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HelpTest Code LAB6037 Culture, Bacterial—Aerobic Only with Gram Stain, Respiratory
Additional Codes
| Test Name in EPIC | EPIC Test Code | Mnemonic | Order LOINC |
|---|---|---|---|
| CULTURE, RESPIRATORY | LAB6037 | Resp Cx | 32355-0 |
Useful For/Utility
Aiding in the diagnosis of lower respiratory bacterial infections including pneumonia.
Clinical Information
Common bacterial agents of acute pneumonia include: Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, Pseudomonas aeruginosa, and members of the Enterobacterales (Escherichia coli, Klebsiella species, and Enterobacter species). Clinical history, physical examination, and chest X-ray are usually adequate for the diagnosis of pneumonia, and antimicrobial treatment is typically based on these findings. Culture of expectorated sputum is used by some for the evaluation of pneumonia, although controversy exists regarding this practice; both sensitivity and specificity of sputum cultures are generally regarded as poor (<50%). Specificity is improved by collecting expectorated purulent matter from the lower respiratory tract and avoiding mouth and oropharyngeal matter, thereby reducing contamination. Prior to culture, the specimen should be examined for the presence of white blood cells (evidence of purulent matter) and paucity of squamous cells (evidence of minimal contamination by oral matter). "Blood cultures should be performed to establish the definitive etiology of an associated pneumonia. However, only 20%-30% of patients with bacterial pneumonia are bacteremic."
Specimen Requirements
Whenever possible, culture specimens should be obtained before antibiotics or antimicrobial agents have been administered.
Specimen source is required.
Specimen Type: Bronchial washings
Container/Tube: Sterile container
Specimen Volume: >1 mL
Additional Information:
1. Label container with patient’s name (first and last), date and actual time of collection, and source/type of specimen.
2. If there is a delay in transport of >8 hours, process specimen as follows:
a. Inoculate and streak to appropriate agar medium and make a direct smear.
b. Blood agar plate (BAP), CNA, and chocolate (CHOC) agar plate should be incubated in Bio-Bag type C. MAC should be in regular air.
c. Incubate all plates at 33° C to 37° C.
d. Transport to the laboratory within 72 hours.
Specimen Type: Sputum, induced
Container/Tube: Sterile container
Specimen Volume: ≥5 mL
Specimen Minimum Volume: 1.5 mL
Collection Instructions: Nasal secretions or saliva (watery, colorless, foamy specimens) are not acceptable.
Additional Information:
1. Label container with patient’s name (first and last), date and actual time of collection, and source/type of specimen.
2. If there is a delay in transport of >8 hours, process specimen as follows:
a. Inoculate and streak to appropriate agar medium and make a direct smear.
b. Blood agar plate (BAP), CNA, and chocolate (CHOC) agar plate should be incubated in Bio-Bag type C. MAC should be in regular air.
c. Incubate all plates at 33° C to 37° C.
d. Transport to the laboratory within 72 hours.
Specimen Type: Sputum, spontaneous
Container/Tube: Sterile container
Specimen Volume: ≥5
Specimen Minimum Volume: 0.5 mL
Collection Instructions:
1. Nasal secretion or saliva (watery, colorless, foamy specimens) are not acceptable.
2. Overnight accumulation of secretions usually give best results, collect specimens in the morning as follows:
a. Instruct patient to brush his/her teeth and/or rinse mouth well with water to minimize contaminating specimen with food particles, mouthwash, or oral drugs.
b. Have patient remove dentures.
c. Instruct the patient to take a deep breath, hold it momentarily, then cough deeply and vigorously into a container.
Additional Information:
1. Label container with patient’s name (first and last), date and actual time of collection, and source/type of specimen.
2. If there is a delay in transport of >8 hours, process specimen as follows:
a. Inoculate and streak to appropriate agar medium and make a direct smear.
b. Blood agar plate (BAP), CNA, and chocolate (CHOC) agar plate should be incubated in Bio-Bag type C. MAC should be in regular air.
c. Incubate all plates at 33° C to 37° C.
d. Transport to the laboratory within 72 hours.
Specimen Type: Tracheal secretions
Container/Tube: Sterile container
Specimen Volume: ≥5 mL
Specimen Minimum Volume: 0.5 mL
Collection Instructions: Collect tracheal secretions suctioned from an endotracheal tube.
Additional Information:
1. Label container with patient’s name (first and last), date and actual time of collection, and source/type of specimen.
2. If there is a delay in transport of >8 hours, process specimen as follows:
a. Inoculate and streak to appropriate agar medium and make a direct smear.
b. Blood agar plate (BAP), CNA, and chocolate (CHOC) agar plates should be incubated in Bio-Bag type C. MAC plate should be in regular air.
c. Incubate all plates at 33° C to 37° C.
d. Transport to the laboratory within 72 hours.
Specimen Transport Temperature
Container-Refrigerate 8 hours/Ambient NO/Frozen NO
Plates-Ambient/Refrigerate NO/Frozen NO
Day(s) Test Set Up
Monday through Sunday
Performing Laboratory
Microbiology -
St. Joseph's Medical Center Lab
SMDC Clinical Lab, Virginia Hospital Lab
Fargo Hospital Lab, Fosston Hospital Lab, St. Mary's - Detroit Lakes Hospital Lab
Test Classification and CPT Coding
87070-Culture
87205-Gram stain
Additional CPT codes will be billed when appropriate.
Reference Values
1-2 days to final report if negative
Cautions
When culture of sputum is delayed, successful isolate of bacterial pathogens is less likely due to the overgrowth of usual oropharyngeal flora. Some bacterial agents that cause lower respiratory infections (e.g., mycobacteria, Legionella species, Mycoplasma pneumoniae) are not detected by this assay and require special procedures. If the bacterial culture is negative, clinicians should consider additional testing to detect other bacterial, viral or fungal agents.
Interfretive Data
A negative test result is no growth of bacteria or growth of only usual flora. A negative result does not rule out all causes of infectious lung disease. Organisms associated with lower respiratory tract infections are reported.