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Microbiology

Education & Training, Microbiology, Test Utilization

Viral culture discontinuation

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.

Obsolete order Specimen Recommended alternative
Herpes Simplex Viral Culture (LAB9460)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-Swabs (genital, nasal, ocular, oral, rectal, skin, etc.)

-Cerebrospinal fluid

-Blood

Herpes Simplex PCR (LAB9170)
Aqueous fluid HSV PCR, aqueous fluid (LAB1230247)
Bronchoalveolar lavage HSV PCR, BAL (LAB1230248)
Bronchial washing HSV PCR, bronch wash (LAB1230246)
Tissue HSV PCR, tissue (LAB1230413)
Tracheal aspirate HSV PCR, trach aspirate (LAB1230251)
Tracheal washing HSV PCR, trach wash (LAB1230252)
Vitreous fluid HSV PCR, vitreous fluid (LAB1230253)
Cytomegalovirus (CMV) Culture (LAB255)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Amniotic fluid CMV PCR, amniotic fluid (LAB1230177)
Aqueous fluid CMV PCR, aqueous fluid (LAB1230187)
Bone marrow CMV PCR, bone marrow (LAB1230176)
Bronchoalveolar lavage CMV PCR, BAL (LAB1230179)
Bronchial washing CMV PCR, bronchial washing (LAB1230185)
Cerebrospinal fluid CMV PCR, spinal fluid (LAB1230175)
Eye swab CMV PCR, eye swab (LAB1230186)
Pericardial fluid CMV PCR, pericardial fluid (LAB1230182)
Pleural fluid CMV PCR, pleural fluid (LAB1230181)
Stool CMV PCR, stool (LAB1230178)
Tissue CMV PCR, tissue (LAB1230420)
Tracheal aspirate CMV PCR, trach aspirate (LAB1230184)
Tracheal washing CMV PCR, trach wash (LAB1230188)
Urine CMV PCR, urine (LAB1230174)
Vitreous fluid CMV PCR, vitreous fluid (LAB1230183)
Viral Culture (LAB254)

 

 

 

Bronchoalveolar lavage Respiratory pathogen PCR panel (LAB3359)
Swabs (genital, nasal, ocular, oral, rectal, skin, etc.) Herpes Simplex PCR (LAB9170)

Varicella Zoster Virus (VZV) PCR (LAB1230844)

Adenovirus Antigen (LAB2111005) Stool Adenovirus qualitative PCR, stool (LAB1230211)

 

Main lab, Microbiology, Referral/Sendouts

Measles Ordering and Collecting Specimens

With several suspected cases of measles within Michigan, we thought it would be an excellent time to highlight Corewell Health West’s guidance on testing suspected patients. Specimens are sent to a reference lab for testing, which must be coordinated with local public health departments. Typically an upper-respiratory swab (throat or nasopharyngeal)  is collected for PCR testing in addition to a serum for measles IgM if collection is possible.

  • Patients should not be directed to a Corewell Health Laboratory or other healthcare facility for serum collection if patient is within 4 days after the onset of rash (with onset of rash considered to be Day 0). If Day 5 of rash or later, immunocompetent patients are no longer considered contagious and may be sent to a laboratory for a serum draw.
  • Corewell Health Providers:
    • Please reach out to Corewell Health Infection Prevention (IP) via Perfect Serve to make them aware of the situation.
    • Corewell Health Infection Prevention will contact the appropriate county.
  • Non-Corewell Health Facilities:
    • The provider’s office must coordinate with the county health department that the patient lives in to obtain permission to send measles testing.
    • Visit the following link for county health department contact information: Slide 1 (michigan.gov)
      • The county will coordinate with MDHHS for testing permission.

The preferred testing specimen is a throat or nasopharyngeal swab collected in office. Corewell Health Laboratories do not collect swabs.

For further collection and ordering instructions, please visit: Measles PCR – Laboratory Test Catalog | West

Any additional questions or concerns, please use the contact us link above or reach out to your local health department.

Microbiology

Test Update: Influenza Rapid and RSV Rapid Tests Discontinued

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

Microbiology

Sinus Culture Order Considerations

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

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Microbiology, Test Utilization

Enteric Pathogens PCR Panel: New Order Criteria

The Enteric Pathogens PCR test performed by Spectrum Health Laboratory may be used to detect common pathogenic bacteria and viruses in stool collected from individuals with symptoms of gastrointestinal infection. Specifically, this test detects Campylobacter, Salmonella, Shigella, Vibrio, Yersinia enterocolitica, Norovirus, Rotavirus, and the Shiga toxin virulence factor. Effective August 17, 2022, Spectrum Health’s Epic EMR will contain new ask-at-order questions to help improve the clinical decision support and appropriate utilization of this testing. Continue Reading

General Information, Microbiology, Test Utilization

Discontinuation of Placenta Microbiology Cultures

As of April 12, 2022, Spectrum Health Laboratory will no longer add microbiology cultures to placental tissues received based on paper requisition forms.

Viral and bacterial cultures from placental tissue are rarely clinically beneficial and are no longer the gold standard diagnostic approach due to the relative insensitivity of culture methods.

If viral studies are desired (possible indications could include known CMV exposure with positive IgM or intrauterine fetal demise at < 28 weeks), then molecular testing is the recommended diagnostic approach. HSV and CMV PCR tests may be ordered in Epic.

Herpes Simplex 1/2 Qualitative PCR, Tissue (LAB1230413)

Cytomegalovirus (CMV) Qualitative PCR, Tissue (LAB1230291)

Bacterial cultures are challenging to interpret since they typically grow normal genital flora and histopathological analysis used to diagnose acute chorioamnionitis correlates poorly with growth from bacterial placenta cultures. If indicated, culture and PCR tests may be ordered in Epic.

Tissue Culture (LAB2111173)

Metamycoplasma hominis, Molecular Detection, PCR, Varies (LAB848)

Ureaplasma species, Molecular Detection, PCR, Varies (LAB848)

Placenta tissues sent to the lab in formalin are not acceptable for PCR or culture orders.

Microbiology

Herpes Simplex Virus PCR Update

As of April 5th, 2022, Herpes Simplex viral PCR testing will transition from being performed in the Spectrum Health Molecular department to the Microbiology department. There are no changes to the acceptable specimen sources for this test (cerebrospinal fluid and blood plasma specimens). Benefits of the new Microbiology testing method include:

• The new test method (DiaSorin Simplexa® HSV PCR) is FDA-cleared for testing spinal fluid specimens with a validated modification for testing plasma specimens. The prior method was a lab-developed test for both specimen types.

• Especially for pediatric patients, collecting sufficient specimen volumes can sometimes be challenging. The new method requires a minimum of 0.05 mL specimen per run whereas the prior method required 0.2 mL specimen.

• The frequency of testing will increase from typically one run per day to testing being performed at several times each day.

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General Information, Microbiology

New Test: Varicella Zoster Virus (VZV) PCR, Swab

Effective February 10, 2022, Spectrum Health Regional Laboratory will offer Varicella Zoster Virus (VZV) PCR testing on swab specimens collected from cutaneous and mucocutaneous lesions (e.g. anorectal, genital, nasal, ocular, oral, skin, urethral).

PCR is the test method of choice for the diagnosis of VZV infection due to its enhanced sensitivity and speed as compared to traditional viral cultures, which should no longer be used for VZV detection. Continue Reading