Lab Information Manual

Laboratory:

Clinical Microbiology

Test Name:

FLUID (PERICARDIAL FLUID/PERITONEAL FLUID (INCLUDING CAPD FLUID)/PLEURAL FLUID/SYNOVIAL FLUID/VITREOUS FLUID), CULTURE, AEROBIC/ANAEROBIC BACTERIA - (Fl)

Test Code: FLU, FLAN, FLDB, CAPD, MIST [ORTH, ORAN, ORFU (SBH only)]

Clinical Information:

Test Indications:
To aid in the diagnosis of various infections, including (but not limited to) liver abscess, brain abscess, endophthalmitis, bursitis, empyema, primary peritonitis or CAPD peritonitis. Microbiological diagnosis of community onset secondary peritonitis is not generally indicated.
Aseptically collected fluids from a normally sterile site may be submitted for aerobic and anaerobic culture to determine if an infection is present, the etiological agent(s) and antimicrobial susceptibility profile of the agent(s) in order to help guide therapy.

Recommendations:
Generally, all organisms growing from a specimen collected from a normally sterile site are reported. Therefore, great care must be taken during specimen collection to ensure the specimen is not contaminated.
The anatomical site where specimen was collected from must be clearly indicated on the requisition. The suspected diagnosis should also be included.
Obtain specimen prior to initiation of antimicrobial therapy. If not possible, indicate antimicrobic therapy on ordering requisition.
Always submit as much fluid as possible, DO NOT submit a swab dipped in fluid. When the specimen volume is less than required for multiple test requests, prioritization of testing must be provided to the laboratory.
Test requests for fungi and/or AFB must be indicated when required. Please refer to the corresponding LIM entries for further information.

For CAPD fluid, IN ADDITION to a sterile container, 10 mL of specimen should be collected in an aerobic blood culture bottle and 10 mL in on anaerobic blood culture bottle at the bedside and submitted with the sterile container. CAPD bags should not be submitted to the laboratory and will be rejected.
Please notify the laboratory in advance and on the requisition if there is clinical suspicion of an infection caused by a Risk Group 3 pathogen, e.g., Brucella, Francisella.
Samples and requisitions must be labeled/completed in accordance with the Shared Health Specimen Acceptance Policy.
Accurate patient identification must be made prior to sample collection. Patient identification should be done in accordance with the site policy.

Patient Preparation Instructions:
1. Sample MUST be acquired using aseptic technique.
2. Follow protocols outlined by your health care facility for this sample type.

Collection Devices:

Preferred Device:

1 - Sterile Specimen Container (100 mL)

Sterile Specimen Container (100 mL)
Manufacturer:

Catalogue #:

- Specimens received in other collection devices will not be processed.

Aerobic and anaerobic blood culture bottles (for CAPD fluid only)

Specimen Required:

Always submit as much fluid as possible; larger volumes of fluid produce better results.
Minimum volumes required are as follows (Adult and Pediatric):
Bacterial Culture ≥1 mL
Fungal Culture ≥2 mL (5-10 mL optimum)
AFB (Mycobacteria) Culture ≥2 mL (10-15 mL optimum)

Referral:

Requisition:

_SH Microbiology - Provincial Requisition (R250-10-06)

Reference Values:

No growth after 5 days incubation.
For positive samples, a descriptive report will be provided. Results (interim and/or final) are provided as soon as they become available.

Availability:

Daily

MYCOBACTERIA (ACID-FAST BACILLI [AFB]), CULTURE, FLUID

FLUID (E.G., CEREBROSPINAL FLUID [CSF]/BONE MARROW), CULTURE, AEROBIC BACTERIA - (CSF)

BILE, ASPIRATE, ASEPTICALLY-ACQUIRED, CULTURE, AEROBIC/ANAEROBIC BACTERIA - (Asp)

STILLBIRTH PROTOCOL (AMNION/CHORION/NASAL SWAB), CULTURE, AEROBIC BACTERIA

BLOOD, CULTURE, AEROBIC/ANAEROBIC BACTERIA - (B)

More Information:

Specimen Handling:
Local: Transport as soon as possible, hold at room temperature. Any delay could result in the decreased ability to recover fastidious pathogens.
Courier/local storage: ≤24 hrs at room temperature.
If the patient has received antifungals or antibacterial agents, the specimen should be received within 1 hour of collection.
Ensure samples that are being sent to a referral laboratory are packaged in accordance with Transport of Dangerous Goods recommendations for diagnostic samples.