susceptibility testing) 152

esckþIepþIm 152 eKalkarN_TUeTAénetsþGg;TIb‘ÍyU:Rkam 153

niymn½yKøInikénBakü {Fn;} nig {sg;sIub{ ¬RbB½n§ 3-RbePT¦ 153

karENnaMGMBIkareRbIetsþGg;TIb‘Íy:URkamEdlGnuvtþRbcaMéf¶ 155 kareRCIserIsfñaMsMrab;kareFVIetsþGg;TIb‘Íy:URkamRbcaMéf¶enAkñúgmnÞIrBiesaFn_KøInik 157

bec©keTsEksMrYl Kirby-Bauer 161

etsþGg;TIb‘Íy:URkamedaypÞal; nigedayRbeyal 170

ktþabec©keTsEdlb:HBal;dl;TMhMtMbn;KμanemeraKduHkñúgviFI Disc-diffusion 170

karRtYtBinitüKuNPaB 173

(8)

etsþesr:UmsaRsþ 175 esckáIepþIm 175 karvas;EvgkarRtÜtBinitüKuNPaB 176

RbtikmμenAkñúgetsþesr:UmsaRsþ 179

etsþesr:UmsaRsþsMrab; ^Syphilis 181

etsþ Febrile agglutinins 191

etsþ Antistreptolysin O (ASO) 195

etsþGg;TIEhSn)ak;etrI 198

PaK 2 fñalbNúþHCasarvnþ½ nig Rbtikr 201

esckþIepþIm 202

emeraK fñalbNþúHnigRbtikrsMrab;rkeraKvinic½äy 203

Qam 204 TwkxYrq¥wgxñg 205 Twkenam 206 lamk 207 pøÚvdegðImxagelI 209

pøÚvdegðImxageRkam 210 vtßúviPaKykecjBIRbdab;bnþBUC nigRbB½n§Twkenam BiesssMrab;CMgWqøgtampøÚvePT ^(STDi) 211

taragénfñalbNþúHEdlRtÚveRbI nigRbtikrsMrab;rkeraKvinicä½y sMrab;mnÞIrBiesaFn_ Gtisuxum-

CIvsaRsþfñak;kNþal 213

esovePACMerIsmYycMnYn sMrab;karGanbEnßmeTot 217

(9)

GarmÖkfa

CMgWqøgCamUlehtucMbgénmrN³PaBenAkñúgRbeTskMBugGPivDÆn¾ ehIykareFVIeraKvinicä½y nigkarBüa)alCMgW TaMg enHtMNageGaybBaðaRbQmnana cMeBaHesvasuxaPi)alenAkñúgtMbn;TaMgenH. GgÁkarsuxPaBBiPBelak)an nigkMBugBak;Bn§½ya:gskmμkñúgkarGPivDÆn¾ nigelIkkMBs;sþg;darbec©keTs sMrab;karRsavRCavmnÞIrBiesaFn¾én CMgWEbbenH karb:unb:g CabzmkñúgkareFVIeGayeTACasþg;darénkareFVIetsþrkemeraK)ak;etrIbgáCMgWRtUv)aneKeFVI eLIgkñúgqñaM1960¹. eFVIkarbnþelIbBaðaenHkñúgqñaM1970 KN³kmμkarénGñkCMnajkarEpñksþg;darCIvsaRsþrbs;

GgÁkarsuxPaBBiPBelak )aneRBognUvtMrUvkarnanasMrab;kareFVIetsþPaBkbnwgGg;TIb‘ÍyUTIkedayeRbIR)as;

viFIsaRsþ^Disc².

kñúgeBldMNalKñaenaHEdr kic©RbwgERbgRtUv)aneKeFVIeLIgkñúgkarbBa©ÚlkarRtYtBinitüeTAkñúgkarGnuvtþrbs;mnÞIr- BiesaFn¾ enAkñúgqñaM 1981 GgÁkarsuxPaBBiPBelak)anbegáItnUvviFIvaytMélKuNPaBBIxageRkACalkçN³ GnþrCatisMrab;GtisuxumsaRsþ. mnÞIrBiesaFn¾EdlTak;TgnwgviFIenHGacnwgedIrtYQanmuxkñúgkarGnuvtþviFIsaRsþ vaytMélKuNPaBfñak;Cati enARKb;fñak;TaMgGs;énRbBn§½EfTaMsuxPaB.

kare)aHBumÖpSaybc©úb,nñenH RbEmRbmUl nigeFVIeGaymanbc©úb,nñPaBnUvmKÁúeTsn¾ENnaMepSg² EdlpliteLIg edayGgÁkarsuxPaBBiPBelakkñúgb:unμanqñaMknøgmkenH eTAelIviFIeRCIserIsvtßúviPaKsMrab;karRsavRCavmnÞIr- BiesaFn¾ kMnt;GtþsBaØaNemeraK nigetsþPaBsuaMrbs;emeraKeTAnwgfñaMRbqaMgnwgemeraK. Bt’mannanaEdl manenATIenHKWcg;naMeTArkPaBsuxdmrmniykmμénkarRsavRCavGtisuxumsaRsþ nigetsþrkemeraK nigedIm,IelIk kMBs;KuNPaBmnÞIrBiesaFn¾nana TaMgenAfñak;mCÄwmnigfñak;mFüm. vaepþateTAelITMrg;EdleKRtUveFVItamCaCag eTAelIbec©keTsmUldæanén mIRkUTsSn¾ nigkarbMBak;BN’Edl)anBiBN’nalMGitrYcmkehIyenAkñúgkare)aHBumÖ déTeTotrbs;GgÁkarsuxPaBBiPBelak ³.

1 The public health aspects of antibiotics in feedstuffs. Report on a Working Group, Bremen, 1-5 October 1973. Copenhagen, WHO Regional Office for Europ, 1973 (document no. EURO 3604 (2).

2 WHO Expert Committee on Biological Standardization. Twenty-eighth report. Geneva, World Health Organization, 1977 (WHO Technical Report Series, N.610).

3

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esckþIepþIm

CMgWqøg

enAEtTajuyksmamaRtd¾x<s;hYsehtuénfvikasMrab;suxaPi)al enAkñúgRbeTskMBugGPivDÆn¾. eyag eTAtamr)aykarN_suxPaBBiPBelak ( World health report1

) )an bgðajfa enAkñúgmYyqñaM² manGñksøab;

RbmaN 2/2 lannak;edaysarCm¶WraKRsYcRsav. cMENkÉCm¶WrlakpøÚvdegðIm ( Primarily pneumonia )

KWCamUlehtusMxan;mYy epSgeTotEdlbNþal[mancMnYnGñksøab;Cag 4 lannak;enAkñúgmYyqñaM². eyagtam karviPaKTinñn½yCMgWsYt)anbgðaj[eXIjfa enAkñúgRbeTskMBugGPivDÆn¾BBYk)ak;etrI Haemophilus influenzae nig Streptococcus pneu-moniae KWCaemeraKbgáCMgWeRcInCagbNþalmkBIBBYk ^Virus cMeBaHCm¶W pøÚvdegðImEdlekItenAelIkumar. cMeBaHBBYk H.influenzae nig S.pneumoniaeEdlbegáIt β-Lactamase

edaybnßynUvPaBkbCamYy Benzylpenicillin )anelcmuxenAEpñkxøHkñúgBiPBelakeFVIeGaykarXøaMemIl emeraKbgáCMgWTaMgenHmansar³sMxan;ya:gxøaMg.

cMeBaHCm¶WkameraKk¾kMBugEtmansPaBekIneLIg. bBaðaTaMgGs;enH)anKMramKMEhgdl;karratt,at nigkarrat t,atCasklénCMgWEdlmanRbPBCa)ak;etrI b¤vIrusEdlhak;dUcCaekIteLIgedayRbBn§½XøaMemIl eGBIedmIsaRsþ min smRsb nigviFankarkarBarminRKb;RKan;. edIm,IkarBar nigTb;sáat;nUvCm¶W)ak;etrIsMxan;² KWcaM)ac;RtUvman ]bkrN_samBaØ² eRbIR)as;enAkñúgkarXøaMemIleGBIedmIsaRsþnigkartamemIlCm¶WCaRbcaMnigk¾dUcCaRtUvman bec©keTsénkareFVIeraKvinicä½ygayRsYl nigGaceCOCak;)an .

edIm,sMerc)annUvbBaðaRbQmEdlmannabc©úb,nñenH esvamnÞIrBiesaFn_suxaPi)al RtUvEtBwgEp¥keTAelIbNþaj mnÞIrBiesaFn_EdleFVIeraKvinicä½yGtisuxumsaRsþsMrab;mNÐlsuxPaB evC¢bNÐitenAtammnÞIreBTü nigGñkCMnaj xageGBIedmIsa®sþnana.

PaBsμúRKsμajénkargarenHnwgekIneLIgtaMgBImnÞIrBiesaFn¾fañk;eRkameTAdl;mnÞIrBiesaFn¾fñak;kNþal nigfñak;

mCÄwm. enHKWCameFüa)ayEtmYyKt;EdlnwgGacRbmUl)anya:gelOnnUvBt’manEdlTak;TgRKb;RKan;edIm,IeFIV eGayRbesIreLIgnUvkarXøaMemIl nigGaceGayeKdwgTan;eBlevlanUvkarratt,at b¤karqøgeraKEdlminFmμta nigkar erobcMGnuvtþ nigvaytMélnUvviFankarGnþraKmn¾Cak;lak;nana.

