Ordering Recommendations

This test order is acceptable in a few cases, but not routinely recommended. The CXFLD order should be used for the majority of routine body fluid cultures. Consult the Microbiology Lab Director if unsure about whether CXFBB is appropriate.

Some examples of appropriate situations would be:
  1. Large volume of sterile body fluid
  2. Extended incubation period required for slow growing organisms

Tests Included

  1. Gram stain will be performed on all positive culture bottles
  2. Identification will be performed on all isolates
  • Exceptions: Mixed gastrointestinal microbiota from peritoneal or bile fluids
  1. Susceptibilities will be performed on applicable isolates

Performed

Daily

Methodology

Bactec Continuous Monitoring System
Standard reference procedures for culture and identification of aerobic and anaerobic microorganisms

Reported

Preliminary (Negative): No growth at 24 hours, 48 hours, 72 hours, and 96 hours
Final (Negative): No Growth at 5 days, unless extended time is requested
Positives: Cultures are reported as soon as detected.  Susceptibility results on applicable organisms will require an additional minimum of 48 hours.
  • False Positive preliminary results will be reported as "Bottle flagged as positive by Bactec FX, but Gram stain and culture negative to date."
*Refer to the Result Interpretation Tab for additional details

Synonyms

  • Culture Fluid in Blood Bottles
  • Bacterial Body Fluid Culture
  • Bacterial Culture, Body Fluid
  • Body Fluid Culture, Bacterial
  • Aerobic Bacteria Culture, Body Fluid
  • Bacterial Culture, Aerobic, Body Fluid
  • Culture, Aerobic Bacteria, Body Fluid
  • Body Fluid Culture in Blood Bottles
  • Body Fluid in Culture Bottles
  • Bacteriology
  • Microbiology Laboratory

Performing Lab

Microbiology

Add-on Eligibility

Extended time of incubation can be added within 1 - 4 days of specimen receipt if clinically indicated by calling the Microbiology Lab 858-657-5790. 

Additional Susceptibility Requests: Submit an ADSEN order through EPIC

Specimen Type

The following sterile body fluids are approved for this test:
  • Abdominal Fluid
  • Amniotic Fluid
  • Ascites
  • Bile
  • Joint (Synovial) Fluid
  • Pericardial Fluid
  • Peritoneal Fluid
  • Pleural Fluid
  • Vitreous Fluid

Specimen Volume

Aerobic: 8 - 10 mL (Minimum: 3 mL)
Anaerobic: 8 - 10 mL (Minimum: 3 mL)

Sterile Container / Red Top Vacutainer: Send additional fluid in sterile container or red top vacutainer

*Optimal fill volumes critically determine the diagnostic yield of culture bottles. Refer to Collection Remarks for more details.

Collection Container

  1. 1 BD BACTEC Plus Aerobic / F Culture Vial
AND
 
  1. 1 BD BACTEC Lytic / 10 Anaerobic / F Culture Vial

AND
 
  1. Sterile Container for additional fluid
 
OR
 
  1. Serum Tube (Red Top Vacutainer) for additional fluid

Unacceptable Conditions

  1. No drainage, discharge, abscess, body site, or aspirate sources; must be a normally sterile body fluid
  2. Specimens that have been improperly collected, stored, or transported
  • Specimens submitted in an improper bottle type
  • Specimens submitted in tubes containing anticoagulants
  • Specimens received in non-sterile container
  • Culture bottles that have been stored in an incubator or refrigerator
  • Specimens that have been frozen
  • Specimens not received within 24 hours of collection
  • Specimens that arrive in leaky containers
  1. Unlabeled or mislabeled specimens

*Due to invasive procedures required for collection, suboptimal body fluid specimens are handled on a case-by-case basis. The physician will be alerted of any concerns regarding results for suboptimal specimens.

Storage/Transport Temperature

Transport Instructions      
Collection Location Specimen Type Transport Temperature Timeframe
ED/Inpatient Culture Bottles Room Temperature Specimen must be received by the lab within 24 hours of collection
Sterile Container/
Red Top Vacutainer		 Room Temperature Specimen must be received by the lab within 24 hours of collection
Sterile Container/
Red Top Vacutainer		 Refrigerated Specimen must be received by the lab within 24 hours of collection
Laboratory/Outpatient/Off-Site Culture Bottles Room Temperature Specimen must be received by the lab within 24 hours of collection
Sterile Container/
Red Top Vacutainer		 Room Temperature Specimen must be received by the lab within 24 hours of collection
Sterile Container/
Red Top Vacutainer		 Refrigerated Specimen must be received by the lab within 24 hours of collection

Storage: Room Temperature

Stability (from collection to initiation)

Stability:
Culture Bottles:
  • Room Temperature: 24 hours
  • Refrigerated: Unacceptable
  • Frozen: Unacceptable
Sterile Container / Red Top Vacutainer:
  • Room Temperature: 24 hours
  • Refrigerated: 1 week
  • Frozen: Unacceptable

