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The number and types of tests done in such a laboratory depend on its size and the population it serves. Highly specialized or rarely performed tests should be done only by reference laboratories. Physicians, clinical laboratory personnel, and reference laboratory personnel must have a good working relationship if patients are to receive first-rate care. In addition, the physician and the clinical laboratory personnel must know which diseases and isolates are reportable to public health laboratories and how to report them.

Above the Species Level In addition to species and subspecies designations, clinical microbiologists must be familiar with genera and families. A genus is a group of related species, and a family is a group of related genera. An ideal genus would be composed of species with similar phenotypic and phylogenetic characteristics. Some phenotypically homogeneous genera approach this criterion (Citrobacter, Yersinia, and Serratia). More often, however, the phenotypic similarity is present, but the genetic relatedness is not.

Also, even if a metabolic gene is functional, negative reactions can occur because of the inability of the substrate to enter the cell, because of a mutation in a regulatory gene, or by production of an inactive protein. There is not necessarily a one-toone correlation between a reaction and the number of genes needed to carry out that reaction. For instance, six enzymatic steps may be involved in a given pathway. If an assay for the end product is performed, a positive reaction indicates the presence of all six enzymes, whereas a negative reaction can mean the, absence or nonfunction of one to six enzymes.

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