EPIC Code

LAB3452
CAFB

Performing Lab

UCHealth University of Colorado Hospital Clinical Laboratory - Microbiology (BSL3)

Collect

Submit specimens in a sterile container:

Specimen Type Optimal Volume Minimum Volume Notes
Respiratory (culture only)
  • Bronchial lavage/wash
  • Sputum
  • Tracheal aspirate
 5-10 mL 3 mL Refer to order set in EPIC LAB3452 for specific instructions.
Sample quality yield is improved when optimal volume is submitted.  Minimum volume is required for testing.
Submit three early morning specimens on three consecutive days or submit three specimens collected every 6 - 8 hours for inpatients.
Specimens may be collected over one to two hours if needed.
Specimens may be induced.
Respiratory (culture with MTB/RIF PCR)
  • Bronchial lavage/wash
  • Sputum
  • Tracheal aspirate
 5-10 mL 5 mL Refer to order set in EPIC LAB8656 AFB Culture with MTB/RIF PCR Panel if PCR is requested.
Blood and bone marrow 3-5 mL 1 mL Refer to AFB Blood Culture & Bone Marrow LAB3452 in the Test Catalog for detailed instructions.
Body fluids (aspirates) 5 mL 2 mL Unpreserved specimens only.
Cath tips and Devices     Generally unacceptable for AFB culture.  Must obtain prior approval from UCH Microbiology Medical Directors.
CSF 5-10 mL 4 mL Requires one of the following additional approval criteria:
  • Low CSF glucose
  • Elevated CSF protein
  • Elevated CSF leukocytes
Refer to AFB Culture with MTB/RIF PCR Panel LAB8656 if PCR is requested.
Pleural fluid 5-10 mL 4 mL Refer to AFB Culture with MTB/RIF PCR Panel LAB8656 if PCR is requested.
Tissues varies   Contact Microbiology Laboratory with questions 720-848-7084
Stool     Must obtain prior approval from UCH Microbiology Medical Directors.
Swabs     Not acceptable for culture.  Swabs will be rejected.
Urine 50 mL 40 mL Unpreserved specimens only.
Preferred specimens are three early morning urines collected on consecutive days.  First morning voids contain the highest concentration on mycobacteria.

Specimen Preparation

For reference laboratories submitting tissue for AFB Culture, thoroughly grind the sample in 5 mL sterile saline prior to transport.

For Bactec Myco/F Lytic blood culture bottles please contact local laboratory.

Unacceptable Conditions

  • Swabs.
  • Cath tips or devices.
  • Refrigerated or frozen Bactec® Myco/F Lytic bottle culture bottle.
  • Sample not properly identified, incorrect container or past stability.
  • Insufficient specimen volume. Refer to minimum volume guidelines.

Storage/Transport Temperature

Internal: Deliver to lab immediately.
Offsite: Refrigerate specimens (except blood and bone marrow) until delivered to the laboratory. Include full date of collection on specimens.

Blood and Bone Marrow: Transport ASAP at ambient temperature. Do not refrigerate.

Performed

Daily

Stability (from collection to initiation)

Room Temp: 24 hours
Refrigerated: 48 hours*
Frozen: Unacceptable

*Exceptions:

  • Outpatient sputum samples collected over a three day period will be accepted until 96 hours after the collection of the first sputum.
  • Blood and bone marrow specimens may not be refrigerated. Refer to AFB Blood Culture & Bone Marrow test catalog for detailed instructions.

Remarks

  • Test includes culture and stain, if appropriate.
  • Physicians will be notified of all positive cultures and/or stains.
  • Negative cultures are reported at 8 weeks.
  • Antibiotic susceptibility testing is automatically ordered and performed on any isolates of Mycobacterium tuberculosis or rapidly-growing Mycobacterium species.
  • Antibiotic susceptibility testing on Mycobacterium species other than Mycobacterium tuberculosis or rapidly growing Mycobacterium species are available upon request.  Contact the Microbiology Laboratory for additional information or to submit additional susceptibility orders.
  • Susceptibility testing is performed by a reference laboratory.

Notes

  • Specimens that require approval from the Microbiology Medical Directors will be delayed if approval is not documented prior to specimen submission.
  • Stains are not performed on urine specimens due to the presence of saprophytic mycobacteria in the genital secretions of normal patients.
  • Stains are not performed on blood, bone marrow or CSF specimens due to the extremely low sensitivity of the test.
  • Stains are not performed on cornea/eye/vitreous fluid specimens directly inoculated by physician, or specimens with insufficient quantity.
  • Minimum volume is required for testing.