1

(11)

karFanaKuNPaBenAkñúg)ak;etrIsa®sþ

esckþIepþIm

kmμviFIFanaKuNPaBCameFüa)ayd¾manRbsiT§BlmYykñúgkarrkSasþg;darénkareFVIeraKvinicä½yedaymnÞIrBiesaFn_

nigkarGPivDÆn¾eGaykan;EtRbesIrnUvsþg;darTaMgenaH enATINaEdlcaM)ac;. enAkñúgGtisuxumCIvsaRsþKuNPaB minRtwmEtGaRs½yeTAelIbec©keTsb:ueNÑaHeT EteKRtUvKiteTAelIel,Óntémø ehIynwgsar³sMxan;énPaB Tak;TgetsþKøInik. CaTUeTAkareFVIetsþmnÞIrBiesaFn_vamantémøéføCamYynwgkarvivDÆn¾énevC¢saRsþ eKmanbMNg nwgbegáIn smmaRtfvikasMrab;suxaPi)al.

niymnn½y

edIm,I[manKuNPaBl¥ etsþeraKvinicä½ymYyRtUvTak;TgnwgsBaØaKøInik KWfavaRtUvEtCYykñúgkarkarBar nigBüa)al Cm¶WTaMgGs;enaH. karvas;KuNPaBetsþeraKvinicä½yepSgeTotman ³

• kareCOCak;)an ( Reliability ) ³ etIlT§plRtwmRtUvb¤eT ?

• karGaceFVIbBa¢ak;eLIgvij)an (Reproducibility)³ etIlT§pldUcKñab¤eT enAeBlEdleyIgeFVIetsþ sareLIgvij ?

• el,Ón ^{( Speed )} ³ etIel,ÓnénkareFVIetsþvaTan;eBlevla tamkartRmUvrbs;evC¢bNÐitb¤eT ?

• témøtbsñg ( Cost-benefit ratio ) ³

etItémøénkareFVIetsþvasmRsbCamYyplRbeyaCn_Edlcg; )anrbs;GñkCm¶W b¤ shKmn_b¤eT ?

ktþaEdlTak;TgCamYyPaBGaceCOCak;)an nigkarGaceFVIbBa¢ak;eLIgvij)an énlT§plrbs;mnÞIrBiesaFn_

RbPBénkarxusqÁgGacbNþalmkBI ³

y buKÁlik³ karRbtibtþirbs;kmμkrmnÞIrBiesaFn¾ b¤ Gñkbec©keTsénmnÞIrBiesaFn_ KWvaBak;B½n§eday pÞal;eTAelIKuNPaBénkarGb;rM nigkarbNþúHbNþalEdlBYkeK)anTTYlbTBiesaFn¾ niglkçxNÐ½ kargar.

y ktþabrisßan³ TIkEnøgeFVIkarminsmRsbBnøW b¤xül;ecjcUl sItuNðPaBTabb¤x<s;eBk semøgxøaMg eBk b¤lkçxNÐ½kargarminmansuvtßiPaBEdlGacb:HBal;dl;lT§pl .

y vtßúviPaK³ bec©keTs nigeBlevlaénkarykvtßúviPaK nigRbPBvtßúviPaKCaerOy² vasßitenAeRkA karRtYtRtapÞal;rbs;mnÞIrBiesaFn_ b:uEnþvaCar)aMgmYypÞal;eTAelIlT§PaBrbs;mnÞIrBiesaFn¾

(12)

kñúgkareFVIeGaysMerc)annUvlT§plEdlKYreGayeCOCak;)an. ktþadéTeTotEdlmnÞIrBiesaFn_

Gac®tYtRta)an ehIyEdlvab:HBal;dl;KuNPaBlT§plenaHKWkardwkCBa¢ÚnkarkMNt;GtþsBaØaN karrkSaTuk nigkarerobcMvtßúviPaK. dUcenHehIymnÞIrBiesaFn_mantYnaTIkñúgkarbNþúHbNþaldl;

GñkEdlyk nigdwkCBa¢ÚnvtßúviPaKesckþIENnaMCalaylkç½GkSr KYrEtmannigBinitüeLIgvijCa eTogTat;CamYynwgbuKÁlikKøIniknigbuKÁlikEfTaMevC¢sa®sþ.

y smÖar³mnÞIrBiesaFn_³ KuNPaBRbtikr smÖar³KImI Ekv BN’sMrab;bMBak; fñalbNþúHemeraK nigstV mnÞIrBiesaFn¾TaMgGs;enHman\T§iBleTAelIPaBGaceCOCak;)anrbs;lT§pletsþ.

y viFIsa®sþeFVIetsþ³ viFIsa®sþxøHmanPaBeCOCak;CagviFIsa®sþmYycMnYneTot.

y ]bkrN_³ kgVH]bkrN_ b¤]bkrN_EdlBMuRtUvsþg;dar b¤]bkrN¾EdlEfTaMmin)anl¥ nwgpþl;

lT§plEdlminGaceCOCak;)an.

y karBinitü nigkarGan³ karGand¾Rbjab;Rbjal;nUvlT§pl b¤k¾karmin)anBinitücMnYnRbLg;

mIRkUTsSn¾ eGay)anRKb;RKan; GacnaM[mankarPan;RcLM.

y r)aykarN_³ karcMlgkarPan;RcLM b¤ r)aykarN¾mineBjelj bgáCabBaða.

KuNPaBénkarbkRsaylT§pletsþ

karbkRsayKWCaEpñkmYyd¾sMxan;enAkñúgGtisuxumCIvsa®sþ. enAdMNak;kalnimYy²énkarBinitüvtßúviPaKmYy eK KYrbkRsaylT§pledIm,IeRCIsyketsþEdll¥bMput edayEp¥kelIel,Ón nigPaBeCOCak;)ansMrab;tMNak;kal bnþbnÞab;eToténkarBinitü.

karFanaKuNPaBenAkñúgmnÞIBiesaFn_GtisuxumCIvsaRsþ

karFanaKuNPaPaB KWCakarrYmbBa©ÚlnUvskmμPaBTaMgLayEdlmnÞIrBiesaFn_RtUveFVIedIm,IFanafalT§pletsþ manKuNPaBl¥ . vaRtUvEt ³

- RKb;RCugeRCay³ RKbdNþb;RKb;dMNak;kalnimYy² taMgBIkarRbmUlvtßúviPaK rhUtdl;karbBa¢Ún r)aykarN¾eGayeTAevC¢bNÐit ¬ rUbTI1 ¦

- manehtupl³ epþatkarykcitþTukdak;eTAelIdMNak;kalEdlsMxan;bMputenAkñúgvdþ - eTogTat;³ pþl;kartamdanCaRbcaM énrebobeFVIetsþ

- sgVak;³ EsVgrk nigEktRmUvPaBxusqÁgkñúgkrNIEdlekItman.

esvamnÞIrBiesaFn_manKuNPaBl¥ mann½yfa Ca»sfEdlmanKuNPaBl¥

(13)

karFanaKuNPaBCYykñúgkarFanafa etsþEdlmantémøx<s;eKRtUveRbIya:gsnSMsMécEdlGaceFVIeTA)an. vak¾CYy pgEdrkñúgkarkMNt;fa etIetsþfμI²manRbsiT§PaB b¤k¾Kμan)ankar. CYyeFVIeGaykan;EtRbesIreLIgnUvkarRbtibtþi mnÞIrBiesaFn¾KøInik nigsuxPaBsaFarN³.

RbePTénkarFanaKuNPaB

RbePTénkarFanaKuNPaBman2 KWkarFanaKuNPaBépÞkñúg ^(Internal) nig karFanaKuNPaBBIxageRkA

(External)

y Internal³ enHRtUv)aneKeehAfa karRtYtBinitüKuNPaB Quality control EdlmnÞIrBiesaFn_

nImYy² mankmμviFIBinitüKuNPaBkareFVIetsþrbs;xøÜnpÞal;.

rUbPaBTI1 ³ dMNak;kalkñúgkarRsavRCavrbs;mnÞIrBiesaFn_énGñkCm¶Wqøgmñak;

karykvtßúviPaK kardwkCBa¢Ún karbiTpøak

karTukdak;

karvaytMéledayEPñkpÞal; køin mIRkUTsSn¾ bkRsay

bNþúH ³ eRCIsfñalbNþúH sItuNðPaB briyakas bnSúT§karbNþúH Antibiogram

kMNt;GtþsBaØaN karbkRsay

(vtßúqøgeraK^,vtßúEdlb:HnwgemeraK b¤ emeraK ⁾

GñkCm¶WCamYyCm¶Wqøg

vtßúviPaK Bt’manKøInik

r)aykarN_bzmdl;RKUeBTü

r)aykarN_cugeRkaydl;RKUeBTü

(14)

Internal Quality Control Bak;B½n§CamYy ³ - kartamdanCaRbcaMénKuNPaBetsþ

- kar®tYtBinitüRKb;RCugeRCayenARKb;dMNak;kal cab;taMgBIkarRbmUl ^Specimen ¬RKb;eBl EdlGaceFVI)an ¦ rhUtdl;karbBa¢Únr)aykarN¾cugeRkay

mnÞIrBiesaFn_mankarTTYlxusRtUvRkmsIlFm’cMeBaHGñkCm¶W kñúgkarplitnUvlT§plRtwmRtUv mann½y.

y External³ enHRtUveKehAfa QUALITY ASSESSMENT EdllT§plrbs;mnÞIrBiesaFn_

nwgRtUv)an®tYtBinitüedayPñak;garxageRkA . enAtambNþaRbeTsmYycMnYn Gñkshkarkargar enHKWeFVItamGaNtþi ¬Edl dwknaMedayrdæaPi)al¦ ehIytRmUv[manGaCJab½NÑRtwmRtUv.