Laboratory Storage:
  • Culture Bottles: Room Temperature
  • Sterile Container: Refrigerated
Laboratory Retention:
  • Negative Culture Bottles: Discarded once results are finalized
  • Positive Culture Bottles: 2 weeks
  • Culture Isolates: 5 days
  • Sterile Container / Red Top Vacutainer: 7 days

Remarks

Optimal body fluid fill volumes critically determine the diagnostic yield of culture bottles.  Each mL of body fluid, up to 10 mL, can increase the sensitivity of the culture bottle by 3-5%.  While overfilling of bottles may cause false-positivity, underfilling reduces the sensitivity of culture bottles.

Specimens exposed to refrigerated temperatures or delayed transport may diminish the recovery of fastidious organisms.

Collection Instructions

Labeling Instructions:
  1. When labeling culture bottles and specimen containers, leave a small window visible for the lab to assess the fill volume and sample integrity
  2. Ensure that the barcode is in the correct orientation and not covering important information
  • Do NOT cover the bottom of the bottle with labels. This will erroneously cause the instrument to flag it as positive.
  1. Include the specimen source on the label
 
 

Collection Instructions:

Culture Bottles:
  1. Refer to the following resource for specimen collection instructions for microbiology cultures bottles:
  1. If inoculating more than one tube type, including the red top tube for additional body fluid specimen, follow the correct order of draw:
     

Sterile Container:
  1. Using sterile technique, collect specimen into Sterile Container
  • Limit how long container is left open to prevent environmental contamination
  1. Ensure that the cap on the collection container is tightly closed

Red Top Vacutainer:
  1. Transfer 1-5 mL of the body fluid into the Red Top Vacutainer
  • Invert the collection tube 5 times to ensure proper mixing
  • If transferring to more than one tube type, follow the correct order of draw as shown above

Reference Interval

No Growth

Interpretive Data

False Positives: Cases are classified as false-positive when the automated continuous monitoring system produces a positive signal but no microorganisms are detected on Gram-stained smears and no microorganism growth is observed in blood subcultures.  False positives from the BACTEC system may be due to elevated patient leukocyte counts, high sensitivity of the system to background increases in CO2 concentration, or overfilling of culture bottles at > 10 mL of specimen volume.
Ordering

Ordering Recommendations

This test order is acceptable in a few cases, but not routinely recommended. The CXFLD order should be used for the majority of routine body fluid cultures. Consult the Microbiology Lab Director if unsure about whether CXFBB is appropriate.

Some examples of appropriate situations would be:
  1. Large volume of sterile body fluid
  2. Extended incubation period required for slow growing organisms

Tests Included

  1. Gram stain will be performed on all positive culture bottles
  2. Identification will be performed on all isolates
  • Exceptions: Mixed gastrointestinal microbiota from peritoneal or bile fluids
  1. Susceptibilities will be performed on applicable isolates

Performed

Daily

Methodology

Bactec Continuous Monitoring System
Standard reference procedures for culture and identification of aerobic and anaerobic microorganisms

Reported

Preliminary (Negative): No growth at 24 hours, 48 hours, 72 hours, and 96 hours
Final (Negative): No Growth at 5 days, unless extended time is requested
Positives: Cultures are reported as soon as detected.  Susceptibility results on applicable organisms will require an additional minimum of 48 hours.
  • False Positive preliminary results will be reported as "Bottle flagged as positive by Bactec FX, but Gram stain and culture negative to date."
*Refer to the Result Interpretation Tab for additional details

Synonyms

  • Culture Fluid in Blood Bottles
  • Bacterial Body Fluid Culture
  • Bacterial Culture, Body Fluid
  • Body Fluid Culture, Bacterial
  • Aerobic Bacteria Culture, Body Fluid
  • Bacterial Culture, Aerobic, Body Fluid
  • Culture, Aerobic Bacteria, Body Fluid
  • Body Fluid Culture in Blood Bottles
  • Body Fluid in Culture Bottles
  • Bacteriology
  • Microbiology Laboratory

Performing Lab

Microbiology

Add-on Eligibility

Extended time of incubation can be added within 1 - 4 days of specimen receipt if clinically indicated by calling the Microbiology Lab 858-657-5790. 

Additional Susceptibility Requests: Submit an ADSEN order through EPIC
Collection

Specimen Type

The following sterile body fluids are approved for this test:
  • Abdominal Fluid
  • Amniotic Fluid
  • Ascites
  • Bile
  • Joint (Synovial) Fluid
  • Pericardial Fluid
  • Peritoneal Fluid
  • Pleural Fluid
  • Vitreous Fluid

Specimen Volume

Aerobic: 8 - 10 mL (Minimum: 3 mL)
Anaerobic: 8 - 10 mL (Minimum: 3 mL)

Sterile Container / Red Top Vacutainer: Send additional fluid in sterile container or red top vacutainer

*Optimal fill volumes critically determine the diagnostic yield of culture bottles. Refer to Collection Remarks for more details.

