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Automatic Reflex Aerobic Eye Culture Recommendations

The Conjunctivitis Team along with the Red Book and the Children's Mercy Department of Infectious Diseases recommends eye culture in the low risk group for GC, Chlamydia, and HSV. This recommendation is made as it is difficult to differentiate, by clinical exam alone, between high risk (GC, Chlamydia, and HSV) and other lower risk organisms.

Historically at Children's Mercy, when a clinician was concerned about GC neonatal conjunctivitis, an aerobic eye culture was ordered. In reviewing aerobic eye culture data obtained from CM Outpatient and Inpatient (see Table 1) areas between March 2013 and June 2017, the results revealed predominately low-risk organisms or normal flora growth (see Tables 2 and 3). Results for GC were inconclusive (see Table 2) due to the fastidious nature of the bacteria when the specimen was cultured from the standard charcoal aerobic media (STARswab 2 at CM). Per CM Microbiology Lab recommendations and EBP review it is now recommended to plate eye culture specimens suspected for GC directly onto Thayer-Martin agar, or other GC specific culture media. Gonorrhea specific culture media such as Thayer-Martin is a selective media that inhibits the overgrowth of low-risk organisms and normal flora, while improving the yield of the fastidious GC organism. Is it key to note that a separate routine aerobic eye(s) culture no longer needs to be ordered as this test is reflexed within the neonatal conjunctivitis sub-phase GC eye culture order. If GC is not isolated, but the patient does not clinically improve, the reflex aerobic culture results may provide further information for the clinician to make therapy adjustments.

 

 

 

 

 

These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly these guidelines should guide care with the understanding that departures from them may be required at times.