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EPIC CODE: LAB223 Enteric Pathogens Culture, Feces

Additional Codes

Sunquest: STLM
Mayo:        STL

Reporting Name

Enteric Pathogens Culture, Stool

Useful For

Determining whether a bacterial enteric pathogen is the cause of diarrhea

 

May be helpful in identifying the source of the infectious agent (eg, dairy products, poultry, water, or meat)

 

This test is generally not useful for patients hospitalized more than 3 days because the yield from specimens from these patients is very low, as is the likelihood of identifying a pathogen that has not been detected previously.

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Specimen Type

Fecal


Ordering Guidance


1. If Vibrio is suspected, order VIBC / Vibrio Culture, Feces.

2. If susceptibility testing is needed; also order ZMMLS / Antimicrobial Susceptibility, Aerobic Bacteria, MIC, Varies. Pathogens for which susceptibility testing would be pursued are: Shigella species, Yersinia species, Campylobacter species, Arcobacter species, and Vibrio species. If susceptibilities are not appropriate they will not be performed and ZMMLS will be canceled at report time.

3. Clostridioides (Clostridium) difficile, a major cause of nosocomial diarrhea, is not detected by this test. Order CDFRP / Clostridioides [Clostridium] difficile Toxin, Molecular Detection, PCR, Feces.

4. Escherichia coli O157:H7 is not detected by this test. Order STFRP / Shiga Toxin, Molecular Detection, PCR, Feces.



Additional Testing Requirements


In some cases, local public health requirements may impact Mayo Clinic Laboratories (MCL) clients and require submission of isolates to a public health laboratory. Clients should familiarize themselves with local requirements and will be responsible for submitting isolates to the appropriate public health laboratory. Clients can obtain isolates of Vibrio species by calling 800-533-1710 as soon as possible to ensure viability of the organism.



Shipping Instructions


Specimen must arrive within 96 hours of collection.



Necessary Information


Specimen source is required.



Specimen Required


Patient Preparation: Medications: Do not use barium or bismuth before collection of specimen.

Supplies: C and S vial (T058)

Specimen Type: Preserved Feces

Container/Tube: Commercially available transport system specific for recovery of enteric pathogens from fecal specimens (15 mL of non-nutritive transport medium containing phenol red as a pH indicator, either Cary-Blair or Para-Pak C and S)

Specimen Volume: Representative portion of fecal specimen

Collection Instructions:

1. Collect fresh feces and submit 1 gram or 5 mL in container with transport medium.

2. Place feces in preservative within 2 hours of collection.

3. Place vial in a sealed plastic bag.


Specimen Minimum Volume

1 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Fecal Ambient (preferred) 4 days
  Refrigerated  4 days

Reference Values

No growth of pathogens

Day(s) Performed

Monday through Sunday

CPT Code Information

87045-Enteric Pathogens Culture, Stool-with isolation and preliminary examination

87046 x 3-Stool Culture Aerobic Bacteria, each

87077-Ident by MALDI-TOF mass spec (if appropriate)

87077-Bacteria Identification (if appropriate)

87153-Aerobe Ident by Sequencing (if appropriate)

87077-Additional Identification Procedure (if appropriate)

87147 x 3-Serologic Agglut Method 1 Ident (if appropriate)

87147 x 4-Serologic Agglut Method 3 Ident (if appropriate)

LOINC Code Information

Test ID Test Order Name Order LOINC Value
STL Enteric Pathogens Culture, Stool 625-4

 

Result ID Test Result Name Result LOINC Value
STL Enteric Pathogens Culture, Stool 625-4

Clinical Information

Diarrhea may be caused by a number of agents (eg, bacteria, viruses, parasites, and chemicals) and these agents may result in similar symptoms. A thorough patient history covering symptoms, severity, duration of illness, age, travel history, food consumption, history of recent antibiotic use, and illnesses in the family or other contacts will help the physician categorize the disease and ensure that any special requests are communicated to the laboratory.

Interpretation

The growth of an enteric pathogen identifies the cause of diarrhea.

Cautions

No significant cautionary statements

Clinical Reference

1. York MK, Rodrigues-Wong P, Church L: Fecal culture for aerobic pathogens of gastroenteritis. In Clinical Microbiology Procedures Handbook, Third edition. Washington, DC, ASM Press, 2010, Section 3.8.1

2. Jerris RC, Fields PI, Nicholson MA: Fecal culture for Campylobacter and related organisms. In Clinical Microbiology Procedures Handbook, Third edition. Washington, DC, ASM Press, 2010, Section 3.8.2

3. DuPont HL: Persistent diarrhea: A clinical review. JAMA June 28, 2016;315(24):2712-2723 doi:10.1001/jama.2016.7833

Method Description

The fecal specimen is inoculated onto selective media designed to inhibit growth of normal bowel flora while allowing growth of the enteric pathogens. The following media are used: sheep blood agar, Hektoen enteric (HE) agar, eosin-methylene blue (EMB) agar, Campylobacter agar, cefsulodin-irgasan-novobiocin (CIN) agar, and the enrichment broth, selenite F. After incubation, suspect colonies are identified using 1 or a combination of the following techniques: matrix-assisted laser desorption/ionization time of flight (MALDI-TOF) mass spectrometry, conventional biochemical tests, carbon source utilization, serologic methods, or nucleic acid sequencing of the 16S ribosomal RNA (rRNA) gene.(Koneman's Color Atlas and Textbook of Diagnostic Microbiology. Seventh edition. Edited by GW Procop, DL Church, GS Hall, et al. Philadelphia, Wolters Kluwer/Lippincott Williams and Wilkins, 2017)

Report Available

3 to 8 days

Specimen Retention Time

7 days

Reject Due To

Unpreserved stool ECOFIX preservative Formalin or PVA fixative Reject

Reflex Tests

Test ID Reporting Name Available Separately Always Performed
GID Bacteria Identification No, (Bill Only) No
ISAE Aerobe Ident by Sequencing No, (Bill Only) No
REFID Additional Identification Procedure No, (Bill Only) No
SALS Serologic Agglut Method 1 Ident No, (Bill Only) No
SHIG Serologic Agglut Method 3 Ident No, (Bill Only) No
RMALD Ident by MALDI-TOF mass spec No, (Bill Only) No

Testing Algorithm

When this test is ordered, the reflex tests may be performed and charged separately. Reportable pathogens include: Aeromonas, Campylobacter, Salmonella, Shigella, and Yersinia.

Note: Does not include culture for Escherichia coli O157:H7. All bacterial isolates worked up, to rule in or out as a pathogen, will be billed for work performed and resources consumed.

 

See Laboratory Testing for Infectious Causes of Diarrhea in Special Instructions.

NY State Approved

Yes

Method Name

Conventional Culture

Test Classification

This test has been cleared, approved, or is exempt by the US Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.

Forms

If not ordering electronically, complete, print, and send a Gastroenterology and Hepatology Client Test Request (T728) with the specimen.

Secondary ID

8098