Test ID: MMLSA
Antimicrobial Susceptibility, Anaerobic Bacteria, MIC
NY State Approved 
Indicates the status of NY State approval and if the test is orderable for NY State clients.
Useful For Suggests clinical disorders or settings where the test may be helpful
Directing antimicrobial therapy for anaerobic infections
Reflex Tests Lists test(s) that may or may not be performed, at an additional charge, depending on the result and interpretation of the initial test(s)
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| BLA | Beta Lactamase | No, (Bill Only) | No |
| SANA | Anaerobe Suscep per agent | No, (Bill Only) | No |
Testing Algorithm Delineates situation(s) when tests are added to the initial order. This includes reflex and additional tests.
When this test is ordered, then Anaerobe Suscep Battery will be performed and charged.
Based on susceptibility criteria, the Beta Lactamase and/or Anaerobe Suscep per agent may be performed at an additional charge.
Method Name A short description of the method used to perform the test
Minimum Inhibitory Concentration (MIC) by E Test
Reporting Name A shorter/abbreviated version of the Published Name for a test; an abbreviated test name
Aliases Lists additional common names for a test, as an aid in searching
Bacterial Susceptibility Testing (1 test)
MIC Test, Anaerobic Bacteria
Susceptibility Testing
Minimum Inhibitory Concentration (MIC)
Specimen Type Describes the specimen type needed for testing
Specimen Required Defines the optimal specimen. This field describes the type of specimen required to perform the test and the preferred volume to complete testing. The volume allows automated processing, fastest throughput and, when indicated, repeat or reflex testing.
Sources: Available only on isolates from blood cultures, bone and joint infections, or brain abscesses and organisms isolated in pure culture from other sources
Container/Tube:
Preferred: Anaerobic transport tube (BBL Port-A-Cul Tube) (Supply T588)
Acceptable: Thioglycollate broth or any other suitable anaerobic transport system
Specimen Volume: Isolate
Collection Instructions:
1. Submit pure culture of bacteria.
2. Label specimen as an etiologic agent.
Additional Information: Specimen source and organism identification are required.
Forms: If not ordering electronically, submit a Microbiology Request Form (Supply T244) with the specimen.
Reject Due To Identifies specimen types and conditions that may cause the specimen to be rejected
| Hemolysis | NA |
| Lipemia | NA |
| Icterus | NA |
| Other | Agar plate |
Specimen Stability Information Provides a description of the temperatures required to transport a specimen to the laboratory. Alternate acceptable temperature(s) are also included.
| Specimen Type | Temperature | Time |
|---|---|---|
| Varies | Ambient | |
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Anaerobic bacteria make up a large part of the human body's normal flora and generally do not cause infection. When usual skin and mucosal barriers are penetrated and in an anaerobic environment, these bacteria can behave as pathogens. Anaerobes grow aggressively in the body under anaerobic conditions and may possess a variety of virulence factors including capsules and extracellular enzymes. They also can develop resistance to antimicrobials by producing beta-lactamase and other modifying enzymes and by alterations in membrane permeability and structure of penicillin-binding proteins.
Because anaerobic bacteria are a significant cause of human infection and they are often resistant to commonly used antimicrobials, susceptibility testing results are useful to clinicians.
The following antimicrobials are routinely tested for the various groups of anaerobes.
| Anaerobic gram-negative bacilli Beta-lactamase positive |
Piperacillin/tazobactam, ertapenem, metronidazole, clindamycin |
| Beta-lactamase negative | Penicillin, clindamycin, metronidazole |
| Anaerobic cocci and nonspore-forming gram-positive bacilli, Clostridium perfringens | Penicillin, clindamycin, metronidazole |
| Clostridium species other than Clostridium perfringens | Penicillin, clindamycin, metronidazole, ertapenem, piperacillin/tazobactam |
| Propionibacterium species | Penicillin, moxifloxacin, minocycline |
| Actinomyces species | Penicillin, clindamycin |
Additionally, the following antimicrobials may be individually requested or added to the above panels:
-Amoxicillin/clavulanic acid, ceftriaxone, meropenem, ciprofloxacin, and vancomycin
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
Minimum inhibitory concentration (MIC) results are reported in mcg/mL with an interpretation of S-susceptible, R-resistant, or I-intermediate. Vancomycin, ciprofloxacin, and minocycline are reported as MIC values only (without interpretation).
Interpretation Provides information to assist in interpretation of the test results
Minimal inhibitory concentration (MIC) and interpretive category (susceptible, intermediate, or resistant) results are reported. Note that vancomycin, ciprofloxacin, and minocycline will have no interpretation attached to the MIC.
Resistant results indicate an organism is resistant to the antimicrobial tested and that the agent should not be used for treatment.
Intermediate results indicate that treatment with high doses might well be successful.
Susceptible results indicate that therapy with usual doses is appropriate.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Susceptibility test results are only one of many factors that influence the outcome of antimicrobial therapy of infections.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
Rosenblatt JE, Brook I: Clinical relevance of susceptibility testing of anaerobic bacteria. Clin Infect Dis 1993;16(Suppl 4):S446-S448
Method Description Describes how the test is performed and provides a method-specific reference
The E test is performed on agar plates that have been inoculated. The appropriate antimicrobials (1 agent per strip) are placed on the agar surface and the antimicrobial diffuses into the agar establishing a concentration gradient. After 48 hours of anaerobic incubation, the minimum inhibitory concentration value is read from the strip at the point where the zone of inhibition of bacterial growth intersects with the strip.(Citron DM, Ostovari MI, Karlsson A, Goldstein EJ: Evaluation of the E test for susceptibility testing of anaerobic bacteria. J Clin Microbiol 1991;29:2197-2203)
Day(s) and Time(s) Test Performed Outlines the days and times the test is performed. This field reflects the day and time the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time required before the test is performed. Some tests are listed as continuously performed, which means assays are performed several times during the day.
Monday through Sunday; Varies
Analytic Time Defines the amount of time it takes the laboratory to setup and perform the test. This is defined in number of days. The shortest interval of time expressed is "same day/1 day," which means the results may be available the same day that the sample is received in the testing laboratory. One day means results are available 1 day after the sample is received in the laboratory.
Maximum Laboratory Time Defines the maximum time from specimen receipt at Mayo Medical Laboratories until the release of the test result
Specimen Retention Time Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location The location of the laboratory that performs the test
Test Classification Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer's instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR), Investigation Use Only (IUO) product, or a Research Use Only (RUO) product.
CPT Code Information Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Medical Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
Antimicrobial Susceptibility, Anaerobic Bacteria, MIC
87181 x 3
Anaerobe Suscep per Agent
87181 (if appropriate)
Beta Lactamase
87185 (if appropriate)
LOINC® Code Information Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the result codes returned for this test or profile.
| Result ID | Reporting Name | LOINC Code |
|---|---|---|
| MMLSA | Susceptibility, Anaerobic, MIC | In Process |
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