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may be associated with colonization or clinically significant infections. Interpretation of the Gram stain often directs the further workup of this organism. The presence of small clusters of Gram-negative organisms surrounded by amorphous material is indicative of biofilm formation compatible with a chronic infection. This finding should be reported to physicians, and incubation should be prolonged, as these isolates usually exhibit slower growth characteristics. Isolation of from sterile body sites should always be interpreted as indicative of probable infection. Isolation in mixed culture requires correlation with the direct smear, other organisms isolated, and clinical history. Isolates from sites of chronic infection, such as cystic fibrosis respiratory sites, often exhibit multiple morphotypes that can make identification difficult. Molecular methods increasingly are finding a role in the identification of this organism, especially for epidemiological studies. Susceptibility testing of this organism is difficult, especially for mucoid isolates, due to increasing resistance, lack of reproducibility of results, and lack of clinical correlation. Piperacillin and piperacillin-tazobactam results obtained from automated systems may be unreliable for spp., and in particular for mucoid isolates, and results should be confirmed by disk diffusion or Etest systems. A basic understanding of the multiple mechanisms of resistance, both intrinsic and acquired, is essential to interpret susceptibility testing results and give therapeutic recommendations to physicians. Other species are infrequently isolated in the laboratory and are usually not clinically significant. Clinical correlation and correlation with the Gram stain are essential before further workup is undertaken.

Citation: HØiby N, Ciofu O, Bjarnsholt T. 2015. , p 773-790. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch42
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Image of FIGURE 1

Different colony morphologies of from CF sputum cultivated on a modified Conradi-Drigalski agar selective for Gram-negative rods (“blue plate”; Statens Serum Institut). M, mucoid; NM_1, nonmucoid colony 1 (dark green); NM_2, nonmucoid colony 2 (light green); SCV, small colony variant. doi:10.1128/9781555817381.ch42.f1

Citation: HØiby N, Ciofu O, Bjarnsholt T. 2015. , p 773-790. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch42
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Image of FIGURE 2

Diversity of biofilms in sputum ( ). Sputum samples from 77 CF patients chronically infected with were examined by Gram stain and PNA FISH. The exclusive presence of was verified by standard culturing and -specific PNA FISH (F). A great diversity in the organization of was detected; both compact biofilm-forming microcolonies (A, B, C, and F: blue arrows pointing at leukocytes in A and B, and black arrows pointing at bacterial aggregates in A, B, and C) and nonadhered planktonic bacteria (E, arrow) were observed. The organization of the polymorphonuclear leukocytes was also diverse, with these cells surrounding the biofilms (A), distant from the biofilms (B), and in a very few cases appearing inside the biofilms (C). The biofilm microcolonies were mostly very compact; however, some samples were perforated with “holes” mimicking water-filled channels visible in some mature biofilms (D, arrow pointing at hole). Magnification, ×1,000. doi:10.1128/9781555817381.ch42.f2

Citation: HØiby N, Ciofu O, Bjarnsholt T. 2015. , p 773-790. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch42
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Characteristics of species found in clinical specimens

Citation: HØiby N, Ciofu O, Bjarnsholt T. 2015. , p 773-790. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch42

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