Clinics and Departments

Laboratory Services

Lab Dept:

Microbiology/Virology

Test Name:

BRONCHOSCOPY CULTURE AND GRAM STAIN

General Information

Lab Order Codes:

BRC

Synonyms:

Culture, Bronchoscopy; Culture, BAL; Culture, Bronchial Brushings; Culture, Bronchial Wash; Bronchial Alveolar Lavage Culture

CPT Codes:

87071 – Culture, bacterial; quantitative, aerobic with isolation and presumptive identification of isolates, any source except urine, blood or stool
87205 – Smear, primary source with interpretation; Gram or Giemsa stain for bacteria, fungi or cell types

The following testing may be added if appropriate based on findings for organism identification (multiple additions are possible if more than one organism is identified) and to aid in patient treatment management.

87077 – Aerobic isolate, additional methods required for definitive identification, each isolate (if appropriate)
87106 – Culture, fungi, definitive identification, each organism, yeast (if appropriate)
87107 – Culture, mold, definitive identification, each organism, mold (if appropriate)
87206 – Smear, primary source with interpretation, fluorescent and/or acid fast stain for bacteria, fungi or cell types (if appropriate)
87184 – Susceptibility studies, disk method, per plate (if appropriate)
87185 – Enzyme detection (eg, beta lactamase), per enzyme (if appropriate)
87186 – Susceptibility studies, microdilution or agar dilution, each multi-antimicrobial, per plate (if appropriate)

Test Includes:

Quantitative culture of aerobic flora and Gram stain. If a Mycobacterium species (AFB, TB), fungus or a virus is suspected. Refer to AFB Culture, Fungal Culture or Viral Culture.

Logistics

Lab Testing Sections:

Microbiology

Phone Numbers:

MIN Lab: 612-813-5866

STP Lab: 651-220-6555

 

Test Availability:

Daily, 24 hours

Turnaround Time:

Preliminary report available at 1 day, final report within 2 - 5 days.

Special Instructions:

Specific site and date/time of collection are required for specimen processing.

Specimen

Specimen Type:

Aspirate, brushing, lavage, wash

Container:

Luki tube or sterile container

Volume:

2 mL (Minimum: 0.5 mL)

Collection:

Bronchoscopy

1. Specimen obtained by physician through the biopsy channel of the bronchoscope.
2.
Transfer specimen into a luki tube.

Bronchial Brush

1. Place brush into a sterile container with 1.0 mL of saline.

Transport/Storage:

Transport to the laboratory immediately at room temperature. Do not send through the pneumatic tube system.

Sample Rejection:

Specimen with a transit time exceeding 2 hours after collection; specimen not submitted in appropriate transport container; improperly labeled specimen; insufficient volume; external contamination. If an unacceptable specimen is received, the physician or nursing station will be notified and another specimen will be requested before the specimen is discarded.

Interpretive

Reference Range:

Bronchial Brush (in 1 mL saline): <103 CFU/mL is within the expected level of contamination

Bronchoalveolar lavages:

1. Bacteria: <104 CFU/mL aerobic bacteria
2.
Normal total cell count: 10 - 15 x 103 /100mL; differential, 80 - 90% alveolar macrophages; 10% lymphocytes; 1% polymorphonuclear cells, 0.2% eosinophils

Bronchial washes: cannot be established; often contaminated heavily with oral flora.

Alert Value:

● Gram-negative rods identified as ESBL or Carbapenemase producers will be called to the physician or patient’s nurse. Infection Prevention will be notified.

● If MRSA is isolated for the first time, and the patient location is not Emergency department, the result will be called to the physician or patient’s nurse.

● Any culture positive for potential agents of Bioterrorism – Bacillus anthracis, Brucella, Burkholderia mallei/pseudomallei, Francisella tularensis, or Yersinia pestis will be called to Infection Disease or Infection Prevention.

Methodology:

Quantitative culture

References:

Cook, JH, and M Pezzlo (1992). Specimen receipt and accessioning. Section 1. Aerobic bacteriology, 1.2.1-4. In HD Isenberg (ed) Clinical Microbiology Procedures Handbook. American Society for Microbiology, Washington DC

Miller, J Michael (1999) A Guide To Specimen Management in Clinical Microbiology, American Society for Microbiology, Washington DC

Miller, J Michael, and HT Holmes (1999) Specimen Collection, Transport, and Storage In PR Murray et al, (ed), Manual of Clinical Microbiology, 7th edition, American Society for Microbiology, Washington DC, pp 33-104

Updates:

3/22/2010: CPT Updates
3/7/2011: CPT Updates
6/19/2012: Addition of Alert Value.
6/20/2012: Alert Value amended



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