External Quality assessment Bak;B½n§CamYy ³ - kartamdanCatMNak;kalénKuNPaBrbs;etsþ

- kartamdanedaymineGaydwgmunénetsþkMNt;GtþsBaØaN ehIymaneBlxøHeTAelIbec©keTsbnSúT§ rkemeraK.

lkçxNÐ½KuNPaBenAkñúgGtisuxumCIvsa®sþ

RtUvnwglkçN³KøInik Clinical relevance

lkçxNÐ½d¾sMxan;mYyénKuNPaBsRmab;etsþGtisuxumCIvsa®sþ KWsMedAfaetIvapþl;sm,TankMritNakñúgkarbgáar b¤Büa)alCm¶WqøgEdlenHeKehAfa Clinical relevance rbs;va. Clinical relevance GacFana)anEtenA eBlNa EdlmanTMnak;TMngl¥rvagRKUeBTüBüa)al nwgmnÞIrBiesaFn_ .

edIm,IbBa¢ak;BI Clinical relevance eyIgman]TahrN_mYycMnYn ³

1> RbsinebImankBa©MúemeraK Gram-negative bnþicbnþÜcRtUveKbnSúT§ecjBIkMhakb¤tM)arBIbMBg;krbs;

GñkCm¶WsRmakenAmnÞIreBTüenaH karkMNt;GtþsBaØaNbEnßmbnþeTot nigkareFVI Antibiogram KW minEmnCa Clinical relevance eT edayehtufaminmanrebobNamYyEdlnwgmanRbsiT§PaBeTAelI karBüa)alGñkCm¶WeLIy.

kar®tYtBinitüKuNPaBépÞkñúg KWmansar³sMxan;Nas;sRmab;rebobRbtibtþiEdll¥

(15)

2> RbsinebI Streptococcus pyogenes RtUveKrkeXIj enaHkareFIV Antibiogram eBjeljmYynwg Kμan Clinical relevance eT edayehtufa Benzylpenicillin KWCafñaMsRmab;kareRCIserIs ehIy EdlEtgEtskmμenAkñúg ^Vitro .

3> RbsinebI Escherichia coli RtUveKrkeXIjBIkrNICm¶WraKEdlKμanQammþgmáal karkMNt;BIRbePT

Serotype nwgKμan Clinical relevance eT edayehtufavaKμanTMnak;TMngc,as;las;rvag ^Serotype nigPaBbgáCaCMgWenaHeT.

4> RbsinebIkarbMBak;BN’ ^Gram enAelIvtßúviPaK bgðajfaman { Anaerobic flora cRmuH } enaH karkMNt;rkBYk ^Anaerobes CaTUeTA KWKμan Clinical relevance eT. vanwgcMNayeBlevla nig smÖar³ ehIynwgKμan b:HBal;dl;karBüa)alrbs;GñkCm¶WeLIy .

5> RbsinebIBYkpSit ^{( Yeast )} RtUveKrkeXIjBIvtßúviPaKBIRbB½n§pøÚvdegðImenaH etsþkMNt;rk ^Cryptoco-

ccus KYrEteFVI. etsþbnþeTot Kμan Clinical relevance eT edayehtufa vanigKμankarb:HBal;dl;

karRKb;RKgGñkCm¶WeT .

Casegçb etsþEdlmanKuNPaBl¥mYyKWCaetsþEdlRtwmRtUv nigpþl;nUvlT§plEdlmansar³RbeyaCn_dl;

karbgáar b¤karBüa)alCm¶Wqøg. vaBuMmankarcaM)ac;eTkñúgkarrkemeraK nigkMNt;nUvral;RbePTepSg²rbs;emeraK enAkñúgvtßúviPaK.

PaBeCOCak;)an

sRmab;etsþEdlpþl;lT§plCatYelx PaBeCOCak;)an RtUveKvas;EvgedayemIlfa etIlT§plenaHvaenAekok b:uNÑaeTAnwgtYelxBitR)akd. ]TahrN_mYycMnYnénkareFVIetsþrebobenH KW ³

- [sakl,g ^Antibiotic énesr:UmQam

- karvas;nUvtMélkMhab;Gb,brmarbs; Inhibitory ( MIC ) én ^Antibiotic kñúg ^Vitro - esrU:m Antibody titrations

sRmab;kareFVIetsþEdlpþl;nUvlT§plCatYelx PaBeCOCak;)an KWvas;edayemIlfaetIlT§plRtwmRtUvEdrb¤eT.

]TahrN_mYycMnYnénkareFVIetsþrebobenH KW ³

- karkMNt;GtþsBaØaNemeraK ( Pathogens )

- kareFVIetsþBIRbsiT§PaBén ^Antibiotic eday Disc method

(16)

vaküsBÞ½nanaCasþg;darsRmab;BBYkGtisuxumR)aN KWmansar³sMxan;dl;kareCOCak;. eQμaHTaMgLayEdlFøab;

)ansÁal;CaGnþrCatiKYrRtUv)anykmkeRbI ]TahrN_dUcCa Staphylococcus aureus EdlBuMEmneRbIfa

“Pathogenic staphylococci” eT . RtUveRbIBakü “Streptococcus pyogenes” BuMEmn “ Haemolytic streptococci “ enaH eT .

kareRbIviFIsa®sþ CaÉkPaB EdleKGnumtþi mansar³sMxan;Nas;. ]TahrN_ etsþPaBrYsrbs;emeraK edayeRbI

Disc KYreFVIeLIgCamYynwgbec©keTsEdleKTTYlsÁal;CaGnþrCati dUcCa Kirby-Bauer test ¦.

PaBEdlGacbBa¢ak;eLIgvij)an

PaBEdlGacbBa¢ak;eLIgvij)an b¤k¾PaBCak;lak;énetsþGtisuxumCIvsaRsþ RtUvkat;bnßyedayrbs;BIr³ - kgVHPaBdUcKña vtßúviPaKEtmYyBIGñkCMgWmñak;GacpÞúknUvemeraKelIsBImYy. dUecñHkarbNþúHsar

eLIgvijGacnwgrkeXIjemeraKepSg.

- kgVHesßrPaB³ enAeBlEdleBlevlaknøgeTA GtisuxumR)aNenAkñúgvtßúviPaKkrekItkan;EteRcIn b¤k¾søab;enAkñúgGRtaxus²Kña. dUcenHkarbNþúHsareLIgvij GacnwgrkeXIjemeraKepSg. dUecñH ehIyedIm,IbegáIn PaBCak;lak; eKRtUveFVIetsþvtßúviPaKya:gqab;EdlGaceFIVeTA)aneRkayBIeFVIkar RbmUl.

RbsiT§Bl ( Efficiency )

RbsiT§BlénkareFVIetsþGtisuxumR)aNmYy KWCalT§PaBrbs;vaEdlpþl;nUveraKvinicä½yRtwmRtUvénemeraKbgámYy b¤ CMgWmYy. karenHRtUv)anvas;EvgedaylkçN³BIry:ag ³

lT§PaBbBa¢ak;eraKvinicä½yviC¢man ( Diagnostic sensitivity )

cMnYnsrubénlT§plviC¢man

Sensitivity =

cMnYnsrubénGñkCm¶W QW

ebI sensitivity rbs;etsþkan;Etx<s; cMnYnlT§plGviC¢-xus kan;Ettic .

]TahrN_ sensitivity én MacConkey agar minl¥eTsRmab;karEjkrkemeraK Slamonella typhi BI lamk. emeraKbgáCMgWeBaHevond¾sMxan;enH CaerOy²eKminGacrkeXIjeT

edaysarEtkarduHdalya:geRcInelIslubénBBYk)ak;etrIEdlminbgáCMgWenAkñúgeBaHevon.

(17)

lT§PaBbBa¢ak;eraKvinicä½yGviC¢man (Diagnostic specificity)

cMnYnsrubénlT§plGviC¢man

Specificity =

cMnYnsrubénGñkCm¶W minQW

Specificity rbs;etsþkan;Etx<s; cMnYnlT§plviC¢man-xuskan;Ettic .

]TahrN_ ³

• karbMBak;BN’ Ziehl-Neelsen énkMhakKWman Specificity x<s;sMrab;kareFVIeraKvinicä½y

Tuber-culosis BIeRBaHvapþl;nUvcMnYnlT§plviC¢man-xustictYcb:ueNÑaH .

