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The page below is a sample from the LabCE course Case Studies in Clinical Microbiology. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Case Study: Gram-Negative Sepsis
A 67-year-old man is admitted to the hospital with a cough, right lower chest pain accentuated by deep breathing, and fever. He has a history of chronic obstructive pulmonary disease (COPD), secondary to a long history of smoking. His temperature on admission is 102.5º F and auscultation of the chest reveal rales in the right lower lung field. The admission white blood count (WBC) is 13,500/mL with 80% segmented neutrophils and a shift to the left. A blood culture is obtained.
The colonies shown on the blood agar plate (BAP) (upper) and MacConkey (MAC) agar (lower) biplate represent 24 hour growth from an aerobic blood culture bottle that became positive at 12 hours after inoculation. The appearance of the colonies on MAC agar rules out which two of the following bacterial species? (Select two responses.)

More than one answer is correct. Please select all correct answers