Deep wound culture
Test Code
CXDWD
Specimens sent under anaerobic condition will be culture for aerobic and anaerobic pathogens. Specimens not sent under anaerobic conditions will only be examined for aerobic pathogens.
Sterile sources include: Lymph node, brain, heart, liver, spleen, vitreous fluid, kidney, pancrease, ovary, vascular tissue.
Organism seen in the Gram stain or recovered in culture from a sterile source is considered a critical result. Critical results are called to the ordering physician in accordance with the NJH critical policy.
Description
Deep wound culture is used to determine infectious agents in various sites of tissue below the dermis. This test includes Gram stain and culture.
Collect
Tissues,biopsies, and bone: Can be collected from any deep subcutaneous site. Specimen should be taken from within and adjacent to the area of infection. A few drops of sterile nonbacteriostatic saline can be added to prevent the speicmen from drying out.
Deep wounds: Debride wound, then thoroghly rinse with sterile saline. Only take specimen from viable tissue of wounds that appear to be infected or do not appear to be healing over a long period of time.
Fine needle aspirates & drainage from non-sterile sources (i.e. abscesses): Disinfect skin with 2% chlorhexidine or 70% alcohol followed by iodine solution. Remove idoine with 70% alcohol before collection. Aspirate with a needle and syringe. If the first attempt fails to produce pus, inject sterile saline subcutaneously, then repeat the aspiration. Expel the excess air, remove the needle, and cap the syringe before sending to the laboratrory.
All specimen types should be collected in a sterile container, sterile syringe, or sterile swab.
Swab collection should be avoided if a tissue/biopsy or aspiration of the infected area can be performed. The specimen should be collected from a subcutaneous site. Place the swab in an appropriate transport system and send to the
laboratory.
Preferred volume: 1-3 mL
Minimum Volume: 1 mL
Patient Prep
- Debride and rinse open wounds with sterile saline.
- Clean closed wounds with 2% chlorhexidine or 70% alcohol followed by iodine solution. The iodine solution should be removed before collecting the sample.
- Disinfect any collection tubing before collecting drainage samples.
Unacceptable Conditions
- Specimens received frozen
- Specimens received in formalin
- Aspirates with < 1ml
- Specimens >3 days from collection
- Mislabeled or unlabeled specimen (exception with attestation for specimes from irretraveble source, i.e tissue or bone)
Storage Transport Temp
- Speicmens should be sent to the laboratory as soon as possible. For optimal recovery of potential pathogens, specimens should arrive within 2 hours.
- If transportation is delayed, specimens may be storged at room temperature (20-25°C) for 24 hours from collection.
Stability
- Speicmens should be sent to the laboratory as soon as possible. For optimal recovery of potential pathogens, specimens should arrive within 2 hours.
- If transportation is delayed, specimens may be storged at room temperature (20-25°C) for 24 hours.
- Specimens will be accepted up to 3 days post collection.
Performed
7 days a week from 8am to 6pm.
Methodology
Conventional culture
Turnaround Time
Expected turn around time is 4 days to final report.
Department
Microbiology Lab
Synonyms
WDEEP, Tissue culture, CXTIS
Ordering Recommendations
Order when there is a suspected infection in tissue deeper than the dermis.
Reference Interval
No growth for sterile sources.
Normal comensal skin flora for non-sterile sources may be observed.
Interpretation
The table below describes reportable organism and if antimicrobial susceptibility testing (AST) is routinely included. If susceptibilites are needed for an organims that AST is not routinely included, please contact ADx Client Services to submit a request.
|
Organism |
Threshold for Pathogenicity |
Reporting |
|
Acinetobacter baumanni complex |
Pure or predominant |
ID and AST |
|
Actinomyces spp. |
Pure or predominant |
ID and AST‡ |
|
Aeromonas hydrophila |
Any |
ID and AST‡ |
|
Aracanobacterium haemolyticum |
Any |
ID and AST‡ |
|
Bacillus anthracis |
Any |
ID |
|
Bacillus spp. (not anthracis) |
Pure |
ID |
|
Bacteroides fragilis group |
Pure or predominant |
ID and AST‡ |
|
Bartonella spp. |
Any |
ID |
|
Burkholderia mallei |
Any |
ID |
|
Burkholderia pseudomallei |
Any |
ID |
|
Candida spp. |
Pure or predominant |
ID |
|
Capnocytophaga spp. |
Any |
ID |
|
Clostridium novyi |
Any |
ID |
|
Clostridium prefringens |
Any |
ID |
|
Clostridium septicum |
Any |
ID |
|
Clostridium sordellii |
Any |
ID |
|
Coagulase-negative staphylococci (not listed individually) |
Pure |
ID and AST |
|
Corynebacterium diptheriae |
Any |
ID and AST‡ |
|
Corynebacterium kroppenstedtii |
Any |
ID and AST‡ |
|
Corynebacterium minutissimum |
Any |
ID and AST‡ |
|
Corynebacterium pseudotuberculosis |
Any |
ID and AST‡ |
|
Corynebacterium ulcerans |
Any |
ID and AST‡ |
|
Eikenella spp. |
Pure or predominant |
ID and AST |
|
Enterobacterales (not listed separately) |
Pure or predominant |
ID and AST |
|
Enterococcus spp. |
Pure or predominant |
ID and AST |
|
Francisella tularensis |
Any |
ID |
|
Fusobacterium spp. |
Pure or predominant |
ID and AST‡ |
|
Haemophilus ducreyi |
Any |
ID |
|
Neisseria gonorrhoeae |
Any |
ID |
|
Nocardia spp. |
Any |
ID and AST |
|
Non-glucose fermenting GNR |
Pure or predominant |
ID and AST |
|
Other anaerobes |
Pure |
ID and AST‡ |
|
Pasteurella spp. |
Any |
ID; β-lactamase |
|
Pseudomonas aeruginosa |
Any |
ID and AST |
|
Staphylococcus aureus |
Any |
ID and AST |
|
Staphylococcus intermedius group |
Pure or predominant |
ID and AST |
|
Staphylococcus lugdunensis |
Pure or predominant |
ID and AST |
|
Staphylococcus schleiferi |
Pure or predominant |
ID and AST |
|
Stenotrophomonas maltophilia |
Pure or predominant |
ID and AST |
|
Streptococcus agalactiae (group B) |
Pure or predominant |
ID |
|
Streptococcus anginosus |
Pure or predominant |
ID and AST |
|
Streptococcus pneumoniae |
Any |
ID and AST |
|
Streptococcus pyogenes (group A) |
Any |
ID |
|
Vibrio vulnificus |
Any |
ID and AST‡ |
|
Viridans group Streptococcus |
Pure |
ID and AST |
|
Yersinia pestis |
Any |
ID |
‡AST is not performed in house; isolate will be sent to reference lab for susceptibility testing
CPT Code
87205, 87070