• karbMBak;BN’ Ziehl-Neelsen énTwkenam KWman Specificity ticbMput eRBaHvapþl;nUv lT§plviC¢man-xuseRcIn ¬dUcCaeGaylT§plCaBBYk Mycobacteria EdlminR)akdRbCa¦.

• etsþ ^Widal KWman Specificity TabEmnETn sRmab;eraKvinicä½yCm¶WRKuneBaHevon BIeRBaH

Cross-agglutinating antibodies EdlenAesssl;taMgBIeBlqøgCMgWCamYynwg Salmonella Serotype )an pþl;nUvlT§plviC¢man-xus.

Sensitivity nig Specificity rbs;etsþmYyvamankarTak;TgrvagKña. edaybBa©úHkMritEbgEck Sensitivity

énetsþ mYyGacRtUvbegáInenAkñúgtémøfycuHén Specificity rbs;va ehIybRBa©asmkvij. Diagnostic sensitivity nig Specificity énetsþmYyk¾Tak;TgpgEdreTAnwgeRbva:Lg;Cm¶W enAkñúgcMeNamRbCaCnEdlsßit kñúgkarRsavRCav.

kar®tYtBinitüKuNPaBépÞkñúg

lkçxNÐ½tRmUv

kmμviFI®tYtBinitüKuNPaNépÞkñúgRtUvEtCakarmYyEdlGacGnuvtþn_)anCak;lak; nigsnSMsMéc.

kmμviFI®tYtBinitüKuNPaBépÞkñúgminRtUvmaneKaledAvaytémøRKb;viFIsa®sþ Rbtikr nigkarbNþúHemraK enAral;éf¶

eFVIkar enaHeT. vaKYrEtvaytMélviFIsa®sþnImYy² Rbtikr nigfñalbNþúHemeraKTaMgLayeTAtamkalviPaKEdl GacGnuvtþ)an edayEp¥keTAelIsar³sMxan;énvtßúnImYy² cMeBaHKuNPaBénkareFVIetsþTaMgmUl .

viFIsa®sþ ( Procedures )

kar®tYtBinitüKuNPaBépÞkñúgepþImeLIgCamYyRbtibtþikarRtwmRtUvrbs;mnÞIrBiesaFn_ .

(18)

esovePARbtibtþirbs;mnÞIrBiesaFn_

enARKb;mnÞIrBiesaFn_KYrmanesovePARbtibtþimYyEdlrYmmanRbFanbTdUcxageRkam ³ - karsm¥atkEnøgeFVIkar

- Gnam½ypÞal;xøÜnrbs;buKÁlbMeBjkargar - karRbytñ½RbEygGMBIsuvtßiPaB

- karerobcMkEnøgjúaMnigCk;[enAeRkAmnÞIrBiesaFn_

- karerobcMTukdak; nige)aHecalsmÖar³qøgeraK

- cak;va:k;saMgsmRsbkarBarGñkRbtibtþikr ]TahrN_ va:k;saMgkarBarCMgWeføImRbePT ^B - EfrkSa]bkrN_

- karRbmUlvtßúviPaK - cuHbBa¢IvtßúviPaK

- kMeTcecalvtßúviPaKEdlBuM)ankar ( Unsuitable specimen )

- karcat;EcgvtßúviPaK - kt;RtalT§pl - raykarN_lT§pl

eKRtUvGnuvtþtamesovePARbtibtþiedayRby½tñRbEyg nigEksMrYl nigeFVIVIbc©úb,nñPaBya:geTogTat; . karEfTaM]bkrN_

vaCakarmYyd¾sMxan;kñúgkarykcitþTukdak;EfTaM]bkrN_eRbIR)as;TaMgLayenAkñúgmnÞIrBiesaFn¾. etsþEdl RbkbedayKuNPaB nwgminGaceFVIeTA)aneLIy RbsinNaebI]bkrN_EdleKeRbIR)as;manKuNPaBGn; nigkgVH karEfTaM.

fñalbNþúH

fñalbNþúHmYyGacRtUv)anerobcMenAkñúgmnÞIrBiesaFn¾ edayeRbIeRKOgpSMCamUldæannanab¤edayeRbIemS:AedGuIRdat Edlmanlk;enAelITIpSar b¤k¾vaRtUvTijRsab;edIm,IykmkeRbI. emSAedGuIRdatEdllk;enAtam»fsßannana RtUv )anENnaM[eRbI BIeRBaHvaRtUv)andwkCBa¢Ún nigsþúkTukRbkbedayKuNPaBmYyx<s;EdleKeCOCak;fa vaman lkçN³l¥RbesIrCag karerobcMedaymnÞIrBiesaFn_pÞal;. edIm,ITTYl)annUvlT§pll¥mYy eKRtUveFVIkarcab;

GarmμN_eTAelIcMNucdUcxageRkam

(19)

kareRCIserIsfñalbNþúH

mnÞIrBiesaFn_EdlRbkbedayRbsiT§Bl)anrkSaTuknUvcMnYnfñalkñúgbrimaNmYyticbMput eGayRtUvnwgRbePT etsþEdlRtUveFVI. ]TahrN_fñalcahYymYy Edll¥GacRtUveKeRbICafñalsMrab;RKb;eKalbMNgTaMgGs;

sRmab;erobcMfñal bNþúHQam fñaleRbIsUkULa ehIynigfñalepSgeTotmYycMnYn.

fñalCMerI zsd¾x<s;mYy (Salmonella-Shigella agar or deoxycholate citrate agar) nigfñalCMerIsd¾Tab mYyeTot ( Mac Conkey agar ) vamansar³sMxan;Nas;sRmab;rkemeraKbgáCMgWecjBIlamk.

fñalbNþúHBiessmYyeTotKYrRtUveKbEnßmedImI,TajykBYk Campylobacter spp . karbBa¢aTij nigkarTukdak;fñaledGIuRdaet

1- bBa¢aTijfñalkñúgcMnYnEdleRKageRbIR)as;sRmab;ry³eBl 6 Ex b¤eRcInbMputsRmab;ry³eBl 1 qñaM 2- cMnYnfñalTaMgGs;enHRtUverobcMTukdak;enAkñúgkBa©b;EdlsRmab;eRbIry³eBl 1-2 Ex

3- enAeBlTTYlykRtUvmYlKMrbkBa©b;TaMgGs;eGaytwgENnRbkbedaysuvtßiPaB. enAkñúgbriyakas esIm cUrP¢itkBa©b;fñaledGIuRdaetTaMgenH edayRkmYn)a:ra:hVIn ¬ bitcenøaHTaMgLay Edlman nigTuk vaeGayrwg¦.

taragTI1> karRtYtBinitüKuNPaBbrikçar

brikçar karEfrkSaCaRbcaM karRtYtBinitü bec©keTsEfTaM

nigGFikarkic©

Ekv ^Anaerobic

>^Autoclave

>

sm¥atEpñkxagkñúgEkvral;s)aþh_

eFVIeGaykatalIkrskmμeLIgvijeRkayBIdM eNIrkarmþg² ¬160^o^C,2em:ag¦

bþÚrkatalIkrerogral; 3Exmþg sm¥at nig bþÚrTwkral;Ex

eRbIbnÞHGaMgDIkaT½remTIELnexov kñúgeBldMeNIrkar nImYy²

kt;smÁal; nigkt;RtaTuk ry³eBl )at;BN’rbs;GaMgDIkaT½rral;s)aþh_

Binitü nig él[RtUvnUvcMNuH TwkmundMeNIrkarnImYy²

kt;Rtary³eBl nig sItuNðPaB b¤

sm<aFsRmab;dMeNIrkarnImYy² kt;RtakarRbtibtþi enAelIbnÞHs<½r ral;s)aþh_

BinitüemIlRTnab;

biTenAkñúg KRmb ral;s)aþh_

erogral; 6Ex

(20)

Centrifuge

>Hot-air oven

sRmab;karsmøab;

emeraKeRKOgEkv

>^Incubator

>Microscope

>Refrigerator

>^Water-bath

CUtépÞxagkñúgCamYyl,ayEdlsmøab;em eraKral;s)aþh_ b¤ bnÞab;BIkarEbkbMBg;Ekv b¤kMBb;

sm¥atEpñkxagkñúgral;Ex

sm¥atépÞxagkñúg nig eFñIr ral;Ex

CUtEPñkCamYyRkdasTn;b¤^{Lens paper} bnÞab;BIéf¶ eFVIkarnImYy²

sm¥at nig dak;eRbg fasTMrral;s)aþh_

RKbKRmbkarBarFUlIenAeBlmineRbIR)as;

sm¥at nigeFVI[rlayerogral; 2Ex nigbnÞab;BIkar Føak;zamBl CUtépÞxagkñúg nig bþÚrTwkral;Ex

kt;Rtary³eBl nig sItuNðPaB sRmab;deMeNIrkar nImYy²

kt;RtasItuNðPaBenAeBl cab;epþIménéf¶eFVIkarnImYy²

¬sßitkñúg 35^±1^o^C¦ BinitüCYrkg;dg;ral;Ex

dak;canénsuIlIkaexovCamYy^Micro

scope enAeRkamKRmb karBarFUlI edIm,IkarBarkar krekItpSitenAkñúg sItuNðPaBesIm

kt;RtasItuNðPaBral;RBwk

¬sßitkñúg 2-8^o^C¦ BinitüemIlkMritTwkral;éf¶

kt;RtasItuNðPaBenAéf¶dMbUgéns)aþ h_nImYy²

¬sßitkñúg 55-57^o^C¦

bþÚrRcas;ral;qñaM

erogral; 6Ex

edayRbcaMqñaM

erogral; 6Ex erogral; 6Ex

4- sresréf¶ExqñaMénkarTTYlenAelIRbGb;nImYy² 5- rkSaTukenAkEnøgggwt RtCak; nig manxül;ecj-cUll¥