Performed

Daily

Methodology

Liquid and/or solid culture media.

Nonradiometric, continuous monitor instrument, Bactec.

Organism(s) recovered in culture may be identified by MALDI-TOF. Identification by MALDI-TOF was developed and its performance characteristics determined by the University of Colorado Hospital Authority.  It has not been cleared or approved by the U.S. Food and Drug Administration.  The laboratory is regulated under CLIA as qualified to perform high-complexity testing.  This test is used for clinical purposes.  It should not be regarded as investigational or for research.

Reported

Up to eight weeks

Synonyms

  • Acid-fast bacilli culture
  • Acid fast bacillus Culture
  • CAFB

Ordering Recommendations

Include relevant patient history, previous mycobacterial infections, and include accurate specimen type/source for best results.

EPIC Code

LAB3452
CAFB

Interpretive Data

Negative Stain:  No acid fast bacilli seen on direct/concentrated smear

Positive Stain:  Acid fast bacilli seen on direct smear/concentrated smear
Positive Stain Quantitation: 1-9/100 HPF            
                                            1-9/10 HPF
                                            1-9/HPF
                                             >9 HPF

Preliminary Negative Culture Report:  Culture in progress, physician will be notified if culture is positive.
Negative Final Culture Report:  Negative for acid fast bacillus at 8 weeks.  (nonblood specimen source)
                                                 Negative for acid fast bacillus at 6 weeks. (blood and bone marrow source)

Preliminary Positive Culture Report: Culture positive for acid fast bacillus, identification to follow.
Final Positive Culture Report:  Culture positive for Mycobacterium...(reported to species or group if identification is possible by Maldi-tof).

First positive stain or first positive culture is called to the caregiver and emailed to Infection Prevention unless previously notified of positive MTB PCR.
                          

CPT Codes

87116 Culture, acid fast bacilli
87206 Direct Smear (fluorescent stain for mycobacteria)
87015 Concentration, for infectious agents
87176 Homogenization, tissue for culture
87015 Redigestion (concentration, for infectious agents)
87206 Ziehl-Neelson or Kinyoun stain (acid fast stain for mycobacteria)
87118 Culture, mycobacterial, definitive identification, each isolate (performed by Maldi-tof)
87186 Antimicrobial susceptibility test (performed by reference lab)

Collection

EPIC Code

LAB3452
CAFB

Performing Lab

UCHealth University of Colorado Hospital Clinical Laboratory - Microbiology (BSL3)

Collect

Submit specimens in a sterile container:

Specimen Type Optimal Volume Minimum Volume Notes
Respiratory (culture only)
  • Bronchial lavage/wash
  • Sputum
  • Tracheal aspirate
 5-10 mL 3 mL Refer to order set in EPIC LAB3452 for specific instructions.
Sample quality yield is improved when optimal volume is submitted.  Minimum volume is required for testing.
Submit three early morning specimens on three consecutive days or submit three specimens collected every 6 - 8 hours for inpatients.
Specimens may be collected over one to two hours if needed.
Specimens may be induced.
Respiratory (culture with MTB/RIF PCR)
  • Bronchial lavage/wash
  • Sputum
  • Tracheal aspirate
 5-10 mL 5 mL Refer to order set in EPIC LAB8656 AFB Culture with MTB/RIF PCR Panel if PCR is requested.
Blood and bone marrow 3-5 mL 1 mL Refer to AFB Blood Culture & Bone Marrow LAB3452 in the Test Catalog for detailed instructions.
Body fluids (aspirates) 5 mL 2 mL Unpreserved specimens only.
Cath tips and Devices     Generally unacceptable for AFB culture.  Must obtain prior approval from UCH Microbiology Medical Directors.
CSF 5-10 mL 4 mL Requires one of the following additional approval criteria:
  • Low CSF glucose
  • Elevated CSF protein
  • Elevated CSF leukocytes
Refer to AFB Culture with MTB/RIF PCR Panel LAB8656 if PCR is requested.
Pleural fluid 5-10 mL 4 mL Refer to AFB Culture with MTB/RIF PCR Panel LAB8656 if PCR is requested.
Tissues varies   Contact Microbiology Laboratory with questions 720-848-7084
Stool     Must obtain prior approval from UCH Microbiology Medical Directors.
Swabs     Not acceptable for culture.  Swabs will be rejected.
Urine 50 mL 40 mL Unpreserved specimens only.
Preferred specimens are three early morning urines collected on consecutive days.  First morning voids contain the highest concentration on mycobacteria.

Specimen Preparation

For reference laboratories submitting tissue for AFB Culture, thoroughly grind the sample in 5 mL sterile saline prior to transport.

