Advanced Diagnostic Laboratories

Deep Wound Culture

Test Code

CXDWD

Description

Deep wound culture is used to determine infectious agents in normally sterile sites such as organs, deep abscesses and visceral/soft tissue below the dermis. This test is similar to Tissue Culture (CXTIS).

This test includes Gram stain and culture.
Specimens sent under anaerobic condition will be cultured for both aerobic and anaerobic pathogens. Specimens not sent under anaerobic conditions will only be examined for aerobic pathogens.
Common sterile sources include: Lymph node, brain, heart, liver, spleen, vitreous fluid, kidney, pancreas, ovary, vascular tissue, abscesses, deep tissue.
Organisms seen in the Gram stain or recovered in culture from a sterile source are considered a critical result. Critical results are called to the ordering physician in accordance with the NJH critical policy.

Collect

All specimen types should be collected in a sterile container, sterile syringe, or sterile swab (swabs are not recommended due to low specimen volume). Anaerobic culture will be added to the aerobic culture if any of the specimens below are collected anaerobically. This can be done by collecting the sample into a syringe with the air expelled, or collecting into anaerobic transport media.

Tissues, biopsies, and bone: Can be collected from any deep subcutaneous site. Specimen should be taken from within and adjacent to the area of infection. A few drops of sterile nonbacteriostatic saline can be added to prevent the specimen from drying out.

Preferred volume: 6 cm³
Minimum Volume: 1 cm³

Deep wounds: Debride wound, then thoroughly rinse with sterile saline. Only take specimen from viable tissue of wounds that appear to be infected or do not appear to be healing over a long period of time.

Fine needle aspirates & drainage from non-sterile sources (i.e. abscesses): Disinfect skin with 2% chlorhexidine or 70% alcohol followed by iodine solution. Remove iodine with 70% alcohol before collection. Aspirate with a needle and syringe. If the first attempt fails to produce pus, inject sterile saline subcutaneously, then repeat the aspiration. Expel the excess air, remove the needle, and cap the syringe before sending to the laboratory.

Preferred volume: 3 mL
Minimum Volume: 1 mL

Swabs: should be collected from a deep tissue site (non-cutaneous), and collection should be avoided if a tissue/biopsy or aspiration of the infected area can be performed because swabs typically have insufficient volume. Place the swab in an appropriate transport system and send to the laboratory.

Patient Prep

Avoid antibiotic administration prior to sample collection.

Unacceptable Conditions

Specimens received outside of temperature storage requirements (DO NOT refrigerate)
Specimens received outside of stability time frame
Specimens received in formalin
Specimens that do not meet the minimum volume requirement
Specimens in non-sterile containers
Specimens in expired transport media
Specimens from a source not acceptable for this testing
Specimens that are excessively leaking
Mislabeled or unlabeled specimen (exception with attestation for specimens from irretrievable source, i.e tissue or bone)
Anaerobic portion of testing will not be performed if the samples was not submitted under anaerobic conditions

Stability

For optimal recovery of potential pathogens, specimens should arrive as soon as possible at room temperature (20-25°C)
If transportation is delayed, specimens may be stored at room temperature (20-25°C) for 24 hours

Notes

Specimens from irretrievable sources will be processed with a disclaimer if specimen was received in sub optimal conditions.

Performed

7 days a week from 8am to 6pm

Methodology

Aerobic and anaerobic (if appropriately collected) bacterial culture

Turnaround Time

4 days

Department

Microbiology Lab

Study Offerings

CAP/CLIA

Related Tests

CXTIS, CXSWD

Reference Interval

No growth for sterile sources
Normal commensal flora may be observed some cases (e.g. GI flora or skin flora) due to non-sterile collection or non-sterile sources being submitted.

Interpretation

The table below describes reportable organisms and if antimicrobial susceptibility testing (AST) is routinely included. If susceptibilities are needed for an organism that AST is not routinely performed, please submit the request through EPIC using the OP Add-On/Comm Message type addressed to NJH LAB ADD-ON POOL.

Threshold for Reporting	Organism	Testing performed
Any	Aeromonas hydrophila	ID and AST^‡
	Aracanobacterium haemolyticum	ID and AST^‡
	Bacillus anthracis	ID
	Bartonella spp.	ID
	Burkholderia mallei	ID
	Burkholderia pseudomallei	ID
	Capnocytophaga spp.	ID
	Clostridium novyi	ID
	Clostridium prefringens	ID
	Clostridium septicum	ID
	Clostridium sordellii	ID
	Corynebacterium diptheriae	ID and AST^‡
	Corynebacterium kroppenstedtii	ID and AST^‡
	Corynebacterium minutissimum	ID and AST^‡
	Corynebacterium pseudotuberculosis	ID and AST^‡
	Corynebacterium ulcerans	ID and AST^‡
	Francisella tularensis	ID
	Haemophilus ducreyi	ID
	Neisseria gonorrhoeae	ID
	Nocardia spp.	ID and AST
	Pasteurella spp.	ID; β-lactamase
	Pseudomonas aeruginosa	ID and AST
	Staphylococcus aureus	ID and AST
	Streptococcus pneumoniae	ID and AST
	Streptococcus pyogenes (group A)	ID
	Vibrio vulnificus	ID and AST^‡
	Yersinia pestis	ID
Pure or Predominant	Acinetobacter baumanni complex	ID and AST
	Actinomyces spp.	ID and AST^‡
	Bacteroides fragilis group	ID and AST^‡
	Candida spp.	ID
	Eikenella spp.	ID and AST
	Enterobacterales (not listed separately)	ID and AST
	Enterococcus spp.	ID and AST
	Fusobacterium spp.	ID and AST^‡
	Non-glucose fermenting GNR	ID and AST
	Staphylococcus intermedius group	ID and AST
	Staphylococcus lugdunensis	ID and AST
	Staphylococcus schleiferi	ID and AST
	Stenotrophomonas maltophilia	ID and AST
	Streptococcus agalactiae (group B)	ID
	Streptococcus anginosus	ID and AST
Pure	Bacillus spp. (not anthracis)	ID
	Coagulase-negative staphylococci (not listed individually)	ID and AST
	Other anaerobes	ID and AST^‡
	Viridans group Streptococcus	ID and AST

^‡AST is not performed in house; isolate will be sent to reference lab for susceptibility testing