6- bgVil ^Stock edIm,IeRbIsmÖar³cas;mun

7- enAeBlebIkRbGb; RtUvsresréf¶ExqñaMénkarebIkva 8- e)aHecalral;fñal ^DehydratedEdleLIgdMurwg b¤ eLIgexμA 9- rkSakMNt;Rtalaylkç½GkSrénfñalbNþúH enAkñúg^Stock karerobcMfñalbNþúH

1- Gnuvtþ[)anhμt;ct;tamesckþIENnaMrbs;plitkrsRmab;karerobcM

2- erobcMcMnYnEdlnwgRtUveRbIGs;munéf¶hYskMNt;eRbIR)as;xøÜnva ¬sUmemIlxageRkam¦

(21)

taragTI2> kMNt;Rta]bkrN¾RbtibtþisItuNðPaB

Temperature ____________

Instrument ________________________________ Room _________________

Read daily. Check it temperature indication is acceptable. If aberrant, record temperature in space

Date Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Date

1 1

2 2

3 3

4 4

5 5

6 6

7 7

8 8

9 9

10 10

11 11

12 12

13 13

14 14

15 15

16 16

17 17

18 18

19 19

20 20

21 21

22 22

23 23

24 24

25 25

26 26

27 27

28 28

29 29

30 30

31 31

(22)

karTukdak;fñalEdlerobcMrYcehIy 1- karBarTl;nwgkMedARBHGaTitü

2- karBarTl;nwgkMedA . fñalbNþúHpÞúknUvQam sirIr³epSgeTot b¤k¾Gg;TIb‘Íy:UTik KYEtTukenAkñúgTUTwkkk 3- GayukaleRbIR)as;rbs;fñalbNþúHEdlerobcMrYcehIy enAeBlTukenAkEnøgRtCak;-ggwt vanwgGaRs½y

eTAelIRbePTRbGb;EdleKeRbI. GayukaleRbIR)as;CaTUeTAKW ³ - bMBg;EdlmanqñúksMLI 3s)aþh_

- bMBg;EdlmanKRmbrlug 2s)aþh_

- RbGb;EdlmanKRmbmYl 3s)aþh_

- can ^PetriRbsinebIbiTenAkñúges,ag)aøsÞik 4s)aþh_

karRtYtBinitüKuNPaBfñalbNþúHEdlerobcMrYcehIy

1- kareFVIetsþ ^pH. ^pH rbs;fñalbNþúHEdlerobcMrYcehIy mincaM)ac;BinitüeTogTat;CaFmμtaenaHeT enAeBlEdleK)anerobcMvaRtwmRtUvBIemS:A ^Dehydrated. RbsinebIfñalbNþúH RtUveKerobcMeLIgBI eRKOgpSMmUldæan eKKYrEtTukva[RtCak;sinmunnwgeFVIetsþ ^pH. cMeBaHfñalbNþúHrwg eKKYrEtetsþ CamYynwgépÞeGLicRtUc b¤ bnÞab;BIRtaMenAkñúgTwkbit. RbsinebI ^ph xusKña eRcInCag 0/2 Ékta BI kRmitbBa¢ak; cUrtMrUvvaCamYynwgGasIut b¤Gal;kaLaMg b¤erobcMLÚmYyfμI.

2- etsþGMBIPaBs¥atKμanemeraK. Gnuvtþn_etsþBIPaBs¥atKμanemeraK CaTUeTAFmμta enAelIfñalbNþúHEdl eK)anbEnßmQam b¤smasPaKdéTeTot eRkayBIsMlab;emeraKedayGUtUkøav. cUryk 3-5° BILÚ nImYy² nigTukecalenAsItuNðPaB 35 ^o^C ry³eBl 2éf¶. ehIyTukrbs;EdlenAsl; enAkñúgTU Twkkk. RbsinebIeXIjman kBa©úMemeraKduHRcInCagBIrkñúgmYycan cUre)aHecalLÚTaMgmUl.

3- etsþelIlT§pl. mnÞIrBiesaFn_KYrEtrkSaTuk ememeraKenAkñúgsþúkmYyQut sRmab;eFVIkarRtYtBinitü lT§plrbs;fñalbNþúH. bBa¢IememeraKEdlKYrsþúkRtUv)anpþl;enAkñúgtarag2. ^StrainsTaMgenHGac TTYl)anBIkargarRbcaMéf¶ b¤BITIpSar b¤BIRbPBpøÚvkar. karENnaMsRmab;karEfTaMnigeRbIR)as;em emeraKEdlsþúkTukmanpþl;CUnenA.

bBa¢IetsþelIlT§pl sRmab;fñalbNþúHEdleKeRbICaTUeTA manpþl;CUnenAkñúgtarag.

(23)

taragTI 2>Suggested stock strains for quality control ¹

Gram-possitive cocci Enterobacteriaceae Enterococcus faecalis (ATTC 29212 Citrobacter freundii

or 33186) Enterobacter cloacae

Staphylococcus aureus (ATCC 25923 Escherichia coli (ATTC 25922) Staphylococcus epidermidis Klebsiella pneumoniae

Streptococcus agalactiae Proteus mirabilis

Steptococcus mitis Salmonella typhimurium Streptococcus pneumoniae Serratia marcescens Streptococcus pyogenses Shigella flexneri Gram-negative fastidious organisms Yersinia enterocolitica Moraxella catarrhalis Other Gram-negative rods Haemophilus influenzae type b Acinetobacter Iwoffi

β-lactamase-negative Pseudomonas aeruginosa (ATCC 27853) β-lactamase-positive Vibrio cholerae (non-01)

Mhaemophilus parainfluenzae Fungi

Neisseria gonorrhoeae Candida albicans

Neisseria meningitidis Anaerobes

Bacteroides fragilis Clostridium perfringens

(24)

taragTI3 ³ etsþelIlT§plenAelIfñalbNþúHEdleKeRbICajwkjab;

Medium Incubation Control organism Expected result

Bile-aesculin agar 24h Enterococcus faecalis Growth and blackening a-Haemolytic No growth, with haemolysis Streptococcus

Blood agar 24h, CO2 Streptococcus Growth and B-Haemolysis pyogenes

S. pneumoniae Growth and a-haemolysis

Chocolate agar 24h, CO2 Haemophilus influenzae Growth

Decarboxylase (cover with sterile oil)

lysine 48h Shigella typhimurium Positive

Shigella flexneri Negative

ornithine 48h S. typhimurium Positive

Klebsiella pneumoniae Negative

Dyhydrolase

arginine 48h S. typhimurium Positive

Proteus mirabilis Negative

Gelatinase (rapid tests) 24h Escherichia coli Negative Serratia marcescens Positive

Kligler iron agar (see triple sugar iron agar) MacConkey agar with

crystal violet 24h E. coli Red colonies

P. mirabilis Colourless colonies (no swarming)

E. faecalis No growth

Malonate broth 24h E. coli Negative (green)

K. pneumoniae Positive (blue) Mannitol salt agar 24h Staphylococcus aureus Yellow colonies

Staphylococcus aureus Rose colonies epidermidis

E. coli No growth

(25)

taragTI3 ³ etsþelIlT§plenAelIfñalbNþúHEdleKeRbICajwkjab; ¬t¦

Medium Incubation Control organism Expected result Methyl red/Voges-

Proskauer 48h E. coli Positive/negative

K. pneumoniae Negative/positive

Mueller-Hinton agar 24h E. coli ATCC 25922

S. aureus ATCC 25923 Acceptable zone sizes Pseudomonas (Table 24, p. 110) aeruginosa ATCC 27853

Nitrate broth 24h E. coli Positive

Acinetobacter Iwoffi Negative

Oxidation/fermentation 24h P. aeruginosa Oxidation at the surface dextrose (without oil) A. Iwoffi No change

Peptone water (indole) 24h E. coli Positive

K. pneumoniae Negative

Phenylalanine deaminase. 24h E. coli Negative

ferrichloride P. mirabilis Positive

Salmonella-Shingella agar

or 24h E. coli No growth

deoxycholate citrate agar S. typhimurium Colourless colonies Yersina enterocolitica Colourless colonies S. flexneri Colourless colonies Selenite broth 24h S. typhimurium Growth after subculture

