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HelpTest Code ESBLS Extended-Spectrum Beta-Lactamase-Producing Gram-Negative Bacteria Surveillance Culture, Feces
Shipping Instructions
Specimen must arrive within 96 hours of collection.
Specimen Required
Patient Preparation: Do not use barium or bismuth before specimen collection.
Supplies: Culture and Sensitivity Stool Transport Vial (T058)
Specimen Type: Preserved feces
Container/Tube: Cary-Blair or modified Cary-Blair transport system is required.
Commercially available transport system specific for recovery of enteric pathogens from fecal specimens (15 mL of nonnutritive transport medium containing phenol red as a pH indicator. Submit sample in original Cary Blair medium container (not an aliquot of Cary Blair medium).
Specimen Volume: Representative portion of feces; 1 gram or 5 mL
Collection Instructions:
1. Collect fresh fecal specimen and place 1 gram or 5 mL in container with transport medium.
2. Place feces in preservative within 2 hours of collection.
3. Place vial in a sealed plastic bag.
Reflex Tests
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| RMALD | Ident by MALDI-TOF mass spec | No, (Bill Only) | No |
| CHESB | ESBL SUS Test Charge | No, (Bill Only) | No |
Testing Algorithm
When this test is ordered, the reflex tests may be performed at an additional charge. All bacterial isolates tested, to rule in or out as a potential extended-spectrum beta-lactamase (ESBL)-producing pathogen, will be billed for work performed and resources consumed. The following Enterobacterales will be tested for ESBL production: Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca, and Proteus mirabilis.
Method Name
Conventional Culture Technique
Specimen Type
FecalSpecimen Minimum Volume
See Specimen Required
Specimen Stability Information
| Specimen Type | Temperature | Time |
|---|---|---|
| Fecal | Ambient (preferred) | 4 days |
| Refrigerated | 4 days |
Reject Due To
| Products containing formalin SAF fixative PVA fixative EcoFix preservative Endoscopy specimen Processed stool |
Reject |
Clinical Information
In June 2019, the US Food and Drug Administration recommended stool testing of fecal microbiota transplant (FMT) donors to assess for the presence of certain infectious agents.(1) FMT donor feces should be screened for extended-spectrum beta-lactamase (ESBL)-producing organisms. ESBLs are enzymes that confer variable resistance to third- and fourth-generation cephalosporins as well as aztreonam. Because these resistance genes are encoded on plasmids, which are easily transmissible, ESBL-producing organisms raise important infection control issues.
FMT donor feces may be screened on a regularly scheduled basis for ESBL-producers. Screening will be performed via culture of stool samples using vancomycin, amphotericin B, ceftazidime, and clindamycin (VACC) agar. Remel VACC agar is a primary selective medium for the isolation of ESBL-producing Enterobacterales. In addition to multiple substrates necessary for bacterial growth, this medium also contains multiple antimicrobials which inhibit normal intestinal microbiota. Possible ESBL-producers isolated on VACC agar will be confirmed by the Clinical and Laboratory Standards Institute ESBL disk diffusion test.(2)
Reference Values
Negative for extended-spectrum beta-lactamase-producing organisms
Positive for extended-spectrum beta-lactamase-producing organisms
Day(s) Performed
Monday through Sunday
Report Available
4 to 6 daysPerforming Laboratory
Mayo Clinic Laboratories in Rochester
CPT Code Information
87081-ESBL GNB surveillance culture
87077-Ident by MALDI-TOF mass spec (if appropriate)
87184-ESBL SUS test charge (if appropriate)
Forms
If not ordering electronically, complete, print, and send a Microbiology Test Request (T244) with the specimen.