Lower Respiratory Culture, Other Than Expectorated Sputum

CPT: 87070
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Test Details

Synonyms

  • Bronchial Lavage Culture
  • Bronchoscopy, Transtracheal Aspirate Culture
  • Lung Tissue Culture

Test Includes

Isolation and identification (additional CPT code) of aerobic bacteria considered pathogenic in the lower respiratory tract. Susceptibilities are performed, at additional charge, when appropriate.

Limitations

In bronchoscopy and aspirated specimens reduction of contamination may be accomplished by a head-down position to reduce gravitational flow of saliva. Oral contamination may successfully be reduced by using a telescoping double catheter with a plug to protect the brush or a sheathed brush. The use of the telescoping plugged catheter (TPC) and bronchoalveolar lavage (BAL) increases the overall diagnostic yield, however, a high frequency of false-positives, circa 25%, is a drawback. Bronchial washings are unfortunately commonly diluted with topical anesthetics, which are bacteriostatic, and with irrigating solutions. If anaerobic bacteria are suspected in a transtracheal aspiration, a properly collected specimen for anaerobic culture should be submitted.

Methodology

Culture

Additional Information

Potential pathogens recovered by usual culture methods include Staphylococcus aureus, Haemophilus influenzae, Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus parainfluenzae, Pseudomonas aeruginosa, Escherichia coli, Proteus sp, Moraxella catarrhalis, and (rarely) many other organisms. Haemophilus sp and Neisseria sp may not be routinely isolated and identified. Thus, if their presence is clinically suspected, they should be specifically requested.

Agents such as Bordetella pertussis, Chlamydia pneumoniae, Corynebacterium diphtheriae, Legionella pneumophila, Mycoplasma pneumoniae, and Mycobacterium tuberculosis require special laboratory measures for isolation. Clinical suspicion of involvement by these agents should be communicated to the laboratory.

Specimen Requirements

Specimen

Aspirates, biopsy, tissue, bronchial washing

Volume

1 g tissue, 10 to 50 mL lavage fluid, 5 mL bronchial washing

Container

Sterile screw-cap container

Storage Instructions

Refrigerate at 2°C to 8°C

Causes for Rejection

Unlabeled specimen or name discrepancy between specimen and request label; inappropriate specimen transport device; leaking specimen; specimen received after prolonged delay (usually >72 hours)

Clinical Information

Special Instructions

Sputum specimens should not be cultured under the test number for lower respiratory culture as this test does not include a Gram stain evaluation. Use test number 182352 Gram Stain Evaluation With Sputum Culture Reflex for sputum culture.

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
180815 Lower Respiratory Culture 32355-0 180815 Lower Respiratory Culture 32355-0
Reflex Table for Lower Respiratory Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 180813 Result 180814 Result 1 6463-4
Reflex Table for Lower Respiratory Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 180813 Result 180816 Result 2 6463-4
Reflex Table for Lower Respiratory Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 180813 Result 180817 Result 3 6463-4
Reflex Table for Lower Respiratory Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 180813 Result 180818 Result 4 6463-4
Reflex Table for Lower Respiratory Culture
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 180813 Result 180819 Antimicrobial Susceptibility 23658-8

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