E. coli No growth after subculture Simmons citrate agar

(incubate 48h E. coli No growth

with loose screw-cap) K. pneumoniae Growth, blue colour Thiosulfate citrate bile salts 24h Vibrio spp. (non-

agglutinating) Yellow colonies agar

Thayer-Martin agar 24h, CO2 Neisseria meningitidis Growth

Neisseria gonorrhoeae Growth

Staphylococcus spp. No growth

E. coli No growth

(26)

taragTI3 ³ etsþelIlT§plenAelIfñalbNþúHEdleKeRbICajwkjab; ¬t¦

Medium Incubation Control organism Expected result Thioglycollate broth 24h Bacteroides fragilis Growth

Triple sugar iron agar

(depth of 24h Citrobacter freundii A/A gas^a + H2S butt should be at least

2.5cm; S. typhimurium K/A gas^a + H2S

incubate with loose

screw-cap) S. flexneri K/A gas^a

A. Iwoffi No change

Urea medium 24h E. coli Negative

P. mirabilis Positive (pink) Voges-Proskauer (see

methyl

red/Voges-Proskauer)

a A/A : Acide slant; K/A : Alkaline slant.

rebobEdleKRtUvGnuvtþtamenAeBleFVIetsþelIlT§pl enAelILÚfμI²énfñalbNþúH KW ³

1- erobcM Suspension én stock strain CamYynwgPaBl¥k; EdlswgEtemIlGVImineXIjEdlsmmUl eTAnwg Barium sulfate standard EdleRbIenAkñúgviFIsa®sþ Modified Kirby-Bauer (McFarland 0.5) nigeRbIvamYyRkv:g;sMrab;Cakarcak;ePJac.

2- Tukecalkñúgry³eBldUcEdleKeRbICaFmμta. Gan caneTAtamviFIFmμta.

3- rkSaÉksarlT§pl[)ansmrmü.

BN’sMrab;bMBak; nigRbtikr

karENnaMsRmab;etsþ RbtikrmYycMnYn manpþl;CUnkñúgtarag4. etsþEdlKYreFVI KW³ - enAral;eBlEdleKerobcMLÚénl,aysRmab;eRbIkarfμInImYy²

- erogral;s)þah_¬enHsMxan;Nas;sRmab;kBN’RtCak; Ziehl-Neelsen³ BN’EdleKeRbItaMgBI bUrmburaNmkmanGayukaleRbIR)as; 3 b¤ 4 Ex ¦.

BN’ nigRbtikrKYrEtRtUv)ane)aHecalenAeBl Edl³ - dl;éf¶ Ex qñaM énkarhYskMNt;eRbI

- elceLIgnUvsBaØaEdlGacemIleXIjBIkarxUcxat ¬l¥k; kkr ehIrBN’¦

(27)

Antigen nig^AntiserasMrab;eFVIeraKvinicä½y edIm,ITTYl)annUvlT§pll¥BI ^antigensnig Antisera ³

- rkSavaTukenAsItuNðPaBEdleKENnaM . Rbtikr Serological xøH minRTaMnwgkMNkeT.

taragTI4 ³ karRbtibtþietsþenAelIRbtikrEdleKeRbICaTUeTA

Reagent or stain Species suitable for testing

Medium Positive Negative Bacitracin disc S. pyogenes (zone) E. faecalis Blood agar

Catalase S. aureus E. faecalis Tryptic soy agar

Coagulase plasma S. aureus S. epidermidis Tryptic soy agar B-Glucuronidase (PGUA)^a E. coli K. pneumoniae Tryptic soy agar Gram stain Staphylococcus spp E. coli Mixed in smear

ONPG^b E. coli S. typhimurium Triple sugar iron

agar or Kligler iron agar

Optochin disc S. pneumoniae (zone) Streptococcus mitis Blood agar Oxidase Pseudomonas aeruginosa E. coli Tryptic soy agar Tellurite disc E. faecalis (no zone) Streptococcus Blood agar

agalactiae (zone) V-factor (disc or strips) Haemophilus

parainfluenzae

Haemophilus

influenzae Tryptic soy agar XV-factor (disc or strips) H. influenzae Tryptic soy agar Ziehl-Neelsen stain Mycobacterium

tuberculosis Mixed non-acide-

fast flora Sputum smear ^c

a 4- Nitrophenyl-β-D-glucopyranosiduronic acid. (PGUA)

b o-Nitrophenyl-β-D-galactopyranoside.

c Prepare a number of smears from known positive and negative patients. Fix by heat, wrap individually in paper, and store in the refrigerator

(28)

• eCosvagkarkk nigrlaysarcuHsaeLIg. munnwgbgák cUrEbgEck ^Antiserum CaPaKKuN[)an RKb;RKan; sRmab;etsþ 2 b¤ 3 .

• e)aHecalenAeBl dl;éf¶ Ex qñaM énkarhYskMNt;rbs;plitpl.

Serum GñkCm¶W b¤ BIRbPBTIpSar.

• RbsinebIGaceFVI)ankmøaMgrbs; Control Serum KYrEtbgðajCa International Units kñúg mYymIlIlIRt

• KUrbs; ^SeraEdlykBIGñkCMgWEtmYy EdleKykkñúgkMLúgeBléndMNak;kalRsYcRsav nigeTIbeRkakBIQW KYrRtUveFVIetsþCamYynwgRbtikrkñúgLÚEtmYy.

• sRmab;eraKvinicä½y Serological énCMgWsVayKWRtUveRbIEtviFIEdlfñak;Cati b¤GnþrCatiTTYlsÁal;b:ueNÑaH

• LÚetsþ serological nImYy² KYrrYmman ³ - ^SerumGviC¢man ¬Specificity control¦ - Rbtikr ^SerumexSay ¬Senitivity control¦

- Rbtikr ^SerumxøaMg ¬Titration control¦ EdleKKYrEtGanvaenAkñúgBRgavNamYy én ^Titrerbs;

vaenAeBlEdl ^Titre cugeRkayRtUveKeFVIetsþ.

eKENnaMeGayeRbIR)as;CaFmμtaTUeTAénviFIsa®sþ Kirby-bauer. edIm,IeCosvagnUvkMhus karENnaMxageRkam KYrRtUv)aneRbI ³

• DiscsKYrEtmanmuxkat;RtwmRtUv ¬6/35 ^mm¦

• Discs KYrEtmankmøaMgRtwmRtUv ¬tarag24 ¦

• karrkSaTukKYrEtrkSaenAkEnøgRtCak; ¬-20 GgSares ¦

• sMPar³kargarKYrEtrkSaTukmin[yUrCag 1Ex enAkñúgTUrTwkkk ¬2-8 GgSares¦

• KWmanEt Mueller-Hinton agar etsþRbtibtþiKuNPaBb:ueNÑaHEdlKYreRbI .

• Inoculum KYrRtUveFVIeGaysþg;dareFobnwgsþg;darPaBl¥k;EdleKsresr

• brievNTMhMKYrEtvas;[)anRtwmRtUvBitR)akd.

(29)

sirIr³nImYy² KYrsßitenAkñúgcenøaHEdlmanenAkñúgtarag24.

• Standard control strains TaMg3 man³

- Staphylococcus aureus(ATCC 25923; NCTC 6571);

- Escherichia (ATCC 25922; NCTC 10418);

- Pseudomonas aeruginosa(ATCC 27853; NCTC 10622);

• etsþKYrEtGnuvtþCamYynwg Standard strain TaMg3 ³

- enAeBlEdlLÚfμIén ^DiscRtUveKdak;eGayeRbIR)as;

- enAeBlEdlLÚfμIénfñalbNþúHRtUveKdak;eGayeRbIR)as;

- mþgkñúgmYys)aþh_ edayeFVIRsbKñaCamYynwg AntibiogramEdleKeFVICaFmμtaTUeTAral;éf¶

• eRbItaragRtYtBinitüKuNPaBEdlmanbgðajenAkñúgrUbPaBTW 16 sRmab;eFVIkarkt;Rta nigvaytémø

Performance Tests enH.

karEfTaM nigkareRbIR)as;

Stock culture

kareRCIserIs nigRbPB

cUreRCIserIs ^StrainedIm,I[cMnYnGtibrmaénlkçN³ Morphological metabolic nig Serological Gac eGayeKykmkeFVIetsþCamYynwgcMnYnGb,rmaénkarbNþúHemeraK. manbBa¢Ipþl;CUnenAkñúgtarag2 eKGacTTYl )an ^StrainTaMgenHBIkarrYmbBa©ÚlKñaénRbPBdUcteTA ³

- BIvtßúviPaKKøInikEdleK)ancgRkgCaÉksarTukya:gRtwmRtUv - karRbmUlpþúMkarbNþúHemeraKCapøÚvkarnana

- GñkplitsMrab;CMnYj

- karGegátvaytMélKuNPaBBIGñkxageRkA - mnÞIrBiesaFn_bEg¥knana

karrkSaTuk

karrkSaTukry³eBlEvg

viFIsa®sþkñúgkarrkSaTukry³eBlEvgGnuBaØati[manry³eBlcenøaHrab;Ex b¤ qñaM rvagkarbNþúHemeraKbnþ²eTot nana. viFIsa®sþEdll¥bMputKW Lyophilization ¬RtCak;-s¶Üt¦ b¤rkSaTukenAsuItuNðPaB-70^o^C b¤TabCagenH enAkñúgm:asuInRtCak;GKÁIsnI b¤enAkñúgTwknIRtUEsn. viFIsa®sþepSgeTotEdlCMnYs)an manerobrab;dUcxageRkam³

(30)

GlycerolenA -20^o^C

1- cUrbNþúHemeraKd¾suT§l¥enAelIfñalrwgsmRsbmYy

2- enAeBlkarbNþúHemeraKvivtþn_eBjelj cUrekasvaecjCamYynwgEdksMrab;ekas 3- dak;BMnUktUc²énemeraKbNþúHenAkñúg Sterile Neutral Glycerol.

