Mycobacterium tuberculosis Susceptibility, Broth Dilution and Confirmation

CPT: 87188(x5)
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Test Details

Synonyms

  • AFB Susceptibility Testing
  • Susceptibility Testing, M tuberculosis
  • TB Susceptibility Testing

Use

Determine the susceptibility of Mycobacterium tuberculosis to a profile of antimycobacterial agents.

Limitations

Susceptibilities cannot be reported if the organism fails to grow in the test medium. Susceptibilities cannot be performed on mixed cultures.

Methodology

Broth-based and conventional method.

Additional Information

Susceptibilities should be performed on the first organism isolated from a patient, and at one and three-month intervals if that organism continues to be isolated while the patient is on therapy. Susceptibility tests should be performed in patients with recurrent tuberculosis, as resistant strains are common in recurrent infection. Outbreaks have occurred in health care workers, prison inmates, and prison employees.1,2 Failure to take all drugs in a multidrug regimen can lead to a shift toward resistant organisms and treatment failure. Nontuberculosis Mycobacteria, particularly strains of the M avium complex, are resistant to those drugs used for therapy of M tuberculosis.3

Susceptibilities will be performed based on state regulations and/or statutes. Many states require first isolates of M tuberculosis at an institution to be tested.

Specimen Requirements

Specimen

Mycobacterium tuberculosis isolated from a primary clinical specimen, on a submitted AFB conventional solid medium, and a bacterial swab inoculated with isolated colonies from a pure culture or an AFB broth medium.

Volume

Pure culture isolate on an AFB conventional solid medium and a bacterial swab inoculated with isolated colonies from a pure culture, or a minimum of 1 mL of AFB broth medium.

Container

Conventional or broth medium, tightly sealed, in etiologic agent packaging.

Storage Instructions

Maintain media at room temperature.

Causes for Rejection

Specimen received leaking or in broken transport tube or vial; specimen received in expired transport medium; mixed culture; unlabeled culture or name discrepancy between specimen and test request label

Clinical Information

Special Instructions

Isolates found to be resistant will have the resistance confirmed by the agar proportion method.

Footnotes

1. Beck-Sague C, Dooley SW, Hutton MD, et al. Hospital outbreak of multidrug-resistant Mycobacterium tuberculosis infections. Factors in transmission to staff and HIV-infected patients.JAMA.1992; 268(10):1280-1286.
2. Dooley SW, Villarino ME, Lawrence M, et al. Nosocomial transmission of tuberculosis in a hospital unit for HIV-infected patients. JAMA. 1992; 267(19):2632-2634.1573751
3. Wolinsky E. Mycobacterial diseases other than tuberculosis. Clin Infect Dis. 1992 Jul; 15(1):1-10.1617048

References

Clinical and Laboratory Standards Institute. Susceptibility Testing of Mycobacteria, Nocardia, and Other Aerobic Actinomycetes; Approved Standard. Document M24-A, vol 23, N°18. Villanova, Pa: CLSI; 2003.
Heifets L. Qualitative and quantitative drug susceptibility tests in mycobacteriology. Am Rev Respir Dis. 1988; 137(5):1217-1222.3195815
Van Scoy RE, Wilkowske CJ. Antituberculous agents.Mayo Clin Proc. 1992; 67(2):179-187.1347579

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
182576 Mtb Susceptibility Broth 182575 Organism ID 9825-1
182576 Mtb Susceptibility Broth 998513 Streptomycin 1 ug/mL 48177-0
182576 Mtb Susceptibility Broth 998514 Isoniazid 0.1 ug/mL 25217-1
182576 Mtb Susceptibility Broth 998515 Rifampin 1 ug/mL 25202-3
182576 Mtb Susceptibility Broth 998516 Ethambutol 5 ug/mL 25194-2
182576 Mtb Susceptibility Broth 998517 Pyrazinamide 100 ug/mL 25229-6
182576 Mtb Susceptibility Broth 182577 Agar Proportion Confirmation N/A
Reflex Table for Organism ID
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 000000 Antimicrobial Susceptibility 000000 Antimicrobial Susceptibility N/A
Reflex Table for Agar Proportion Confirmation
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 182691 Mtb AST Confirmation 998522 Streptomycin 2 ug/mL 25205-6
Reflex Table for Agar Proportion Confirmation
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 182691 Mtb AST Confirmation 998523 Streptomycin 10 ug/mL 25206-4
Reflex Table for Agar Proportion Confirmation
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 182691 Mtb AST Confirmation 998519 Isoniazid 0.2 ug/mL 25218-9
Reflex Table for Agar Proportion Confirmation
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 182691 Mtb AST Confirmation 998521 Isoniazid 1 ug/mL 25219-7
Reflex Table for Agar Proportion Confirmation
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 182691 Mtb AST Confirmation 998525 Rifampin 1 ug/mL 25202-3
Reflex Table for Agar Proportion Confirmation
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 182691 Mtb AST Confirmation 998636 Ethambutol 5.0 ug/mL 25194-2

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