Collection Container

  1. 1 BD BACTEC Plus Aerobic / F Culture Vial
AND
 
  1. 1 BD BACTEC Lytic / 10 Anaerobic / F Culture Vial

AND
 
  1. Sterile Container for additional fluid
 
OR
 
  1. Serum Tube (Red Top Vacutainer) for additional fluid

Unacceptable Conditions

  1. No drainage, discharge, abscess, body site, or aspirate sources; must be a normally sterile body fluid
  2. Specimens that have been improperly collected, stored, or transported
  • Specimens submitted in an improper bottle type
  • Specimens submitted in tubes containing anticoagulants
  • Specimens received in non-sterile container
  • Culture bottles that have been stored in an incubator or refrigerator
  • Specimens that have been frozen
  • Specimens not received within 24 hours of collection
  • Specimens that arrive in leaky containers
  1. Unlabeled or mislabeled specimens

*Due to invasive procedures required for collection, suboptimal body fluid specimens are handled on a case-by-case basis. The physician will be alerted of any concerns regarding results for suboptimal specimens.

Storage/Transport Temperature

Transport Instructions      
Collection Location Specimen Type Transport Temperature Timeframe
ED/Inpatient Culture Bottles Room Temperature Specimen must be received by the lab within 24 hours of collection
Sterile Container/
Red Top Vacutainer		 Room Temperature Specimen must be received by the lab within 24 hours of collection
Sterile Container/
Red Top Vacutainer		 Refrigerated Specimen must be received by the lab within 24 hours of collection
Laboratory/Outpatient/Off-Site Culture Bottles Room Temperature Specimen must be received by the lab within 24 hours of collection
Sterile Container/
Red Top Vacutainer		 Room Temperature Specimen must be received by the lab within 24 hours of collection
Sterile Container/
Red Top Vacutainer		 Refrigerated Specimen must be received by the lab within 24 hours of collection

Storage: Room Temperature

Stability (from collection to initiation)

Stability:
Culture Bottles:
  • Room Temperature: 24 hours
  • Refrigerated: Unacceptable
  • Frozen: Unacceptable
Sterile Container / Red Top Vacutainer:
  • Room Temperature: 24 hours
  • Refrigerated: 1 week
  • Frozen: Unacceptable

Laboratory Storage:
  • Culture Bottles: Room Temperature
  • Sterile Container: Refrigerated
Laboratory Retention:
  • Negative Culture Bottles: Discarded once results are finalized
  • Positive Culture Bottles: 2 weeks
  • Culture Isolates: 5 days
  • Sterile Container / Red Top Vacutainer: 7 days

Remarks

Optimal body fluid fill volumes critically determine the diagnostic yield of culture bottles.  Each mL of body fluid, up to 10 mL, can increase the sensitivity of the culture bottle by 3-5%.  While overfilling of bottles may cause false-positivity, underfilling reduces the sensitivity of culture bottles.

Specimens exposed to refrigerated temperatures or delayed transport may diminish the recovery of fastidious organisms.

Collection Instructions

Labeling Instructions:
  1. When labeling culture bottles and specimen containers, leave a small window visible for the lab to assess the fill volume and sample integrity
  2. Ensure that the barcode is in the correct orientation and not covering important information
  • Do NOT cover the bottom of the bottle with labels. This will erroneously cause the instrument to flag it as positive.
  1. Include the specimen source on the label
 
 

Collection Instructions:

Culture Bottles:
  1. Refer to the following resource for specimen collection instructions for microbiology cultures bottles:
  1. If inoculating more than one tube type, including the red top tube for additional body fluid specimen, follow the correct order of draw:
     

Sterile Container:
  1. Using sterile technique, collect specimen into Sterile Container
  • Limit how long container is left open to prevent environmental contamination
  1. Ensure that the cap on the collection container is tightly closed

Red Top Vacutainer:
  1. Transfer 1-5 mL of the body fluid into the Red Top Vacutainer
  • Invert the collection tube 5 times to ensure proper mixing
  • If transferring to more than one tube type, follow the correct order of draw as shown above
Result Interpretation

Reference Interval

No Growth

Interpretive Data

False Positives: Cases are classified as false-positive when the automated continuous monitoring system produces a positive signal but no microorganisms are detected on Gram-stained smears and no microorganism growth is observed in blood subcultures.  False positives from the BACTEC system may be due to elevated patient leukocyte counts, high sensitivity of the system to background increases in CO2 concentration, or overfilling of culture bottles at > 10 mL of specimen volume.

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