Advanced Diagnostic Laboratories

Collect

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 speicmen from drying out.

Deep wounds: Debride wound, then thoroghly 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 idoine 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 laboratrory.  

All specimen types should be collected in a sterile container, sterile syringe, or sterile swab.

Swab collection should be avoided if a tissue/biopsy or aspiration of the infected area can be performed. The specimen should be collected from a subcutaneous site. Place the swab in an appropriate transport system and send to the
laboratory.

Preferred volume: 1-3 mL
Minimum Volume: 1 mL

Patient Prep

• Debride and rinse open wounds with sterile saline.
• Clean closed wounds with 2% chlorhexidine or 70% alcohol followed by iodine solution. The iodine solution should be removed before collecting the sample.
• Disinfect any collection tubing before collecting drainage samples.

Unacceptable Conditions

• Specimens received frozen
• Specimens received in formalin
• Aspirates with <  1ml
• Specimens >3 days from collection
• Mislabeled or unlabeled specimen (exception with attestation for specimes from irretraveble source, i.e tissue or bone)

Storage Transport Temp

• Speicmens should be sent to the laboratory as soon as possible. For optimal recovery of potential pathogens, specimens should arrive within 2 hours.
• If transportation is delayed, specimens may be storged at room temperature (20-25°C) for 24 hours from collection.

Stability

• Speicmens should be sent to the laboratory as soon as possible. For optimal recovery of potential pathogens, specimens should arrive within 2 hours.
• If transportation is delayed, specimens may be storged at room temperature (20-25°C) for 24 hours.
• Specimens will be accepted up to 3 days post collection.

Performed

7 days a week from 8am to 6pm.

Methodology

Conventional culture

Reported

Expected turn around time is 4 days to final report. 

Department

Microbiology Lab

Synonyms

WDEEP, Tissue culture, CXTIS

Ordering Recommendations

Order when there is a suspected infection in tissue deeper than the dermis. 

Reference Interval

No growth for sterile sources. 

Normal comensal skin flora for non-sterile sources may be observed. 

Interpretation

The table below describes reportable organism and if antimicrobial susceptibility testing (AST) is routinely included. If susceptibilites are needed for an organims that AST is not routinely included, please contact ADx Client Services to submit a request.  

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

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

CPT Code

87205, 87070