Test Overview
Test Methodology

BD Bactec FX Blood Culture System; Verigene® Gram-Positive Blood Culture Nucleic Acid Test (BC-GP); Verigene® Gram-Negative Blood Culture Nucleic Acid Test (BC-GN)

Test Usage

Isolate and identify bacteria or yeast causing bacteremia or fungemia.

Reference Range *

No growth

* Reference ranges may change over time. Please refer to the original patient report when evaluating results.

Test Limitations

Limitations of Verigene Test performance:
• The assay does not differentiate Staphylococcus spp. other than Staphylococcus aureus, Staphylococcus epidermidis and Staphylococcus lugdunensis.
• The assay does not differentiate Streptococcus spp. other than Streptococcus agalactiae, Streptococcus anginosus group, Streptococcus pneumoniae and Streptococcus pyogenes.
• Verigene will not distinguish Escherichia coli from Shigella spp.
• Verigene can only detect OXA types belonging to groups 23, 40, 48 and 58.
• Certain strains of Streptococcus that are genetically homologous to S. pneumoniae, but currently classified as S. mitis, will cross-react with Streptococcus pneumoniae probes. Therefore, S. pneumomoniae will be reported as S. pneumoniae/mitis
• K. variicola is not detected by Verigene, and is difficult to distinguish from K. pneumoniae by conventional culture. Isolates suggestive of K. variicola will be reported as Klebsiella spp. at the time of conventional culture.

The following additional cross reactivities may occur:
• Lactococcus spp. strains could cause a false positive “Streptococcus” detected result.
• Aerococcus spp. strains could cause a false positive “Staphylococcus” detected result.
• On rare occasions, both a “K. oxytoca Detected” result and a “K. pneumoniae Detected” result may be obtained when Klebsiella pneumoniae is present in the specimen.
• C. amalonaticus may yield false negative results
• Kluyvera ascorbata, Raoultella ornithinolytica, Raoultella planticola, and Cedecea davisae cross-react with Verigene Klebsiella oxytoca probes, which will cause a false positive “K. oxytoca Detected” result.
• Leminorella grimontii, Enterococcus raffinosus and Candida parapsilosis cross-react with Verigene CTX-M probes, which will cause a false positive “CTX-M Detected” result.
Cord blood is a source that has not been validated (SNV).

Test Details
Days Set Up
Daily, 24 hrs
Analytic Time

Preliminary results are reported in 24 hours. Negative cultures are reported in 5 days. The health care provider will be notified of initial positive cultures and gram stain results. Verigene Blood Culture Nucleic Acid Tests will be run on the first positive set of bottles in an episode of bacteremia. Results will typically be available 3-6 hours after the time of gram stain notification.

Soft Order Code
BLD/BLDAE/BLDAN/BLDOT/ BLDC
Synonyms
  • BLD
  • BLDAE
  • BLDAN
  • ADULT BLOOD CULTURE
  • BLOOD CULTURE (AER)
  • BLOOD CULTURE (ANA)
  • Anaerobe Culture, Blood
  • Blood Culture, Brucella
  • Blood Culture, Candida
  • Blood Culture, Yeast
  • Brucella Blood Culture
  • Candida Blood Culture
  • Culture, Blood, Bacteria
  • Culture, Blood-Bacteria & Yeast
  • SBE, Blood Culture
  • Yeast Blood Culture
  • Anaerobe Culture, Blood
  • Blood Culture, Brucella
  • Blood Culture, Candida
  • Blood Culture, Yeast
  • Brucella Blood Culture
  • Candida Blood Culture
  • Culture, Blood, Bacteria
  • Culture, Blood-Bacteria & Yeast
  • SBE, Blood Culture
  • Yeast Blood Culture
  • Anaerobe Culture, Blood
  • Blood Culture, Brucella
  • Blood Culture, Candida
  • Blood Culture, Yeast
  • Brucella Blood Culture
  • Candida Blood Culture
  • Culture, Blood, Bacteria
  • Culture, Blood-Bacteria & Yeast
  • SBE, Blood Culture
  • Yeast Blood Culture
  • Anaerobe Culture, Blood
  • Blood Culture, Brucella
  • Blood Culture, Candida
  • Blood Culture, Yeast
  • Brucella Blood Culture
  • Candida Blood Culture
  • Culture, Blood, Bacteria
  • Culture, Blood-Bacteria & Yeast
  • SBE, Blood Culture
  • Yeast Blood Culture
  • BLDOTH
  • ADULT BLOOD CULTURE
  • BLOOD CULTURE
  • BLOOD CULTURE
  • BLOOD CULTURE
  • Verigene Gram-Positive Blood Culture Nucleic Acid Test (BC-GP)
  • Verigene Gram-Negative Blood Culture Nucleic Acid Test (BC-GN)
Laboratory
Microbiology
Section
Microbiology
Specimen Requirements
Collection

Two blood culture sets (if BLDAE ordered, only the aerobic bottle is needed) from different anatomic sites should be submitted to detect suspected bacteremia or fungemia. Draw blood before initiating antibiotic therapy if possible. Invert BD BACTEC bottles after each collection. For optimum recovery, send immediately to Microbiology or store BD BACTEC bottles at room temperature and send within 18-24 hours. Do not refrigerate. A maximum of 3 blood culture sets will be accepted within a 24-hour period. If an unacceptable specimen is received, the client will be notified before disposal of the original specimen.

