Test Catalog

Test Id : ANAES

Bacterial Culture, Anaerobic with Antimicrobial Susceptibilities, Varies

Useful For
Suggests clinical disorders or settings where the test may be helpful

Diagnosing anaerobic bacterial infections

 

Directing antimicrobial therapy for anaerobic infections

Reflex Tests
Lists tests that may or may not be performed, at an additional charge, depending on the result and interpretation of the initial tests.

Test Id Reporting Name Available Separately Always Performed
ANAID Anaerobe Ident No, Bill Only No
RMALA Id MALDI-TOF Mass Spec Anaerobe No, Bill Only No
ISAN Anaerobe Ident by Sequencing No, Bill Only No
PCRID Identification by PCR No, Bill Only No
TISSR Tissue Processing No, Bill Only No
BLA Beta Lactamase No, Bill Only No
BATTA Anaerobe Suscep Battery No, Bill Only No
SANA Anaerobe Suscep per agent No, Bill Only No

Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

When this test is ordered the reflex tests may be performed at an additional charge. All bacterial organisms submitted will automatically have susceptibility testing performed and billed as appropriate. Antimicrobial agents appropriate to the organism and specimen source will be tested according to Mayo Clinic's practice and the laboratory’s standard operating procedures.

 

See Anaerobic Bacteria Antimicrobials for a listing of the antimicrobials routinely tested in our laboratory as well as antimicrobials that may be tested upon request. Call 800-533-1710 and ask to speak to the Bacteriology Anaerobe Laboratory if the organism or antimicrobial of interest is not listed in this table.

Special Instructions
Library of PDFs including pertinent information and forms related to the test

Method Name
A short description of the method used to perform the test

Conventional Culture Technique with Minimal Inhibitory Concentration (MIC) by Agar Dilution (if appropriate)

NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.

Yes

Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test

Bacterial Culture, Anaerobic + Susc

Aliases
Lists additional common names for a test, as an aid in searching

Actinobaculum

Actinomyces

Amoxicillin-clavulanate

Ampicillin-sulbactam

Anaerococcus

Bacterial Susceptibility Testing (1 test)

Bacteroides

Bifidobacterium

Campylobacter

Cefotaxime

Ceftriaxone

Ciprofloxacin

Clindamycin

Clostridioides

Clostridium

Cutibacterium

Eggerthella

Ertapenem

Finegoldia

Fusobacterium

Helcococcus

Imipenem

Lactobacillus

Meropenem

Metronidazole

MIC Test, Anaerobic Bacteria

Minimal Inhibitory Concentration (MIC)

Minimum Inhibitory Concentration (MIC)

Minocycline

Moxifloxacin

Penicillin

Peptoniphilus

Piperacillin-tazobactam

Porphyromonas

Prevotella

Propionibacterium

Staphylococcus saccharolyticus

Susceptibility Testing

Vancomycin

Veillonella

Antibiotic Susceptibility

Rifampin

Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

When this test is ordered the reflex tests may be performed at an additional charge. All bacterial organisms submitted will automatically have susceptibility testing performed and billed as appropriate. Antimicrobial agents appropriate to the organism and specimen source will be tested according to Mayo Clinic's practice and the laboratory’s standard operating procedures.

 

See Anaerobic Bacteria Antimicrobials for a listing of the antimicrobials routinely tested in our laboratory as well as antimicrobials that may be tested upon request. Call 800-533-1710 and ask to speak to the Bacteriology Anaerobe Laboratory if the organism or antimicrobial of interest is not listed in this table.

Specimen Type
Describes the specimen type validated for testing

Varies

Shipping Instructions

Specimen should arrive within 72 hours of collection.

 

See Infectious Specimen Shipping Guidelines in Special Instructions for shipping information.

Necessary Information

Specimen source is required.

Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing

Supplies: Anaerobic Transport Tube (T588)

Acceptable Sources: Deep tissues, sterile body fluids, abscesses, percutaneous transtracheal aspirates, suprapubic aspirations, or wounds

Collection Instructions: Specimen should be obtained by using a needle and syringe from a source not normally colonized by anaerobes.

Special Instructions
Library of PDFs including pertinent information and forms related to the test

Forms

If not ordering electronically, complete, print, and send a Microbiology Test Request (T244) with the specimen.

Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected

Swab Reject

Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included

Specimen Type Temperature Time Special Container
Varies Ambient (preferred) 72 hours

Useful For
Suggests clinical disorders or settings where the test may be helpful

Diagnosing anaerobic bacterial infections

 

Directing antimicrobial therapy for anaerobic infections

Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

When this test is ordered the reflex tests may be performed at an additional charge. All bacterial organisms submitted will automatically have susceptibility testing performed and billed as appropriate. Antimicrobial agents appropriate to the organism and specimen source will be tested according to Mayo Clinic's practice and the laboratory’s standard operating procedures.

 

See Anaerobic Bacteria Antimicrobials for a listing of the antimicrobials routinely tested in our laboratory as well as antimicrobials that may be tested upon request. Call 800-533-1710 and ask to speak to the Bacteriology Anaerobe Laboratory if the organism or antimicrobial of interest is not listed in this table.

Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Anaerobic bacteria are the greatest component of the human body's normal bacterial flora. Anaerobes colonize the skin, oral cavity, and genitourinary and lower gastrointestinal tracts, and generally do not cause infection. Their presence is important for vitamin and other nutrient absorption and in preventing infection with pathogenic bacteria.

 

When usual skin and mucosal barriers are compromised, in an anaerobic environment, these bacteria can behave as pathogens. Typical anaerobic infections include periodontitis, abdominal or pelvic abscesses, endometritis, pelvic inflammatory disease, aspiration pneumonia, empyema and lung abscesses, sinusitis, brain abscesses, gas gangrene, and other soft tissue infections.

 

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. Susceptibility testing results are useful to clinicians because anaerobic bacteria are a significant cause of human infection, and they are often resistant to commonly used antimicrobials. Bacteroides and Parabacteroides species produce beta-lactamases. Ertapenem, metronidazole, and clindamycin are generally effective agents although resistance to clindamycin, and occasionally ertapenem, is increasing.

 

The minimal inhibitory concentration (MIC) obtained during antimicrobial susceptibility testing is helpful in indicating the concentration of antimicrobial agent required at the site of infection necessary to inhibit the infecting organism. For each organism-antimicrobial agent combination, the Clinical and Laboratory Standards Institute and/or the European Committee on Antimicrobial Susceptibility Testing provides interpretive criteria for determining whether the MIC should be interpreted as susceptible, susceptible dose dependent, intermediate, nonsusceptible, resistant, or epidemiological cutoff value.

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.

No growth

 

Identification of probable pathogens

 

Susceptibility results are reported as minimal inhibitory concentration (MIC) in mcg/mL. Breakpoints (also known as "clinical breakpoints") are used to categorize an organism as susceptible, susceptible-dose dependent, intermediate, resistant or nonsusceptible according to breakpoint setting organizations, either the Clinical and Laboratory Standards Institute (CLSI) or the European Committee on Antimicrobial Susceptibility Testing (EUCAST), as applicable.

 

In some instances, an interpretive category cannot be provided based on available data and the following comment will be included: "There are no established interpretive guidelines for agents reported without interpretations."

 

Clinical and Laboratory Standards Institute (CLSI) Interpretive Category Definitions:

Susceptible:

A category defined by a breakpoint that implies that isolates with an MIC at or below or a zone diameter at or above the susceptible breakpoint are inhibited by the usually achievable concentrations of antimicrobial agent when the dosage recommended to treat the site of infection is used, resulting in likely clinical efficacy.

 

Susceptible-Dose Dependent:

A category defined by a breakpoint that implies that susceptibility of an isolate depends on the dosing regimen that is used in the patient. To achieve levels that are likely to be clinically effective against isolates for which the susceptibility testing results (either MICs or zone diameters) are in the susceptible-dose dependent (SDD) category, it is necessary to use a dosing regimen (ie, higher doses, more frequent doses, or both) that results in higher drug exposure than that achieved with the dose that was used to establish the susceptible breakpoint. Consideration should be given to the maximum literature-supported dosage regimens, because higher exposure gives the highest probability of adequate coverage of a SDD isolate. The drug label should be consulted for recommended doses and adjustment for organ function.

 

Intermediate:

A category defined by a breakpoint that includes isolates with MICs or zone diameters within the intermediate range that approach usually attainable blood and tissue levels and/or for which response rates may be lower than for susceptible isolates.

