Example 2 - Detection of Pseudomonas aeruginosa in an aerobic blood culture with non-susceptibility to penicillins, cephalosporins, and carbapenems

The procedures illustrated in this example are:

• Bacterial culture
• Multiplex PCR
• Agar diffusion for phenotypic resistance testing (qualitative results)

As in the first example, the result of the culture enrichment in the anaerobic blood culture bottle is negative.

Growth is detectable in the aerobic blood culture bottle. In this example, the transmission of the multiplex PCR result is crucial for the results of the aerobic blood culture bottle.

In accordance with the rules for handling semantics for molecular methods, in this pilot phase, the individual analytes of the multiplex PCR are represented in individual "Observations" on the "component" axis. The example shown below contains a selection of analytes from a panel for multiplex PCRs from blood cultures.

For phenotypic resistance testing using agar diffusion, this example reports the quantitative results, including the unit coded according to UCUM, with the result interpreted according to EUCAST.

• The transmission of quantitative results is desired for ARS and should be preferred where possible.
• The norm against which the phenotypic resistance testing results are evaluated is specified in "Observation.referenceRange.extension:norm".
• For gentamicin, EUCAST does not specify a breakpoint, so in this example, the quantitative result is specified under Observation.valueCodeableConcept, and "EUCAST" is specified as the applied norm under "Observation.referenceRange.extension:norm". The SNOMED code "82334004 Indeterminate (qualifier value)" was used under "Observation.interpretation". Alternatively, an interpretation of the quantitative result can be specified and "other" can be specified as the applied norm for evaluating the result under "Observation.referenceRange.extension:norm".