For Bactec Myco/F Lytic blood culture bottles please contact local laboratory.

Unacceptable Conditions

  • Swabs.
  • Cath tips or devices.
  • Refrigerated or frozen Bactec® Myco/F Lytic bottle culture bottle.
  • Sample not properly identified, incorrect container or past stability.
  • Insufficient specimen volume. Refer to minimum volume guidelines.

Storage/Transport Temperature

Internal: Deliver to lab immediately.
Offsite: Refrigerate specimens (except blood and bone marrow) until delivered to the laboratory. Include full date of collection on specimens.

Blood and Bone Marrow: Transport ASAP at ambient temperature. Do not refrigerate.

Performed

Daily

Stability (from collection to initiation)

Room Temp: 24 hours
Refrigerated: 48 hours*
Frozen: Unacceptable

*Exceptions:

  • Outpatient sputum samples collected over a three day period will be accepted until 96 hours after the collection of the first sputum.
  • Blood and bone marrow specimens may not be refrigerated. Refer to AFB Blood Culture & Bone Marrow test catalog for detailed instructions.

Remarks

  • Test includes culture and stain, if appropriate.
  • Physicians will be notified of all positive cultures and/or stains.
  • Negative cultures are reported at 8 weeks.
  • Antibiotic susceptibility testing is automatically ordered and performed on any isolates of Mycobacterium tuberculosis or rapidly-growing Mycobacterium species.
  • Antibiotic susceptibility testing on Mycobacterium species other than Mycobacterium tuberculosis or rapidly growing Mycobacterium species are available upon request.  Contact the Microbiology Laboratory for additional information or to submit additional susceptibility orders.
  • Susceptibility testing is performed by a reference laboratory.

Notes

  • Specimens that require approval from the Microbiology Medical Directors will be delayed if approval is not documented prior to specimen submission.
  • Stains are not performed on urine specimens due to the presence of saprophytic mycobacteria in the genital secretions of normal patients.
  • Stains are not performed on blood, bone marrow or CSF specimens due to the extremely low sensitivity of the test.
  • Stains are not performed on cornea/eye/vitreous fluid specimens directly inoculated by physician, or specimens with insufficient quantity.
  • Minimum volume is required for testing.
Ordering

Performed

Daily

Methodology

Liquid and/or solid culture media.

Nonradiometric, continuous monitor instrument, Bactec.

Organism(s) recovered in culture may be identified by MALDI-TOF. Identification by MALDI-TOF was developed and its performance characteristics determined by the University of Colorado Hospital Authority.  It has not been cleared or approved by the U.S. Food and Drug Administration.  The laboratory is regulated under CLIA as qualified to perform high-complexity testing.  This test is used for clinical purposes.  It should not be regarded as investigational or for research.

Reported

Up to eight weeks

Synonyms

  • Acid-fast bacilli culture
  • Acid fast bacillus Culture
  • CAFB

Ordering Recommendations

Include relevant patient history, previous mycobacterial infections, and include accurate specimen type/source for best results.

EPIC Code

LAB3452
CAFB

Result Interpretation

Interpretive Data

Negative Stain:  No acid fast bacilli seen on direct/concentrated smear

Positive Stain:  Acid fast bacilli seen on direct smear/concentrated smear
Positive Stain Quantitation: 1-9/100 HPF            
                                            1-9/10 HPF
                                            1-9/HPF
                                             >9 HPF

Preliminary Negative Culture Report:  Culture in progress, physician will be notified if culture is positive.
Negative Final Culture Report:  Negative for acid fast bacillus at 8 weeks.  (nonblood specimen source)
                                                 Negative for acid fast bacillus at 6 weeks. (blood and bone marrow source)

Preliminary Positive Culture Report: Culture positive for acid fast bacillus, identification to follow.
Final Positive Culture Report:  Culture positive for Mycobacterium...(reported to species or group if identification is possible by Maldi-tof).

First positive stain or first positive culture is called to the caregiver and emailed to Infection Prevention unless previously notified of positive MTB PCR.
                          
Administrative

CPT Codes

87116 Culture, acid fast bacilli
87206 Direct Smear (fluorescent stain for mycobacteria)
87015 Concentration, for infectious agents
87176 Homogenization, tissue for culture
87015 Redigestion (concentration, for infectious agents)
87206 Ziehl-Neelson or Kinyoun stain (acid fast stain for mycobacteria)
87118 Culture, mycobacterial, definitive identification, each isolate (performed by Maldi-tof)
87186 Antimicrobial susceptibility test (performed by reference lab)

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