Aerobic Bacterial Culture, General
| Aerobic Bacterial Culture, General | | | |
| Number | | 008649 |
| CPT | | 87070 |
| Related Information | | Default Test Order for Ambiguous Orders Methicillin-Resistant Staphylococcus aureus (MRSA) Culture and Susceptibility Methicillin-Resistant Staphylococcus aureus (MRSA) Culture Only |
| Synonyms | | Culture, Bacterial, General, Aerobic ; Eye ; Fluids ; Routine Culture: Abscess ; Wound |
| Test Includes | | Isolation and identification (additional CPT codes) of potential aerobic pathogens and drug susceptibility tests (additional charge). Gram stain (additional test) is recommended. CPT coding for microbiology and virology procedures often cannot be determined before the culture is performed. Requests with only a written order and no test number indicated will be processed according to Default Test Order for Ambiguous Orders . |
| Special Instructions | | The request form must state specific site of specimen, age of patient, and time of collection. Inclusion of current antibiotic therapy and clinical diagnosis may aid the laboratory in evaluating the specimen and work-up of the culture. If an unusual organism is suspected, this information must be specifically noted on the request form (eg, Nocardia) and may result in additional charges. Specimens from other sources, such as genital, stool, urine, upper and lower respiratory specimens, cannot be cultured under the aerobic bacterial culture test number. If specimens are incorrectly submitted with an order for aerobic bacterial culture, the laboratory will process the specimen for the test based on the source listed on the request form. The client will not be telephoned to approve this change, but the change will be indicated on the report. |
| Specimen | | Pus or other material properly obtained from a body site (abscesses, eyes, tissue, wounds). Do not send syringe with needle. |
| Volume | | Swab or 0.5 mL aseptically aspirated pus or tissue |
| Container | | Sterile screw-cap container or bacterial swab transport |
| Collection | | Disinfect contiguous areas of skin or mucous membrane containing resident normal flora prior to culture collection. Collect exudates from the interior of productive lesions. Tissue samples must be kept moist. A thin, air-dried smear for Gram stain obtained from the same site as the culture is strongly recommended (additional test). |
| Storage Instructions | | Maintain specimen at room temperature. |
| Patient Preparation | | Sterile preparation of the aspiration site is required. |
| Causes for Rejection | | Improper labeling; specimen received in grossly leaking transport container; specimen received in expired transport media; specimen received after prolonged delay (usually more than 72 hours) |
| Reference Interval | | No growth, routine/normal skin flora, routine/normal “body site” flora. Wounds often become colonized by multiple gram-negative rods and mixed culture results are common. A simultaneous Gram stain should always be prepared and performed (additional charge) to facilitate interpretation. Eye: Routine flora of the eye may include Corynebacterium sp (diphtheroids), Staphylococcus epidermidis, saprophytic fungi, Moraxella (Branhamella) catarrhalis, Moraxella sp, Streptococcus sp (nonhemolytic), and gram-negative rods (rare). Abnormal ocular flora include Haemophilus influenzae, Haemophilus aegyptius, Streptococcus pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa, Bacillus subtilis, Neisseria gonorrhoeae, and Mycobacterium chelonae. Wound: Routine skin flora may include coagulase-negative staphylococci, Corynebacterium sp (diphtheroids), alpha-streptococci (Streptococcus viridans or viridans streptococci). |
| Use | | Isolate and identify potentially pathogenic aerobic organisms. Susceptibility test is performed at additional charge when organisms isolated meet microbiologic criteria for clinical significance. |
