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22496 Culture, Aerobic - with Susceptibilities

Culture, Aerobic - with Susceptibilities
Test Code: AERS
Synonyms/Keywords
​Aerobic culture, C and S
Specimen Requirements
Fasting Required Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
​ ​ ​ ​ ​ ​ No​ ​ ​ ​ ​ ​ Aspirates and exudates​​ Sterile, leakproof container​ ESwab™, or other Amies medium based swab
​1-10 mL
1 swab
 0.5 mL fluid, or one swab ​0.5 mL fluid, or one swab
​Bone Marrow ​Isolator Tube ​ ​1-1.5 mL ​0.5 mL ​0.5 mL
Bronchial brush​
Submit in 1 mL
Sterile saline
 ​ ​1 brush ​1 brush ​1 brush
Bronchial lavage (BAL), bronchial wash Sterile, screw-cap leakproof container (10-100mL) ​ ​1-10 mL 0.5 mL fluid​ ​0.5 mL fluid
Catheter tip (other than Foley) ​ Sterile, wide-mouth screw-cap leakproof container​​ ​ ​1 tip ​1 tip ​1 tip
Endotracheal aspirate​ Aspiration trap (Leuke trap)​ ​ 1-10 mL​ 0.5 mL fluid​ ​0.5 mL fluid
Fluid (other than blood, urine and feces)​ Sterile, leakproof container​ ​ ​1-10 mL 0.5 mL fluid ​0.5 mL fluid
Scrapings​ Sterile, leakproof container​ ​ ​1g ​1g ​1g
Sputum​ Sterile, wide-mouth screw-cap leakproof container​ ​ ​1-10 mL 0.5 mL fluid​​ ​0.5 mL fluid
Tissue, Bone, or Hardware​ Sterile, wide-mouth screw-cap leakproof container.  For small tissues, add several drops of sterile saline to keep moist.​ ​
​1-10g
1 pc hardware
 0.5 g tissue or bone​​ ​0.5 g tissue or bone
Upper respiratory secretions​ Sterile, leakproof container​ ESwab, or other Amies medium based swab
​1-10 mL
1 swab
 0.5 mL fluid, or one swab​ ​0.5 mL fluid, or one swab
Wound​ Sterile, leakproof container​ ESwab, or other Amies medium based swab
​1-10 g
1 swab
 0.5 g tissue, 0.5 mL fluid, or one swab​ ​0.5 g tissue, 0.5 mL fluid, or one swab
Collection Processing Instructions
Specimens should be delivered to the microbiology laboratory as soon as possible.  Culture of specimens older than 24 hours may lead to a reduction in recovery of microorganisms. Gram stains will routinely be performed if sufficient specimen is received.
Swabs: 
       - ESwab: collect one swab for Gram stain, aerobic and anaerobic cultures, and an additional swab for each additional culture type or stain (e.g. fungus or  
          mycobacteria). 
       - Other Amies medium swab types: collect one swab for every culture and stain (including Gram) to be ordered.
 
 
For blood, feces, and urine specimens, use tests specific to those specimen types.
 
Lower Respiratory Tract Secretions: Early morning specimens are preferred because secretions will have pooled overnight. However, samples may be obtained whenever the patient is productive. Sputum samples will be screened for suitability by Gram stain: samples found to be contaminated with saliva will be rejected.

For more information on Specimen Collection Media/Swab, see Specimen Transport Pictorial.
 
For Bone Marrow collections, pediatric 1.5 mL Isolator Tubes can be obtained by calling the Microbiology Laboratory (x16134). Isolator tubes should be received in lab within 14h of collection, as they need to be processed within 16h to be viable.
Acceptable Specimen Types

​Bone, Bronchial, Catheter Tip, Fine Needle Aspirate, Fluid, Hardware, Respiratory Secretions, Skin Scraping, Swab, Synovial, and Tissue.

Specimen Stability Information
​Specimen Type ​Temperature ​Time

Swabs​​ ​

 ​Room temperature ​<= 4 hours
​Refrigerate ​> 4 hours
​Tissues, body fluids, aspirates ​Refrigerate
 ​> 4 hours​
​Catheter tips ​ ​Room temperature ​​<= 4 hours
​Refrigerate ​​> 4 hours
​Gastric, biopsy or lavage ​ ​Room temperature ​​<= 4 hours
​​Refrigerate ​​> 4 hours
Lower respiratory secretions (bronchial, sputum, endotracheal)​ ​ ​Room temperature ​​<= 4 hours
​​Refrigerate ​​> 4 hours
Bone Marrow​ ​Room temperature ​<= 14 hours
 
Rejection Criteria
Contaminated expectorated sputum specimens per Gram stain screening procedure
Dry swabs​
Leaking specimens​
​Specimens older than 4 days
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
​Marshfield Monday through Sunday​ varies with specimen type (average 3-4 days)​

Conventional culture, microscopic exam, standard susceptibility testing, manual or automated identification methods, nucleic acid sequence analysis as needed.

