Effective December 4th 2024, the Corewell Health Microbiology Laboratory will discontinue the following viral culture orders. Viral culture is relatively slow and insensitive as compared to molecular options that are now available as the recommended standard of care.
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Adam Caulfield
This winter, West Michigan influenza infections peaked in February 2024 and significantly declined throughout March and April 2024. Now with a low prevalence of circulating influenza, using the most sensitive diagnostic test is recommended in order to obtain accurate and actionable results. Influenza antigen testing (e.g. Sofia instrument) is no longer appropriate at this time and Influenza PCR testing should be ordered when clinically indicated.
| Low Influenza Prevalence |
High Influenza Prevalence |
|
| Recommended Order | Influenza PCR (LAB3255) | Influenza antigen testing (e.g. Sofia instrument) or Influenza PCR (LAB3255) |
More detailed information can be found as published by the CDC:
Influenza cases numbers are currently increasing throughout West Michigan. Influenza prevalence guides the most appropriate testing approach and sufficient prevalence has now been reached for influenza rapid antigen or point of care testing (e.g. Sofia instrument) to have improved performance. The use of point of care testing as a screening method during high prevalence reduces both the cost to the patient and turn-around-time as compared to lab-based molecular methods. Point of care tests generally have high analytical specificity, but lack the sensitivity of nucleic acid amplification methods (e.g. PCR). For this reason, PCR testing is still recommended for hospitalized patients and for outpatients with a negative result if influenza is still suspected and if the result will impact clinical decision making.
| Low influenza prevalence | High influenza prevalence | |
| Recommended order | Influenza PCR | Influenza Point of Care Testing or Influenza PCR |
Effective October 3, 2023, Corewell Health Laboratories will discontinue the Influenza Rapid and Respiratory Syncytial Virus (RSV) Rapid tests. These antigen tests are less sensitive than the nucleic acid amplification tests (NAAT; such as PCR) that are now the standard of care for diagnosing these respiratory viruses. Specimen collection remains unchanged with PCR testing available for nasopharyngeal and nasal swabs collected in a universal transport media (UTM) tube.
Discontinued:
• Influenza (Flu) A/B Rapid – Epic Code: LAB9240
• Influenza (Flu) A/B Rapid, Influenza A/B PCR if Negative – Epic Code: LAB2111530
• Respiratory Syncytial Virus (RSV) Rapid – Epic Code: LAB495
Replace with:
• Influenza (Flu) A/B PCR – Epic Code: LAB3255
• COVID-19, Influenza A/B, RSV PCR – Epic Code: LAB1230746
Effective September 13, 2023, Corewell Health Laboratory will discontinue the Chlamydia Culture orderable. For patients 14 years of age and older, please order Chlamydia PCR.
• This specimen can be either a swab (genital, rectal, or throat) or a urine sample.
• The collection container is the STD-Multi-Collection Kit.
• For more information please visit: Chlamydia PCR
For patients that are under 14 years of age, a “Reference Miscellaneous Test” [LAB 848], must be ordered.
• This specimen can be either a swab (genital, rectal, or throat) or a urine sample.
• The collection container is the Aptima
• For more information please visit: APTIMA Chlamydia, NAAT, ThinPrep, Swab, Urine
As a reminder, PCR testing is also preferred for gonorrhea, when the specimen types are compatible.
The management of sinusitis is often aided by bacterial and fungal cultures from which Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, and occasionally aerobic Gram-negative bacilli are the most commonly recovered pathogenic organisms. The Corewell Health West Microbiology Lab has several orders available for culturing sinus specimens collected as fluid aspirates, tissue, or swabs. Though more challenging to collect, aspirates are preferred over swab cultures that often grow mixed normal upper respiratory flora for which it is difficult to interpret the clinical significance.
| Available Sinus Culture Orders | Default Specimen Type | Comments |
| Body Fluid Culture [LAB2111016]
Respiratory Culture [LAB3095] Tissue Culture [LAB2111173] |
Aspirated fluid
Swabbed collection Tissue |
For aerobic bacteria |
| Fungal Culture [LAB240] | Aspirated fluid or tissue, preferred
Swabbed collection |
For fungal organisms |
| Anaerobic Culture [LAB233] | Aspirated fluid or tissue* | For anaerobic bacteria |
This winter, West Michigan influenza infections peaked in December 2022 and significantly declined throughout February and March 2023. Now with a low prevalence of circulating influenza, using the most sensitive diagnostic test is recommended in order to obtain accurate and actionable results. Influenza antigen testing (e.g. Sofia instrument) is no longer appropriate at this time and Influenza PCR testing should be ordered when clinically indicated.
Compliance & Safety, Education & Training, General Information, Main lab, Test Utilization
Inform: RSV Testing – Age Restrictions
Respiratory syncytial virus (RSV) primarily infects pediatric patients, but occasionally infects adults and may be of particular concern for the elderly and immunocompromised. Corewell Health Laboratories offers two tests for RSV. A rapid antigen test may be used to confirm RSV diagnosis in pediatric patients. This test is not approved by the FDA for testing adult patients, so tests will be cancelled if ordered on an off-label age group. There are no age restrictions for RSV testing by way of a molecular panel that also includes COVID and influenza as viruses with overlapping symptoms.
| Test name | Epic Test ID | Methodology | Specimen | Age restriction |
| RSV Rapid | LAB495 | Antigen | Nasopharyngeal (NP) swab | Approved for patients 0 – 18 years of age |
| COVID, Influenza, RSV PCR | LAB1230746 | Molecular/PCR | Nasopharyngeal (NP) swab | No age restriction |
Influenza cases numbers are currently increasing throughout West Michigan. Influenza prevalence guides the most appropriate testing approach and sufficient prevalence has now been reached for influenza rapid antigen testing (e.g. Sofia instrument) to have improved performance. The use of rapid antigen testing as a screening method during high prevalence reduces both the cost to the patient and turn-around-time as compared to lab-based molecular methods. Rapid antigen tests generally have high analytical specificity, but lack the sensitivity of nucleic acid amplification methods (e.g. PCR). For this reason, PCR testing is still recommended for hospitalized patients and for outpatients with a negative antigen result if influenza is still suspected and if the result will impact clinical decision making.
Effective immediately, the following Regional Hospital Laboratories have the 4-Plex (COVID-19, Influenza A, Influenza B, RSV) test available for ordering and testing:
- Big Rapids Hospital Laboratory
- Blodgett Hospital Laboratory
- Gerber Hospital Laboratory
- Ludington Hospital Laboratory
- Pennock Hospital Laboratory
- Reed City Hospital Laboratory
- United/Greenville Hospital Laboratory
- Zeeland Hospital Laboratory