Note: The intermediate category implies clinical efficacy in body sites where the drugs are physiologically concentrated or when a higher than normal dosage of a drug can be used. This category also includes a buffer zone, which should prevent small, uncontrolled, technical factors from causing major discrepancies in interpretations, especially for drugs with narrow pharmacotoxicity margins.

 

Resistant:

A category defined by a breakpoint that implies that isolates with an MIC at or above or a zone diameter at or below the resistant breakpoint are not inhibited by the usually achievable concentrations of the agent with normal dosage schedules and/or that demonstrate MICs or zone diameters that fall in the range in which specific microbial resistance mechanisms are likely, and clinical efficacy of the agent against the isolate has not been reliably shown in treatment studies.

 

Nonsusceptible:

A category used for isolates for which only a susceptible breakpoint is designated because of the absence or rare occurrence of resistant strains. Isolates for which the antimicrobial agent MICs are above or the zone diameters are below the value indicated for the susceptible breakpoint should be reported as nonsusceptible.

Note: An isolate that is interpreted as nonsusceptible does not necessarily mean that the isolate has a resistance mechanism. It is possible that isolates with MICs above the susceptible breakpoint that lack resistance mechanisms may be encountered within the wild-type distribution after the time the susceptible-only breakpoint was set.

 

Epidemiological Cutoff Value:

The MIC that separates microbial populations into those with and without phenotypically detectable resistance (non-wild-type or wild-type, respectively). The epidemiological cutoff value (ECV) defines the highest MIC for the wild type population of isolates. ECVs are based on in vitro data only, using MIC distributions. ECVs are not clinical breakpoints, and the clinical relevance of ECVs for a particular patient has not yet been identified or approved by CLSI or any regulatory agency.

 

When an ECV is reported, an interpretive category is not assigned, and the following comment will be included: "This MIC is consistent with the Epidemiological Cutoff Value (ECV) observed in isolates (WITH/WITHOUT) acquired resistance; however, correlation with treatment outcome is unknown."

 

Wild-type (WT): An interpretive category defined by an ECV that describes the microbial population with no phenotypically detectable mechanisms of resistance or reduced susceptibility for an antimicrobial agent being evaluated.

 

Non-wild-type (NWT): An interpretive category defined by an ECV that describes the microbial population with phenotypically detectable mechanisms of resistance or reduced susceptibility for the antimicrobial agent being evaluated.

Note: MIC values for which ECV’s are defined are not to be interpreted or reported as susceptible, intermediate or resistant but rather as WT or NWT. The ECV’s should not be used as clinical breakpoints.(Clinical and Laboratory Standards Institute [CLSI]. Performance Standards for Antimicrobial Susceptibility Testing. 31st ed. CLSI supplement M100. CLSI; 2021:4-6, 268-269)

 

European Committee on Antimicrobial Susceptibility Testing (EUCAST) Interpretive Category Definitions:

S - Susceptible, standard dosing regimen: A microorganism is categorized as "Susceptible, standard dosing regimen", when there is a high likelihood of therapeutic success using a standard dosing regimen of the agent.

 

I - Susceptible, increased exposure*: A microorganism is categorized as "Susceptible, Increased exposure*" when there is a high likelihood of therapeutic success because exposure to the agent is increased by adjusting the dosing regimen or by its concentration at the site of infection.

 

R - Resistant: A microorganism is categorized as "Resistant" when there is a high likelihood of therapeutic failure even when there is increased exposure*.

 

*Exposure is a function of how the mode of administration, dose, dosing interval, infusion time, as well as distribution and excretion of the antimicrobial agent will influence the infecting organism at the site of infection.(The European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters. v11.0, 2021. Available at www.eucast.org)

Interpretation
Provides information to assist in interpretation of the test results

Isolation of anaerobes in significant numbers from specimens collected under sterile conditions including blood, other normally sterile body fluids, or closed collections of purulent fluid indicates infection with those organisms.

 

A susceptible category result and a low minimum inhibitory concentration value indicate in vitro susceptibility of the organism to the antimicrobial tested.

 

For interpretation of various antimicrobial susceptibility interpretive categories (ie, susceptible, intermediate, resistant, or epidemiological cutoff value), see Reference Values.

Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

Specimens may be collected by needle and syringe aspiration or surgical drainage to avoid contamination with normal-flora anaerobes; such contamination would make interpretation of culture results impossible.

 

Specimens must be transported in anaerobic transport vials.