Test Information
Gram stains will routinely be performed on all respiratory secretions, tissues, and fluids (other than blood, feces and urine), specimen volume permitting.  A Gram stain will be performed on swab-collected specimens if an ADDITIONAL swab is submitted (i.e. one swab for aerobic culture and a second swab for Gram stain).
 
For Lower Respiratory Tract (LRT) Secretions:
Gram stains are routinely performed on sputum specimens to determine acceptability for culture.  The reliability of culture is very dependent upon the method of collection, conditions of transport, and the quality of the specimen.  Some organisms will not grow in routine culture, but can be a significant cause of lower respiratory tract disease.  False-negative results may be obtained due to contamination of the specimen with normal oropharyngeal flora, or from previous antimicrobial therapy.  False-positive results may be obtained when the culture is over-interpreted, or when potentially pathogenic organisms that are colonizers of the upper respiratory tract are recovered. 
 
Antimicrobial Susceptibility Testing (AST) will be performed on significant bacterial isolates with unpredictable patterns if standardized methods are available based upon Clinical Laboratory Standards Institute guidelines.  Methods used include disk diffusion, minimum inhibitory concentration (MIC) by broth microdilution, or MIC by Etest®.
A listing of the tested and reported antimicrobial agents can be seen at Antimicrobial Susceptibility Panels.  If testing against a specific antimicrobial agent is desired, contact the microbiology laboratory.
 
The microbiology laboratory uses selective reporting of susceptibility results in order to promote rational antimicrobial usage. For more information on selective reporting, please contact the microbiology technical manager. 
 
Standardized AST is not available for all bacterial species, in which case an MIC determined by a non-standardized method and without interpretation may be available upon request. Contact the microbiology laboratory for more information.
 
The microbiology laboratory publishes an annual cumulative antibiogram for commonly isolated bacteria, available at Cumulative Antibiogram Reports.  Printed copies are also available from the microbiology laboratory.​
 
‘ESwab’ is a trademark of Copan Diagnostics.
‘E-test’ is a registered trademark of bioMerieux Inc.
Reference Range Information
Performing Location Reference Range
All Performing Sites

Sterile sites:  No growth

Non-sterile/mucosal sites:  Mixed Indigenous Flora​

Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
87070​ ​ ​x1 Culture​ ​
87205​​ ​ ​x1 ​Gram stain ​By specimen type
​87176 ​ ​ ​Homogenization, tissue ​By specimen type
​87077 ​ ​ ​Aerobic isolate, definitive ID ​As needed
​87186 ​ ​ ​MIC susceptibility, micro-broth dilution ​As needed
​87184 ​ ​ ​KB (disk) susceptibility ​As needed
87181 ​ ​ ​MIC susceptibility, ​Etest® strip gradient ​As needed
​87147 ​ ​ ​​Serotyping/grouping ​As needed
​87185 ​ ​ Enzyme detection ​As needed
​87153 ​ ​ ​​ID by nucleic acid sequencing method ​As needed
'ESwab' is a trademark of Copan Diagnostics. 
'Etest' is registered by BioMerieux Inc. ​ ​ ​ ​ ​
Synonyms/Keywords
​Aerobic culture, C and S
Ordering Applications
Ordering Application Description
​Cerner ​Aerobic Culture with Sensitivity (w/Gram Stain)
If the ordering application you are looking for is not listed, contact your local laboratory for assistance.
Specimen Requirements
Fasting Required Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
​ ​ ​ ​ ​ ​ No​ ​ ​ ​ ​ ​ Aspirates and exudates​​ Sterile, leakproof container​ ESwab™, or other Amies medium based swab
​1-10 mL
1 swab
 0.5 mL fluid, or one swab ​0.5 mL fluid, or one swab
​Bone Marrow ​Isolator Tube ​ ​1-1.5 mL ​0.5 mL ​0.5 mL
Bronchial brush​
Submit in 1 mL
Sterile saline
 ​ ​1 brush ​1 brush ​1 brush
Bronchial lavage (BAL), bronchial wash Sterile, screw-cap leakproof container (10-100mL) ​ ​1-10 mL 0.5 mL fluid​ ​0.5 mL fluid
Catheter tip (other than Foley) ​ Sterile, wide-mouth screw-cap leakproof container​​ ​ ​1 tip ​1 tip ​1 tip
Endotracheal aspirate​ Aspiration trap (Leuke trap)​ ​ 1-10 mL​ 0.5 mL fluid​ ​0.5 mL fluid
Fluid (other than blood, urine and feces)​ Sterile, leakproof container​ ​ ​1-10 mL 0.5 mL fluid ​0.5 mL fluid
Scrapings​ Sterile, leakproof container​ ​ ​1g ​1g ​1g
Sputum​ Sterile, wide-mouth screw-cap leakproof container​ ​ ​1-10 mL 0.5 mL fluid​​ ​0.5 mL fluid
Tissue, Bone, or Hardware​ Sterile, wide-mouth screw-cap leakproof container.  For small tissues, add several drops of sterile saline to keep moist.​ ​
​1-10g
1 pc hardware
 0.5 g tissue or bone​​ ​0.5 g tissue or bone
Upper respiratory secretions​ Sterile, leakproof container​ ESwab, or other Amies medium based swab
​1-10 mL
1 swab
 0.5 mL fluid, or one swab​ ​0.5 mL fluid, or one swab
Wound​ Sterile, leakproof container​ ESwab, or other Amies medium based swab
​1-10 g
1 swab
 0.5 g tissue, 0.5 mL fluid, or one swab​ ​0.5 g tissue, 0.5 mL fluid, or one swab
Collection Processing
Specimens should be delivered to the microbiology laboratory as soon as possible.  Culture of specimens older than 24 hours may lead to a reduction in recovery of microorganisms. Gram stains will routinely be performed if sufficient specimen is received.
Swabs: 
       - ESwab: collect one swab for Gram stain, aerobic and anaerobic cultures, and an additional swab for each additional culture type or stain (e.g. fungus or  
          mycobacteria). 
       - Other Amies medium swab types: collect one swab for every culture and stain (including Gram) to be ordered.
 
