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Appropriate phenotypic susceptibilities for antimicrobial susceptibility testing of Acid Fast Bacilli

Test Code

PHENO

Description

This is the orderable for appropriate phenotypic susceptibility testing only. Selection of this orderable triggers the appropriate phenotypic testing for each type of organism (Table 1), but genotypic drug resistance testing is not performed, even if appropriate. Since genotypic resistance testing can provide a fast turnaround time and important information about treatment and is only performed when relevant, PHENO is typically not the recommended test. Note that testing is not performed, reported, or billed if it is not appropriate for the organism.

PHENO can be ordered on clinical specimens sent for culture. If an organism is grown, the appropriate drugs are automatically added; testing will not be performed if no organism is cultured. PHENO may also be ordered on isolates. Note that if a customized selection of antibiotics are needed, they can be selected individually. See "Menu of Individual Drug Testing for Acid Fast Bacilli" for the full selection of antibiotics that can be ordered.

Table 1. Phenotypic and genotypic susceptibilities performed based on the organism type when APPRO is ordered.

Organism	Phenotypic testing
Organism	Billing code	Drugs
M. avium complex	NTM13	AMK, CIP, CLO, CLR, DOX, LZD, MIN, MXF, RFB, RIF, STR, TMP/SXT
Slowly growing mycobacteria other than M. avium complex and fastidious mycobacteria	NTM13	AMK, CIP, CLO, CLR, DOX, LZD, MIN, MXF, RFB, RIF, STR, TMP/SXT
Fastidious slowly growing mycobacteria such as M. haemophilum and M. shimoidei.	BMX12	CIP, RFB, STR, AMK, CLR, MXF, CLO, LZD, RIF, EMB
M. tuberculosis complex (First line drugs)	MTB2	INH, PZA, RIF, EMB
Drug resistant M. tuberculosis complex (Second line drugs)	MTB1	AMK, CAP, CS, EMB, ETH, INH, KAN, PAS, RIF, STR
M. abscessus and M. chelonae	NTM6, NTM6V (vet)	AMK, AUG, AXO, AZM, CIP, CLF, CLR, DOX, FEP, FOT, FOX, GEN, IPM, KAN, LZD, MIN, MXF, TGC, TOB, TMP/SXT
Other rapidly growing mycobacteria (e.g. M. fortuitum, M. peregrinum)	NTM6	AMK, AUG, AXO, AZM, CIP, CLF, CLR, DOX, FEP, FOT, FOX, GEN, IPM, KAN, LZD, MIN, MXF, TGC, TOB, TMP/SXT
Partial acid fast bacteria (e.g. Nocardia sp., Gordonia sp., Tskuamurella sp.)	NTM4, NTM4V (vet)	AMK, AUG, AXO, AZM, CIP, CLF, CLR, DOX, FEP, FOT, FOX, GEN, IPM, KAN, LZD, MIN, MXF, TGC, TOB, TMP/SXT

Table 2. Drug abbreviations (used on the requisition)

Abbreviation	Drug	Abbreviation cont'd	Drug cont'd
AMK	Amikacin	INH	Isoniazid
AUG	Augmentin	IPM	Imipenem
AXO	Ceftriaxone	KAN	Kanamycin
AZM	Azithromycin	LZD	Linezolid
CIP	Ciprofloxacin	MIN	Minocycline
CLO	Clofazimine	MXF	Moxifloxacin
CLO/AMK	Clofazimine & Amikacin synergy	OMC	Omadacycline
CLR	Clarithromycin	PAS	p- Aminosalicyclic acid
CAP	Capreomycin	PZA	Pyrazinamide
CS	Cycloserine	RFB	Rifabutin
DOX	Doxycycline	RIF	Rifampin
EMB	Ethambutol	RIF/EMB	Rifampin & Ethambutol synergy
ETH	Ethionamide	STR	Streptomycin
FEP	Cefepime	TGC	Tigecycline
FOT	Cefotaxime	TMP/SXT	Trimethoprim/sulfamethoxazole
FOX	Cefoxitin	TOB	Tobramycin
GEN	Gentamicin

Collection/Transport

Collect

An identified isolate is required for testing (does not necessarily apply to veterinary rapidly growing isolates).

This test can be ordered on a clinical specimen that has been sent to our laboratory for isolation and identification of mycobacteria. See specimen requirements for culture of mycobacteria from a clinical specimen (AFB1, AFB3 or AFB7)
This test can also be ordered on organisms identified elsewhere. Pure mycobacterial isolates should be sent in solid media such as a Middlebrook slant (7H10 or 7H11), Lowenstein-Jensen (LJ) slant, or in broth (7H9, MGIT, MP BACT/Alert, VersaTrek).
Specimen Volume: Laboratory must receive visible growth of an isolate on solid media or an isolate in broth media (≥3 mL).

Unacceptable Conditions

Cultures received with incomplete identifiers.
Mixed cultures; Note that prior to rejection, attempts will be made to isolate organisms. A re-isolation charge will be applied in these cases.
Cultures containing mold.
Solid media with insufficient growth.
Cultures submitted on agar plates.
Liquid media with < 2 mL.
Leaking specimens.

Storage Transport Temp

Transport or mail isolates at ambient temperature. For nontuberculous mycobacteria (NTM), follow IATA/ DOT category B and for M. tuberculosis complex isolates, follow IATA/DOT category A requirements for shipping biological materials.

Test Detail

Performed

Typically all days

Methodology

Phenotypic susceptibilities are performed using agar proportion, broth microdilution, or broth macrodilution methods.

Turnaround Time

MIC's for M. tuberculosis complex and other slowly growing mycobacteria are reported 4 to 6 weeks after a pure culture is achieved.
MIC's for rapidly growing mycobacteria and aerobic actinomycetes are reported 2 to 3 weeks after a pure culture is achieved.

Lab Department

Infectious Disease Laboratory, Mycobacteriology

Synonyms

BMX12, NTM13, AFB6, MTB1, MTB2, NTM4, NTM4V, NTM6, NTM6V

NY State: Approved.

Result Interpretation

Interpretive Data

Susceptible, intermediate, or resistant (S, I, R) interpretations will be included whenever CLSI interpretations are available for a drug-organism combination.

Fees/Coding

CPT Code

Test code performed within APPRO	CPT Code	Billing Code
BMX12	87181 x2 and 87188 x7	BMX12
MTB1	87190 x10	MTBP1
MTB2	87188 x5	MTBP2
NTM4	87186	NTMP4
NTM4V	87186	NTP4V
NTM6	87186	NTMP6
NTM6V	87186	NTMPV
NTM13	87186	NTM13

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Appropriate phenotypic susceptibilities for antimicrobial susceptibility testing of Acid Fast Bacilli

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Appropriate phenotypic susceptibilities for antimicrobial susceptibility testing of Acid Fast Bacilli

Test Code

Description

Collection/Transport

Collect

Unacceptable Conditions

Storage Transport Temp

Test Detail

Performed

Methodology

Turnaround Time

Lab Department

Synonyms

Result Interpretation

Interpretive Data

Fees/Coding

CPT Code

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