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HelpTest Code LAB10406 Lower Respiratory Culture
Performing Laboratory
Barnes-Jewish Hospital Laboratory
Methodology
Testing Algorithm:
Gram stain is routinely performed on lower respiratory specimens, excluding sputum specimens obtained from patients living with cystic fibrosis. Because culture is more sensitive than Gram stain, the Gram stain is only offered in combination with a culture request.
Susceptibility testing is performed on organisms where it is clinically indicated. All requests for additional susceptibility testing should be directed to the Microbiology Laboratory at 314-362-3898.
NOTE: For Pneumonia PCR with lower respiratory culture and Gram stain see LAB10012
Specimen Requirements
Acceptable Specimens:
Bronchoalveolar lavage (BAL), bronchial washing, sputum, tracheal: - ≥5 mL in leakproof screw-capped, sterile container
Airway donor, airway recipient, deep throat: 1 ESwab per test request
Bronchial brush: brush in leakproof, screw-capped, sterile container with sterile saline.
Unacceptable Specimens:
Saliva
Specimen received in container containing additive (EDTA, sodium citrate, etc.)
Specimen collected with ESwab Collection Kit is unacceptable if received without fluid or swab in the transport tube.
Collection Procedure:
Bronchial washing, bronchial alveolar lavage (BAL), and tracheal aspirate
A. Aseptically collect ≥5 mL.
B. Place specimen in a leakproof screw-capped, sterile container.
C. Maintain sterility and forward promptly.
Bronchial brush
A. Obtain a sterile container with 1 mL of sterile saline. If tubes are not available, contact the laboratory.
B. Aseptically collect the bronchial brush and place in the container with 1 mL of sterile saline.
C. Maintain sterility and forward promptly.
Sputum
A. Aseptically collect early-morning specimens avoiding oral contamination in a leakproof screw-capped, sterile container.
B. Instruct patient to brush his/her teeth and rinse mouth well with water.
C. Have patient remove dentures.
D. Instruct patient to take a deep breath, hold it momentarily, and then cough deeply and vigorously into container. Collect 3-5 mL of discharged material.
E. Maintain sterility and forward promptly.
F. Sputum specimens contaminated with excessive oropharyngeal flora will be rejected for culture.
Deep Throat
1. Depress tongue and rub ESwab over each tonsillar area and posterior pharynx.
2. Collect any exudate on swab.
3. Avoid touching tongue and uvula.
4. Return ESwab into transport tube following instructions on kit.
5. Maintain sterility and forward promptly at ambient temperature only.
Day(s) Test Set Up
Monday through Sunday
Turnaround Time:
Gram stain: final report within 4 hours of receipt of specimen in laboratory.
Culture: Final report of no growth, normal upper respiratory flora present, insignificant growth, or clinically significant results available within 48 hours.
Test Classification and CPT Coding
87070-Culture, aerobic (not stool, rectal swab, or urine) (if appropriate)
87181-Susceptibility, agar diffusion (if appropriate)
87184-Susceptibility, disk diffusion (if appropriate)
87185-Susceptibility, enzyme detection (if appropriate)
87186-Susceptibility, microdilution (if appropriate)
87205-Gram stain (if appropriate)
Reference Values
No growth, normal upper respiratory flora present, or insignificant growth
Literature Reference:
Carroll, Karen, et. al. Manual of Clinical Microbiology, 13th edition. ASM Press. Washington, D.C. 2023
Specimen Transport Temperature
Ambient/Refrigerate NO/Frozen NO
Additional Information
Minimum Volume:
BAL, bronchial washing, sputum, tracheal: 3 mL in leakproof, screw-capped, sterile container
Airway donor, airway recipient, deep throat: 1 ESwab per test request; (bronchial brush) - brush in leakproof, screw-capped, sterile container with sterile saline.
Laboratory Processing Instructions:
Test performed in BJH Microbiology.