 
For blood, feces, and urine specimens, use tests specific to those specimen types.
 
Lower Respiratory Tract Secretions: Early morning specimens are preferred because secretions will have pooled overnight. However, samples may be obtained whenever the patient is productive. Sputum samples will be screened for suitability by Gram stain: samples found to be contaminated with saliva will be rejected.

For more information on Specimen Collection Media/Swab, see Specimen Transport Pictorial.
 
For Bone Marrow collections, pediatric 1.5 mL Isolator Tubes can be obtained by calling the Microbiology Laboratory (x16134). Isolator tubes should be received in lab within 14h of collection, as they need to be processed within 16h to be viable.
Acceptable Specimen Types

​Bone, Bronchial, Catheter Tip, Fine Needle Aspirate, Fluid, Hardware, Respiratory Secretions, Skin Scraping, Swab, Synovial, and Tissue.

Specimen Stability Information
​Specimen Type ​Temperature ​Time

Swabs​​ ​

 ​Room temperature ​<= 4 hours
​Refrigerate ​> 4 hours
​Tissues, body fluids, aspirates ​Refrigerate
 ​> 4 hours​
​Catheter tips ​ ​Room temperature ​​<= 4 hours
​Refrigerate ​​> 4 hours
​Gastric, biopsy or lavage ​ ​Room temperature ​​<= 4 hours
​​Refrigerate ​​> 4 hours
Lower respiratory secretions (bronchial, sputum, endotracheal)​ ​ ​Room temperature ​​<= 4 hours
​​Refrigerate ​​> 4 hours
Bone Marrow​ ​Room temperature ​<= 14 hours
 
Rejection Criteria
Contaminated expectorated sputum specimens per Gram stain screening procedure
Dry swabs​
Leaking specimens​
​Specimens older than 4 days
Reference Range Information
Performing Location Reference Range
All Performing Sites

Sterile sites:  No growth

Non-sterile/mucosal sites:  Mixed Indigenous Flora​

For more information visit:
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
​Marshfield Monday through Sunday​ varies with specimen type (average 3-4 days)​

Conventional culture, microscopic exam, standard susceptibility testing, manual or automated identification methods, nucleic acid sequence analysis as needed.

For billing questions, see Contacts
Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
87070​ ​ ​x1 Culture​ ​
87205​​ ​ ​x1 ​Gram stain ​By specimen type
​87176 ​ ​ ​Homogenization, tissue ​By specimen type
​87077 ​ ​ ​Aerobic isolate, definitive ID ​As needed
​87186 ​ ​ ​MIC susceptibility, micro-broth dilution ​As needed
​87184 ​ ​ ​KB (disk) susceptibility ​As needed
87181 ​ ​ ​MIC susceptibility, ​Etest® strip gradient ​As needed
​87147 ​ ​ ​​Serotyping/grouping ​As needed
​87185 ​ ​ Enzyme detection ​As needed
​87153 ​ ​ ​​ID by nucleic acid sequencing method ​As needed
'ESwab' is a trademark of Copan Diagnostics. 
'Etest' is registered by BioMerieux Inc. ​ ​ ​ ​ ​
For most current information refer to the Marshfield Laboratory online reference manual.