Remove outer cap and cleanse bottle tops with alcohol. Clean venipuncture site with soap and water if soiled. Wipe with 70% alcohol and allow to dry. Place swab containing an iodoform solution on the venipuncture site and scrub vigorously for 30 seconds. Allow iodoform solution to remain intact on the skin for 30 seconds before performing the venipuncture. Do not palpate venipuncture site after preparation. If the patient is sensitive to iodine, alcohol alone may be used. Draw Aerobic (blue top) first then draw Anaerobic (purple top). Draw 8-10 mL of blood (minimum 1-3 mL) into each bottle using a butterfly needle. Do not overfill. Label each bottle individually with patient's name, registration number, and anatomic site of blood draw. Place label vertically on the bottle, do not put label on bottom of bottles or across two bottles since this interferes with loading bottles on the instrument. See https://www.pathology.med.umich.edu/static/apps/handbook/Tables/Blood%2… for specimen collection tip sheet.

Additional Instructions:
• Fever of undetermined origin: obtain 2 separate blood cultures initially and 2 more 24-36 hours later, collected 1 hour before the expected temperature elevation.
• Acute endocarditis: obtain 3 separate blood cultures during the first 1-2 hours of evaluation and begin therapy.
• Subacute endocarditis: obtain 3 blood cultures on day 1. If all are negative 24 hours later, obtain 3 more.
• Filamentous fungus (e.g., Histoplasma or Aspergillus sp.) suspected: send isolator tube for fungus blood culture (Fungus Culture, Blood).
• Mycobacterium sp. suspected: send an isolator tube for an AFB blood culture (AFB Culture, Blood).

Normal Volume
Adult 8-10 mL per bottle.
Pediatric: (aerobic only) 1-3 mL in accordance with physician recommendation for each patient.
DO NOT OVERFILL.
Minimum Volume
0.5 mL per bottle
Storage Temperature
Ambient: Yes
Incubation: No
Refrigerate: No
Freeze: No
Additional Information

Recommended minimum culture volumes are based on estimated blood volume for the patient’s weight.

The current recommendation to split volume evenly between aerobic and anaerobic culture bottles is based on best available evidence in order to maximize culture yield and minimize contaminants.

For patients >40 kg, it is recommended to obtain 2 culture sets (1 set = 1 aerobic bottle + 1 anaerobic bottle) on the first draw only. Culture sets should be obtained from 2 different sites (two peripheral or one peripheral and one central).

Follow-up blood cultures should be obtained using the same algorithm. One set is acceptable for all patient weights, unless specifically requested (e.g. checking multiple catheter lumens for clearance).

Routine blood culture is used to detect aerobic and anaerobic bacteria and yeast. The BD Blood Culture System monitors blood cultures continuously for the presence of microorganisms. When microorganisms are present they metabolize nutrients in the culture medium, releasing CO2. The bottle contains a dye in the sensor located in the bottom of the bottle which reacts with the CO2. This reaction modulates the amount of light absorbed by the fluorescent material in the sensor. A photo detector measures the level of fluorescence, which corresponds to the amount of CO2 release by the organisms and this measurement is interpreted by the system with programmed positivity parameters for carbon dioxide production by microorganisms. Positive signaling bottles are gram stained to verify positive status. The first positive set of bottles will be tested using the Verigene Blood Culture Nucleic Acid test at an additional charge. These are interim results that may be updated based on conventional culture. Verigene may not identify all the detectable organisms in the specimen, depending upon the concentration of each target present. In addition, conventional culture may be required to assign a resistance determinant to a specific pathogen. There is a risk of false negative results due to sequence variants in the bacterial targets of the assay. Conventional culture will be performed on all positive bottles at an additional charge. Test includes susceptibility testing of potentially pathogenic organism(s) at an additional charge unless specifically declined. By ordering this test the clinician acknowledges that additional reflex testing will be performed and billed at a separate additional charge if indicated.

Verigene tests for the following organisms and Resistance markers:
Gram Positive organisms: Staphylococcus species, Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus lugdunensis, Streptococcus species, Streptococcus anginosus, Streptococcus pneumoniae, Streptococcus pyogenes, Streptococcus agalactiae, Enterococcus faecalis, Enterococcus faecium, Listeria species, mecA (methicillin), vanA (vancomycin) and vanB (vancomycin) resistance determinants.
Gram Negative organisms: Acinetobacter species, Citrobacter species, Enterobacter species, Proteus species, Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca, Pseudomonas aeruginosa, CTX-M (ESBL), IMP (carbapenemase), KPC (carbapenemase), NDM (carbapenemase), OXA (carbapenemase), VIM (carbapenemase) resistance determinants.

Billing
CPT Code
87040
Fee Code
32206 BLD, 32207 BLDOT, BLDAN, BLDAE
Reflex CPT
87149
Reflex Fee Code
32373
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