Bronchial Aspirate Culture, Mycobacterium

CERNER / EPIC MNEMONIC: C AFBSM
POE DESCRIPTION: CU MYCOBACTERIUM W SMEAR; CU AFB W SMEAR; C AFBSM

CPT CODE: 87117 (culture); 87206 (smear)
CDM NUMBER: 3451029; 3451025
TEST INFORMATION: The test includes culture and acid-fast stain (if specimen volume is adequate). Culture includes decontamination and concentration followed by inoculation of specific mycobacterial conventional media and a rapid medium for automated analysis. If a mycobacterial species is isolated, the organism will be definitely identified. Susceptibility testing will be performed depending on the isolate identification. Other isolated organisms (i.e. aerobes, fungi) may be referred for identification and/or susceptibility testing if medically indicated AND a separate culture procedure has NOT yielded the same organism(s).
DAYS PERFORMED: Daily
TURNAROUND TIME: Smear results: 24 hours after receipt of the specimen in the laboratory. Preliminary culture reports are available after 1 week or when a mycobacterial isolate is detected. Negative cultures with negative smears will be finalized after 8 weeks. Negative cultures with positive smears will be finalized after 12 weeks. Completion of culture reports may require additional time when mycobacteria are isolated and susceptibility testing is performed.
SPECIAL INSTRUCTIONS: The specific anatomic site of the specimen MUST be specified on the order or requisition.
CONTAINER TYPE: Sterile sputum container; sterile Leuken`s tube; sealed sterile container, no preservative
COLLECTION: Specimens are to be collected from a site prepared utilizing aseptic technique. Non-bacteriostatic sterile saline should be used when obtaining washings and/or lavage specimens. Material obtained by needle aspiration (transbronchial lung biopsy) is injected into a sealed sterile container.
SPECIMEN REQUIREMENTS: Bronchial aspirate, bronchial biopsy, bronchial brush
REJECTION CRITERIA:

Inappropriate specimen container, insufficient specimen volume, specimen received in a preservative. Specimens from known positive patients will be accepted only once a week for culture and smear per body site.

MINIMUM VOLUME: 5 mL or a piece of tissue
HANDLING INSTRUCTIONS:

Specimen should be transported as soon as possible. When transportation is delayed, refrigerate.

REFERENCE RANGE: No acid-fast bacilli observed on smear or isolated in culture
LIMITATIONS OF TEST: A single negative smear does not rule out the presence of mycobacterial infection. Anesthetic solutions used during the bronchoscopy procedure may inhibit growth of organisms. Bronchial brushes MUST be transported to the laboratory IMMEDIATELY to eliminate desiccation of the specimen. Specimens collected via bronchoscopy are contaminated with normal oral flora.
METHODOLOGY: Acid-fast smear: fluorochrome stain. Culture: inoculation of conventional culture media and a rapid medium for automated continuous analysis.
ADDITIONAL INFORMATION:

DNA probes may be incorporated to aid with more rapid identification of mycobacterial isolates. This will generate an additional charge(s). Susceptibility testing will be performed only on the first Mycobacterium isolate from each specimen type per patient. Additional susceptibilities may be performed after a period of 4 weeks for patients with suspected treatment failure. Susceptibility testing is performed routinely only for M. tuberculosis complex.  Susceptibility testing for other Mycobacterium species is performed by special request only. The battery of drugs routinely tested will vary by isolate and/or physician request. Patients from whom M. tuberculosis is isolated in culture are reported to the City of Chicago Board of Health. This is mandated by law.

LAST UPDATED:

5-13-2014

TEST SYNONYM(S):Bronchial Aspirate AFB Culture; Bronchial Aspirate TB Culture; Lower Respiratory Mycobacterium Culture; Mycobacterium Culture; Bronchial Aspirate