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Identifying the Causative Bacterium in an Infection

1Why Identification Matters and What the Question Really Asks2Getting a Usable Specimen3Direct Examination: Seeing the Organism Before Culturing It4Culture: Amplifying and Isolating the Organism5From Isolated Colony to Species6Determining Susceptibility and Confirming the Causative Role7Rapid and Molecular Methods When Culture Is Not Enough
Culture: Amplifying and Isolating the Organism

Mixed Growth and the Need for Isolation

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The wound swab example shows why mixed growth is a decision point rather than a result. Three colony types appear on the plate, but only the large beta-hemolytic colonies match what the smear showed, and those are the ones that fit the clinical picture of a wound infection with neutrophils present. The other two types are consistent with skin flora that were picked up as the swab passed over the surface. Before any identification test is run, one beta-hemolytic colony is picked and streaked to a fresh plate, because a biochemical panel or an antigen test performed on a mixture would return a result that belongs to no single organism. Notice the contrast with a normally sterile site: there, several organisms in equal abundance usually means the specimen was contaminated during collection, and the correct response is to question the specimen rather than treat every organism.
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Mixed growth means the plate carries more than one organism. Because every downstream identification method assumes a pure culture, the plate must be subcultured to a fresh medium to separate the organisms into isolated colonies before any identification step is attempted. Subculturing is not a repeat of the original culture; it is a deliberate dilution step that turns a mixture into individual clones.

A wound swab that grows three colony types

A wound swab is streaked on blood agar and MacConkey agar. After incubation, the blood agar shows a heavy growth of large beta-hemolytic colonies, a moderate growth of small white non-hemolytic colonies, and a few pinpoint colonies, while MacConkey agar grows only the large lactose-fermenting colonies. The smear had shown Gram-positive cocci in clusters with many neutrophils. The large beta-hemolytic colonies match the smear finding and are the likely pathogen; the small white and pinpoint colonies are consistent with skin flora. A single beta-hemolytic colony is picked and streaked to a fresh blood agar plate to obtain pure growth before identification proceeds.

Mixed growth from a normally sterile site, such as blood or cerebrospinal fluid, is more often a sign of contamination during collection than a true polymicrobial infection, and it should prompt a review of the collection rather than immediate treatment of every organism grown.

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