| Limitations | | Only rapid-growing, nonfastidious aerobic organisms can be recovered and identified by routine methods. Only organisms that predominate will be identified. Unless specifically requested by the physician, fastidious organisms may not be isolated. Anaerobic, fungal, and mycobacterial pathogens should be considered, and appropriate cultures requested if clinically indicated. The procedure will not detect Chlamydia, viruses, fungi, or mycobacteria. |
| Methodology | | Culture |
| Additional Information | | Eye: The major modes of transmission of disease to the conjunctiva include the hands, airborne fomites, and spread for adjacent adnexal infections. Eye infections include eyelid infections, blepharitis, dacryocystitis, orbital cellulitis, conjunctivitis, keratitis, endophthalmitis retinitis, and chorioretinitis. Pinkeye is caused by adenovirus. It presents as bilateral conjunctivitis with a sudden onset. Herpes simplex and zoster present as periorbital or corneal infections. Nontuberculous mycobacterial keratitis may occur following trauma or surgery accompanied by the use of local corticosteroids.1 Wound: See table. Susceptibility testing is usually performed. The majority of bacteria infecting surgical wounds are common airborne microorganisms.2 Effective treatment of wound infection usually includes drainage, removal of foreign bodies, infected prosthetic devices, and retained foreign objects such as suture material. Suction irrigation may be helpful in resolving wound infections. Species commonly recovered from wounds include Escherichia coli, Proteus sp, Klebsiella sp, Pseudomonas sp, Enterobacter sp, enterococci, other streptococci, Bacteroides sp, Prevotella sp, Clostridium sp, Staphylococcus aureus, and coagulase-negative Staphylococcus. Classification of Soft-Tissue Infections
| Tissue Level | Common Surgical Pathogens | | S. pyogenes | S. aureus | C. perfringens | Mixed Bacteria | | Staph & Strep | Enteric | | Epidermis | Ecthyma contagiosum | Scalded-skin syndrome | | Possibly impetigo | | | Dermis and subdermis | Erysipelas / cellulitis | Folliculitis / abscess | Abscess / cellulitis | Meleny ulcer (synergistic gangrene) | Tropical ulcer | | Fascial planes | Strep gangrene | Carbuncle | Fasciitis | Necrotizing fasciitis | | Muscle tissue | Strep myositis | Muscular abscess / pyomyositis | Myonecrosis | Nonclostridial myonecrosis | | Adapted from Ahrenholz DH, “Necrotizing Soft Tissue Infections,” Surg Clin North Am, 1988, 68:198-214. |
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| Footnotes | | - Bullington RH Jr, Lanier JD, and Font RL, “Nontuberculous Mycobacterial Keratitis. Report of Two Cases and Review of the Literature,” Arch Ophthalmol, 1992, 110(4):519-24.
- Whyte W, Hambraeus A, Laurell G, et al, “The Relative Importance of the Routes and Sources of Wound Contamination During General Surgery. II. Airborne,” J Hosp Infect, 1992, 22(1):41-54
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| References | | Baker AS, “Ocular Infections: Clinical and Laboratory Considerations,” Clin Microbiol Newslet, 1989, 11:97-101. Cheadle WG, “Current Perspectives on Antibiotic Use in the Treatment of Surgical Infections,” Am J Surg, 1992, 164(4A Suppl):44S-47S. Goldstein EJ, “Management of Human and Animal Bite Wounds,” J Am Acad Dermatol, 1989, 21(6):1275-9. Jones DB, Leisegang TJ, and Robinson NM, Laboratory Diagnosis of Ocular Infections, Washington JA, coordinating ed, Cumitech 13, Washington, DC: ASM Press, 1981 (review). Kligman EW, “Treatment of Otitis Media,” Am Fam Physician, 1992, 45(1):242-50. Macknin ML, “Respiratory Infections in Children. What Helps and What Doesn't?” Postgrad Med, 1992, 92(2):235-8, 243, 247-50. Pollack AV and Evans M, “Microbiologic Prediction of Abdominal Surgical Wound Infection,” Arch Surg, 1987, 122(1):33-6. Randall DA, Fornadley JA, and Kennedy KS, “Management of Recurrent Otitis Media,” Am Fam Physician, 1992, 45(5):2117-23. |
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