ABSTRACT
Preface 5
Abbreviations 5
Chapter 1 The Introduction 7 Introduction 8 Critical steps 8 Assessing one’s own microbiology knowledge 9 The laboratory repertoire 9 Specimen collection 9 The request form 9 The role of the laboratory 9 Epidemiology of specimens received from
primary care 13 Public health and the community 15 Notification of infectious diseases and
causative agents 17 Summary and key points 25
Chapter 2 Organisms and Antibiotics 27 Introduction 28 A practical problem 28 Common organisms associated with infection
in the community 28 The activity of antibiotics against bacteria 34 Antibiotic guidelines to use in
common infections 38 Intravenous antibiotic use in the community;
outpatient parenteral antibiotic therapy (OPAT) 42
The role that antibiotics have in predisposing to Clostridium difficile infection, the agent responsible for CDAD 42
The expectations of patients and parents 43 Summary and key points 44
Chapter 3 The urine specimen 45 Introduction 46 Organisms and epidemiology 51 Specific issues relating to the urine specimen 53 Primary care 55 The patient 55 Collecting the urine specimen 57 The request form 61 The laboratory report 61 Sterile pyuria 64 Treatment 64 Summary and key points 65
Chapter 4 The Genital Specimen 67 Introduction 68 Organisms and epidemiology 74 Specific issues associated with the
genital specimen 76 Primary care 77 The patient 77 Collecting the specimen 80 The request form 81 The laboratory report 84 Treatment 84 Summary and key points 84
Chapter 5 The Swab of the Chronic Leg Ulcer 85 Introduction 86 Organisms and epidemiology 86 Specific issues associated with the
chronic leg ulcer swab 90 Primary care 92 The patient 92 Collecting the specimen 92 The request form 94 The laboratory report 94 Treatment 96 Summary and key points 96
Chapter 6 Fungal Scrapings of the Nail Apparatus (Onychomycosis), the Hair, and the Skin 97 Introduction 98 Organisms and epidemiology 98 Specific issues with the fungal
scraping specimen 103 Primary care 104 The patient 104 Collecting the specimen 104 The request form 104 The laboratory report 104 Treatment 104 Summary and key points 106
Chapter 7 The Faecal Specimen 107 Introduction 108 Organisms and epidemiology 111 Specific issues with the faecal specimen 114 Primary care 116 The patient 118 Collecting the specimen 120 The request form 120 The laboratory report 120 Treatment 124 Clostridium difficile and CDAD 125 Hygiene practices 125 Summary and key points 128
Tract Specimen 129 Overview 130 Introduction 130 The eye 135 The ear, nose, and throat 136 The lower respiratory tract 139 Tuberculosis 144 Summary and key points 150
Chapter 9 The Serology Specimen 151 Introduction 152 How to get the most out of the laboratory 154 Markers of infection 156 Screening and determination of
immune status 158 Specimen collection 158 Hepatitis viruses 160 Management of sharps/splash injuries to
members of the public 169 Summary and key points 169
Introduction 172 Role of the antenatal clinic 172 Organisms to consider in pregnancy;
prepregnancy counselling, and the role of screening 175
Screening for HBV, HIV, rubella and syphilis 176 Exposure to a rash-like illness during
pregnancy 182 The pregnant patient with a rash 187 Group B streptococcus (GBS) 187 Urinary tract infections in pregnancy 188 Vaginal discharges and STD 188 Other infections in pregnancy 188 Vaccinations in pregnancy 190 Summary and key points 190
Chapter 11 Antibiotic Guidelines 191 Introduction 192 Treatment guidelines for common infections 192
Self-Assessment Review Cases 199 Appendix 206 References 245 Index 252
The authors wish to thank the Health Protection Agency (HPA) for permission to adapt the Quick Reference Guides for Primary Care, and the Management of Infection Guidance for Primary Care. They also want to thank the authors of these documents in the Health Protection Agency Primary Care Unit, the South West General Practitioners Microbiology Laboratory Use Group, and the British Infection Association. These guides were extremely
helpful in developing this book. The authors also thank the HPA for permission to reproduce text and diagrams from the papers by the PHLS Advisory Committee on Gastrointestinal Infections (Chapter 7), and by the PHLS Joint Working Party of the Advisory Committees of Virology and Vaccines and Immunisation (Chapter 10).