4- EbgEckkñúgbrimaNBI 1-2 m>l eTAkñúgbMBg;EdlmanKMrbmYlbiT b¤ kUndbtUc² .

5- rkSaTukenAsItuNðPaB -20 ^o^C. eCosvageFVI[kk b¤ rlay mþgeTot. epÞrvabnÞab;BI 12-18 Ex . eRbgFmμCati enAsItuNðPaBkñúgbnÞb; ¹

1- erobcMbMBg;rbs; Heart infusion agar edaydak;eGayeRTtbnþic. cMeBaHsirIr³EdlBi)akTukdak;

cUrbEnßmQamRss; b¤QamEdlkMedA.

2- rMgab;emeraKkñúgeRbgFmμCatienaH (Liquide petrolatum) enAkñúgxül;ekþA ¬sItuNðPaB 170 ^o^C ry³eBl 1 em:ag¦.

3- bNþúHvtßúEdlRtUvbNþúHsuT§enAelIkEnøgCMral.

4- enAeBleXIjfavalUtlas;l¥ehIy bEnßmeRbgFmμCatiEdlsMlab;emeraKehIyenARtg;RbEhl 1 sg;TIEm:Rtxag

5- elIkEnøgCMral.

6- eFVIkarbNþúHbnþ²eTotenAeBlmantRmUvkar edaylagduHsm¥atGVIEdllUtlas;BIxageRkameRbg.

7- rkSaTukenAsItuNðPaBkñúgbnÞb;. epÞrvabnÞab;BI 6-12 Ex .

karbNþúHkñúgCMerA enAsItuNðPaBkñúgbnÞb; ¬eRbIsRmab;Et^Non-fastidious organism b:ueNÑaH dUcCaStaphylococci nig Enterobacteriaceae¦

1- erobcMbMBg; EdlmanKUTeRCAdak;cahYyEdlminmanCati Carbohydrate.

eKpþl;Gnusasn¾eGayeRbI Tryptic soy agar (Soybean casein digest agar). 2- cak;sirIr³sMrab;bNþúH cUleTAkñúgfñalcahYy.

3- bNþúHvaeBjmYyyb;enAsItuNðPaB 35 ^o^C.

4- biTbMBg;edayqñúkmYlb¤qñúkcuk. RCmuCKMrbeTAkñúgRkmYnEdlrlayedIm,IbiTP¢it.

5- rkSaTukenAsItuNðPaBkñúgbnÞb; ehIyepÞrvabnÞab;BI1qñaM .

(31)

karbNþúHedaycak;cUleTAkñúgCystine Trypticase Agar (CTA)

¬sRmab;^NeisserianigStreptococci¦ 1- erobcMbMBg;fñal ^CTA.

2- cak; sirIr³sMrab;bNþúH cUleTAkñúgfñal.

4- biTbMBg;edayqñúkmYlb¤qñúkcuk . RCmuCKMrbeTAkñúgRkmYnEdlrlayedIm,IbiTP¢it.

5- sRmab; ^NeisseirkSaTukenAsItuNðPaB35^o^C ehIyepÞrerogral;2GaTitümþg. sRmab; Steptococci

rkSaTukenAsItuNðPaBkñúgbnÞb; nigepÞrvaerogral;Ex .

fñalbNþúHBIsac;q¥insMrab;BYkemeraKEdlminRtUvkarxül; (Anaerobes)

2- bNþúHvaeBjmYyyb;enAsItuNðPaB 35 ^o^C. 3- biTbMBg;edayqñúkmYlb¤qñúkcuk .

4- rkSaTukenAsItuNðPaBkñúgbnÞb;. epÞrvaerogral;2Ex . karrkSaTukry³eBlxøI

karbNþúHsRmab;kareFVIkarviPaKCaFmμtaRbcaMéf¶GacRtUv)anerobcMkñúgviFIdUcteTA . sirIr³EdllUtlas;elOn

2- bNþúHvaeBjmYyyb;enAsItuNðPaB 35 ^o^C. 3- rkSaTukenAkñúgTUrTwkkk . epÞrvaerogral; 2Ex .

Streptococci

1- cak;emeraKeTAelI épÞCMralrbs;fñalEdleFIVIQamenAkñúgbMBg;EdlmanqñúkmYlbiT.

2- bNþúHvaeBjmYyyb;enAsItuNðPaB 35 ^o^C. 3- rkSaTukenAkñúgTUrTwkkk . epÞrvaerogral;2Ex .

(32)

Meninggococci nig Haemophilus

1- cak;emeraKeTAelIépÞCMralrbs;fñal ^Chocolateb¤ can.

3- rkSaTukenAkñúgsItuNðPaBkñúgbnÞb; . epÞrvaBIrdgkñúg1s)aþh_ .

Gonococci

1- cak;emeraKeTAelI Chocolate agar .

2- bNþúHva nigrkSaTukenAsItuNðPaB 35 ^o^C. epÞrvaerogral;2éf¶ .

3- pøas;bþÚr ^StrainEdlsMrab;karRtYtBinitüKuNPaB enAerogral;eBlmaneraKfIμ²BIKøInIk.

kareRbIR)as;mnÞIrBiesaFn_bEg¥k

RbePTénvtßúviPaKdUcxageRkamenH KYrEtbBa¢ÚneTAmnÞIrBiesaFn¾fñak;tMbn; b¤ mnÞIrBiesaFn_bEg¥kfñak;mCÄwm ³ - vtßúviPaKsRmab;RtUvkaryUr²mþg b¤etsþEdlRtUvkarCMnajx<s;⁽]TarhN_ Virology, Serodiagnosis

of parasitic infections)

- vtßúviPaKcmøg dUcCasMrab;BinitüeTAelIlT§plrbs;mnÞIrBiesaFn_xøÜnpÞal;Edl)anbBa¢ÚneTA

- vtßúviPaKEdleKRtUvkarsMrab;eFVIkarbBa¢ak;eTAelIlkçN³Cak;lak;Rkum b¤RbePTénemeraKbgáCm¶WEdl Casar³sMxan;cMeBaHsuxPaBsaFarN³ ¬]TarhN_ Salmonella, Shigella, Vibrio cholerae, Brucella, Meningococci,nig Pneumococci).

mnÞIrBiesaFn_bEg¥kKYrEtmanlT§PaBpÁt;pÁg;nUvkarbNþúHsMrab;CabEg¥ksRmab;karRtYtBinitüKuNPaBnwgtRmUvkar karbNþúHbNþal nigesr:UmnigRbtikrsþg;dar sRmab;kareRbóbeFobCamYynwgGVIEdlkMBugeRbIR)as;enAkñúgmnÞIr BiesaFn_bEg¥k.

RbsinebIminmankmμviFIvaytMélKuNPaBBIxageRkAeTenaH eKKYrEtsMueGaymnÞIrBiesaFn_bEg¥kpÁt;pÁg;vtßúviPaK nigfñalbNþúHEdldak;kUdmineGaynrNadwg. dUcenHmnÞIrBiesaFn_bEg¥kGaceFVIetsþeTAtamRbeyaCn¾rbs;;xøÜn kñúgkarrk nigkMNt;GtþsBaØaNrbs;emeraK .

(33)

karvaytMélKuNPaBBIxageRkA

EpñkenH pþl;nUvBt’man eTAelIGVIEdlRtUvTak;Tg kñúgkarcUlrYmenAkñúgkmμviFIvaytMélKuNPaBBIxageRkA ¬eBl xøHeyIgsÁal;CakmμviFIetsþCMnaj { Proficiency Testing Scheme } ¦.

eKalbMNg

eKalbMNgénkmμviFIvaytMélKuNPaBBIxageRkAKW ³

- pþl;nUvkarFanaGHGag cMeBaHTaMgRKUeBTü nigsaFarN³ CnTUeTAfa kareFVIeraKvinicä½yenAmnÞIrBiesaFn_

enHKWRbkbedayKuNPaBl¥

- eFVIkarvaytMél nigeRbóbeFobPaBTukcitþ)anrbs;lT§plmnÞIrBiesaFn_eTAelIrgVas;smehtupl - eFVIkarkMNt;BIkMhusqÁgrYmCaTUeTA

- elIkTwkcitþkareRbIR)as;viFIsaRsþCaÉkPaB - elIkTwkcitþkareRbIR)as;nUvRbtikrsþg;dar

- Rbkan;yknUvviFankarrdæ)al ¬EdlGacrYmman kardkhUtGaCJab½NÑkargar¦ tTl;nwgmnÞIrBiesaFn_

EdlminRKb;sþg;dar.