 

When antimicrobial susceptibilities are performed, in vitro susceptibility does not guarantee clinical response. Therefore, the decision to treat with a particular agent should not be based solely on the antimicrobial susceptibility testing result.

Clinical Reference
Recommendations for in-depth reading of a clinical nature

1. Rosenblatt JE, Brook I: Clinical relevance of susceptibility testing of anaerobic bacteria. Clin Infect Dis. 1993 Jun;16(Suppl 4):S446-S448

2. Summanen P, Baron EJ, Citron DM, et al: Wadsworth Anaerobic Bacteriology Manual. 6th ed. Star Publishing Co; 2002

3. Schuetz AN, Carpenter DE: Susceptibility test methods: anaerobic bacteria. In: Carroll KC, Pfaller MA, eds. Manual of Clinical Microbiology. 12th ed. ASM Press; 2019:1377-1397

4. Hall GS: Anaerobic Bacteriology. In: Leber AL, ed. Clinical Microbiology Procedures Handbook. Vol 1. 4th ed. ASM Press; 2016:section 4

5. Jenkins SG, Schuetz AN: Current concepts in laboratory testing to guide antimicrobial therapy. Mayo Clin Proc. 2012 Mar;87(3):290-308

Special Instructions
Library of PDFs including pertinent information and forms related to the test

Method Description
Describes how the test is performed and provides a method-specific reference

Appropriate specimens are inoculated onto blood agar, phenylethyl alcohol agar, and lysed blood agar containing gentamicin and vancomycin and into thioglycollate broth tubes. After 48 hours of incubation at 35 degrees C in an anaerobic atmosphere, colonies are identified using 1 or a combination of the following techniques: Gram stain, use of various differential media, aerotolerance testing, conventional biochemical tests, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, real-time polymerase chain reaction, or 16S ribosomal RNA gene sequencing.(Procop GW, Church DL, Hall GS, et al: The anaerobic bacteria. In: Koneman's Color Atlas and Textbook of Diagnostic Microbiology. 7th ed. Wolters; 2017:983-1073)

 

An agar dilution method is used for routine susceptibility testing. The antimicrobial is added to agar in various concentrations depending upon levels attainable in serum. A standardized suspension of the organism is applied to the agar plates, which are incubated anaerobically for 42 to 48 hours at 35 to 37 degrees C. The end point is that in which a marked reduction occurs in the appearance of growth on the test plate as compared to that of growth on the control plate. Examples of marked change include a change from confluent growth to a haze, less than 10 tiny colonies, or 1 to 3 normal-sized colonies.(Clinical and Laboratory Standards Institute [CLSI]. Methods for Antimicrobial Susceptibility Testing of Anaerobic Bacteria. 9th ed. CLSI standard M11. CLSI; 2018)

PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information

No

Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.

Monday through Sunday

Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.

14 to 20 days

Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded

7 days

Performing Laboratory Location
Indicates the location of the laboratory that performs the test

Rochester

Fees
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.

  • Authorized users can sign in to Test Prices for detailed fee information.
  • Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
  • Prospective clients should contact their Regional Manager. For assistance, contact Customer Service.

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 instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.

This test has been cleared, approved, or is exempt by the US Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.

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 Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.

CPT codes are provided by the performing laboratory.

87075-Bacterial Culture, Anaerobic

87076-Anaerobe Ident (if appropriate)

87076-Id MALDI-TOF Mass Spec Anaerobe (if appropriate)

87153-Anaerobe Ident by Sequencing (if appropriate)

87150-Identification by PCR (if appropriate)

87176-Tissue Processing (if appropriate)

87185-Beta Lactamase (if appropriate)

87186-Antimicrobial Susceptibility, Anaerobic Bacteria, MIC (if appropriate)

87181-Anaerobe Susceptibility per agent (if appropriate)

Test Setup Resources

Setup Files
Test setup information contains test file definition details to support order and result interfacing between Mayo Clinic Laboratories and your Laboratory Information System.

Excel | Pdf

Sample Reports
Normal and Abnormal sample reports are provided as references for report appearance.

Normal Reports | Abnormal Reports

SI Sample Reports
International System (SI) of Unit reports are provided for a limited number of tests. These reports are intended for international account use and are only available through MayoLINK accounts that have been defined to receive them.

SI Normal Reports | SI Abnormal Reports