- CMrujeGaymankarRbtibtþiénkmμviFIRtYtBinitüKuNPaBépÞkñúg . karerobcM

kmμviFIvaytMélKuNPaBBIxageRkA mankarGegátmYycMnYn EdlkñúgenaH vtßúviPaKEdleKdak;elxkUdehIy RtUv eKEckcay tamry³karepJItaméRbsNIy¾ eTAkan;mnÞIrBiesaFn_nanaEdlcUlrYmkñúgkmμviFI. vtßúviPaKTaMgenH KYrEtRtUvdak;bBa©ÚleTAkñúgvtßúviPaKCaTUeTAFmμtarbs;mnÞIrBiesaFn_ ehIycat;Ecg nigeFVIetsþeday eRbIrebob dUcKñaEtmYynwg vtßúviPaKEdl)anmkBIKøInik.

karGegátKYrEtRtUveFVIeLIg[RsbtamGnusasn¾dUcxageRkam ³ - karGegátKYrEtRtUv)aneFVIy:agtic4dgkñúg1qñaM

- ry³eBleFVIr)aykarN_KYrEtxøI ]TarhN_ 2 s)þah_ bnÞab;BITTYlvtßúviPaK

- eKKYrrYmbBa©Úl karENnaM nigTRmg;r)aykarN_ eTAkñúgkarGegátnImYy² ehIy taragr)aykarN_RtUv EtmanBIrc,ab;CamYynwgkarkMNt;eBlRbKl;c,as;las;.

(34)

karbNþúH

karbNþúHKYrEtRtUvdak;bBa¢ÚlsRmab;karbBa¢ak;GtþsBaØaN nigsRmab;karetsþPaBkbTl;nwgGg;TIb‘Íy:UTik Ca kMNt;mYycMnYn. vaGacCakarbNþúHsuT§ b¤karlayKñaénkarbNþúHemeraKBIr b¤eRcIn.

karbNþúHKYrEttMNagy:agticnUvlkçN³3dMbUg énlkçN³TaMg6dUcxageRkam ³

1- Rkum)ak;etrIEdlmanskþanuBlcMeBaHsuxPaBsaFarN³ b:uEnþEdlminEmnEtgEteXIj Cajwkjab;enA kñúgkarGnuvtþCaTUeTAFmμtaral;éf¶enaHeT ]TarhN_ Corynebacterium diphtheriae, Salmo- nella paratyphi A.

kMNt;smÁal; ³ ^Brucellanig Salmonella paratyphi minKYrRtUveKeRbIsRmab;kmμviFIvaytMélKuNPaBeT BIeRBaHfa vaGaceGayelceLIgnUvkarqøgeraKF¶n;F¶redayécdnü.

2- RbePTCIvsaRsþEdlminFmμta ehIyEdlCaerOy²mankarkMNt;GtþsBaØaNxus ]TarhN_ ^H²^S-

positive Eschrichia coli, Lactose-negative E.coli , Urease-negative Proteus.

3- emeraKbgáCMgWEdleKsÁal;fμI² b¤ emeraK»kasniym ]TahrN_ Yersinia enterocolitica, Vibrio parahaemolyticus, Burkholderia, Pseudomonas cepacia.

4- karRcbl;Kñaén Shigella, Citrobacter, E. coli nig Klebsiella GacRtUveRbIedIm,IviPaKCMnajrbs;

mnÞIrBiesaFn_ mYykñúgkarrkGtisuxumR)aNbgáCMgWBIkñúgcMnYnGtisuxumR)aNTUeTAmYycMnYn.

5- karRcbl;KñaénGtisuxumR)aNminbgáCMgW GacnwgRtUveKeRbI edIm,IeFVIkarviPaKlT§PaBkñúgkarsÁal;

vtßúviPaKGviC¢man.

6- )ak;etrIEdlmanrUbragFn;RTaMBiess ]TahrN_ meticillin-resistance S. aureus ¬^MRSA¦.

Sera

karviPaKelIesr:UmQam sRmab;karbgáeraKdUcteTAenH KYEtCaEpñkénkmμviFIvaytMélKuNPaBBIxageRkA enAkñúg)ak;etrIsaRsþ ³

- CMgWsVay ^Syphilis - CMgWs¥Úc ^Rubella - CMgWGutkþam Brucellosis

- CMgWedayBYk RsÞibtUkUk (Streptococcal infection)

- CMgWRKuneBaHevon

(35)

kardak;BinÞú nigr)aykarN_lT§pl

qab;² bnÞab;BI)anTTYlr)aykarN¾BIRKb;GñkcUlrYm cemøIyRtwmRtUvKYrEtepJIeTAeGay mnÞIrBiesaFn_nana. kñúg GMLúgeBlmYyExbnÞab;BIenaH r)aykarN_cugeRkayKYrEtepJIeTAmnÞIrBiesaFn_ CamYynwgkarviPaK énlT§pl.

BinÞúeTAelIkarRbtibtþi RtUv)anpþl;eTAeGaymnÞIrBiesaFn_nImYy². mnÞIrBiesaFn_nImYy²KYrEtmanelxsm¶at;

EdldwgEtmñak;ÉgKt;. dUcenHvaGacdwgnUvkarRbtibtþipÞal;rbs;va edayeFobeTAnwgrbs;Gñkd¾éTeTot b:uEnþmnÞIr BiesaFn_déTeTotKWsßitenACaGnamik.

(36)

PaK 1

karRsavRCav)ak;etrIsa®sþ

(37)

Qam

esckþIepþIm

QamRtUv)aneKbNþúHeLIgedIm,IviPaKrk)ak;etrI b¤ GtisuxumR)aNdéTeTotEdleKGacbNþúH)an dUcCaBYk empSit b¤BYkpSitEdlmansrés. vtþmanénBBYk)ak;etrI b¤ pSitTaMgenaHenAkñúgQamRtUv)aneKehAfa ^Bacte-

raemia b¤ ^Fungaemia. CaFmμtaQamKWCavtßús¥atKμanemeraK EtmankrNIelIkElgmYycMnYn EdlbNþal eGayman Bacteraemia CabeNþaHGasnñEdlGacbNþalmkBIkardkeFμj karvHkat;kñúgmat; ^Broncho-

scopy b¤ karjat;bMBg;eTAkñúgepøak b¤bMBg;Twkenam . b:uEnþ Bacteraemia RbePTenHeRcInEtekIteLIgeday sarEt)ak;etrIEdlminbgáCm¶W nigCaTUeTACasHes,IyeTAvijedayÉkÉg edaysarEt Phagocytosis )ak;etrI TaMgenHenAkñúgeføIm nigkñúgpal .

Septicaemia KWCaBaküKøInikEdl)aneKykmkeRbIedIm,IbriyayGMBI Bacteraemia EdlbeBa©jCaeraKsBaØa edaymankarbgáeraKF¶n;F¶r rYmbBa©ÚlTaMgRKunrgar Gs;kmøaMg Bul nigsMBaFQamFøak;cuH nwgGaceGaysuk

:

negative nigkuksuI ^Gram^positive .

etI Bacteraemia GacekIteLIgenAeBlNa nigTIkEnøgNa?

Bacteraemia KWCacMNucsMxan;rbs;CMgWqøgmYycMnYn ]TahrN_ Brucellosis leptospirosis nigRKuneBaH- evon . Bacteraemia sßitenAyUrKWCalkçN³énkarqøgeraKEpñkxagkñúgRbB½n§srésQam dUcCakarrlak sac;ebHdUg e)a:gdac;srésQamEdlqøgeraK nigsÞHsrésQamedaydMuQamkk.

Bacteraemia beNþaHGasnñ Cajwkjab;eRcInEtmankarkreraKenAnwgkEnøgmYycMnYndUcCa ³ rlaksnøak;

karQWcab; edayedkenAelIERKyUr rlakfg;Rbmat; rlakkñúgeBaHevonFM rlakeRsamxYr rlakxYrq¥wg rlaksYt rlaktRmgenam nigkarb:HTgÁic b¤ dMe)AenARtg;kEnøgvHkat; b¤ rbYs. bacteraemia GacekIteLIgeRkaykar vHkat; EtvaEtgEt)at;eTAvijedayÉkÉg cMeBaHGñkmansuxPaBFmμta .

BBYk ^Acteraemia nig ^Fungaemia GacbNþalmkBIkarRCatcUlrbs;GtisuxumR)aNmYycMnYneTAkñúgsrés Qamtamry³karcak;fñaMtamsrésEv:n ^Catheters Rtg;muxm¢úlcak;fñaM. karbgáeraKTaMgBIrenHk¾GacbNþalmk BIGñkEdleRbIR)as;fñaMejóntamkarcak;srés nigGñkEdlmanRbB½n§karBarcuHexSaydUcCaGñkEdlpÞúkemeraK

HIV nigekItCm¶W ^AIDS .

karbgáeraKTaMgBIrEbbenHCajwkjab;eRcInEtbNþalmkBIGtisuxumR)aN»kasniym ^(Oppor^-^Tunistic

Microorganism ) ehIyGacQaneTArkkarbgáeraKF¶n;F¶r. taragTI5 bgðajGMBImUlehtu cm,g²én

Bacteraemia b¤ ^Fungaemia .