Test Overview
Test Methodology

BD Bactec FX Blood Culture System; FilmArray Blood Culture Identification PCR Panel (BCID2)

Test Usage

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. Positive signaling bottles are gram stained to verify positive status. The first positive set of bottles will be tested using the BioFire® Blood Culture Identification 2 (BCID2) Panel at an additional charge. BCID2 may not identify all the detectable organisms in the specimen, depending upon the concentration of each target present. Conventional culture will be performed on all positive bottles at an additional charge. In addition, conventional culture may be required to assign a resistance determinant to a specific pathogen. Test includes susceptibility testing of potentially pathogenic organism(s) at an additional charge. By ordering this test the clinician acknowledges that all aforementioned reflex testing may be performed and billed at a separate additional charge if indicated.

BCID2 tests for the following organisms and resistance markers:
Gram positive organisms and resistance determinants : Enterococcus faecalis, Enterococcus faecium, Listeria monocytogenes, Staphylococcus spp., Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus lugdunensis, Streptococcus spp., Streptococcus agalactiae, Streptococcus pneumoniae, Streptococcus pyogenes, Methicillin Resistance (mecA/C and MREJ), and Vancomycin Resistance (vanA/B).
Gram negative organisms and resistance determinants: Acinetobacter calcoaceticus-baumannii complex, Bacteroides fragilis, Enterobacterales Order, Enterobacter cloacae complex, Escherichia coli, Klebsiella aerogenes, Klebsiella oxytoca, Klebsiella pneumoniae group, Proteus spp., Salmonella spp., Serratia marcescens, Haemophilus influenzae, Neisseria meningitidis, Pseudomonas aeruginosa, Stenotrophomonas maltophilia, ESBL (CTX-M), and Carbapenemase producers (IMP, KPC, OXA-48-like, NDM, VIM).

Reference Range *

No growth

Test Limitations

Optimum recovery of organisms will be achieved by adding up to a 10 mL maximum amount of blood. Published clinical studies have shown that the use of lower blood volumes may adversely affect recovery and/or detection times of organisms. False positivity may occur when the white blood cell count is high. Care must be taken to prevent contamination of the sample during collection and inoculation into the BD BACTEC vial. A contaminated sample will give a positive reading but will not indicate a relevant bacteremic organism. A determination of bacteremia must be made by the clinician based on such factors as type of organism recovered, occurrence of the same organism in multiple cultures, patient history, etc.

Limitations of BCID2 performance:
Blood culture media may contain non-viable organisms and/or nucleic acid at levels that can be detected by the BioFire BCID2 Panel leading to false positive test results. Typically, these false positives may present with more than one positive result because the BioFire BCID2 Panel may also detect the organism that is growing in the culture bottle. In the event of a BCID2 detection of any organism that is not reflected by Gram stain of the bottle, the following comment will be appended to the result:
“BCID2 has detected an organism not seen in the Gram stain of the bottle. This may be due to detection of an organism below the limit of sensitivity of the Gram stain but may also be due to the presence of non-viable organisms and/or nucleic acids in blood culture media.”
The Enterobacterales target is designed to react with species within the following families: Enterobacteriaceae, Erwiniaceae, Hafniaceae, Morganellaceae, Yersiniaceae, Pectobacteriaceae, and Budviciaceae including over 250 species of gram-negative, facultatively anaerobic rods and coccobacilli.
The E. coli assay cross-reacts with Shigella species (S. boydii, S. dysenteriae, S. flexneri, and S. sonnei); which are practically indistinguishable from E. coli by both phenotypic and genetic analyses but are only very rarely isolated from blood culture
The Klebsiella pneumoniae group includes three phylogroups classified as distinct species; K. pneumoniae, K. quasipneumoniae, and K. variicola. All three species have many of the same virulence factors and share biochemical and genetic similarities, which makes it difficult to distinguish K. quasipneumoniae and K. variicola from K. pneumoniae clinically or by standard culture methods. Species level identification will be reported upon culture and MALDI-ToF.
A negative BioFire BCID2 Panel result does not exclude the possibility of bloodstream infection.
In mixed cultures, the BioFire BCID2 Panel may not identify all targeted organisms in the specimen, depending upon the concentration of each target present. In particular, false negative results for Pseudomonas aeruginosa or Stenotrophomonas spp. may occur if another organism is present in the blood culture. Conversely, standard subculture methods may also not identify all organisms in a mixed culture, depending upon the concentration and growth characteristics of each organism present.
False negative test results may occur from sequence variants in the region targeted by the assay, the presence of inhibitors, technical error, sample mix-up, or an infection caused by an organism not detected by the panel.

Test Details
Days Set Up
Daily, 24 hrs
Analytic Time

Preliminary results are reported in 24 hours. Cultures are reported as negative after 5 days of incubation. The health care provider will be notified of initial positive cultures and gram stain results as a critical result. The FilmArray Blood Culture Identification PCR Panel (BCID2) will only be run on the first positive set of bottles in the event multiple sets are positive with the same organism morphology. BCID2 results will typically be available 1-2 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 to three blood culture sets, from different anatomic sites, should be submitted for the culture and recovery of microorganisms (bacteria and yeast) from blood. Draw blood before initiating antibiotic therapy, if possible.
Remove outer cap and cleanse bottle tops with alcohol. Clean venipuncture site with soap and water if soiled. Vigorously scrub (30 sec.) the venipuncture site with Alcohol. Allow to dry completely. 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 mL) into each bottle using a butterfly needle. Mark the bottles (beginning at the growth medium level) calculate up to 10 ml. Do not overfill. Invert BD BACTEC bottles after each collection. 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.

For optimum recovery and best patient care, send bottles immediately to the clinical microbiology lab. If delayed transport is unavoidable, store BD BACTEC bottles at room temperature and send within 18-24 hours. Do not refrigerate or incubate above room temperature. A maximum of three 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.
Additional Instructions:
• Fever of undetermined origin: obtain two separate blood cultures initially and two more 24-36 hours later, collected one hour before the expected temperature elevation.
• Acute endocarditis: obtain three separate blood cultures during the first 1-2 hours of evaluation and begin therapy.
• Subacute endocarditis: obtain three blood cultures on day 1. If all are negative 24 hours later, obtain three more.
• Filamentous fungus (e.g., Histoplasma or Aspergillus sp.) suspected: Collect 10mL into BD Myco AF/Lytic bottle for fungus blood culture (Fungus Culture, Blood).
• Mycobacterium sp. suspected: Collect 10mL into BD Myco AF/Lytic bottle for an AFB blood culture (AFB Culture, Blood).

Collection Instructions

Two to three blood culture sets, from different anatomic sites, should be submitted for the culture and recovery of microorganisms (bacteria and yeast) from blood. Draw blood before initiating antibiotic therapy, if possible.
Remove outer cap and cleanse bottle tops with alcohol. Clean venipuncture site with soap and water if soiled. Vigorously scrub (30 sec.) the venipuncture site with Alcohol. Allow to dry completely. 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 mL) into each bottle using a butterfly needle. Mark the bottles (beginning at the growth medium level) calculate up to 10 ml. Do not overfill. Invert BD BACTEC bottles after each collection. 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.

For optimum recovery and best patient care, send bottles immediately to the clinical microbiology lab. If delayed transport is unavoidable, store BD BACTEC bottles at room temperature and send within 18-24 hours. Do not refrigerate or incubate above room temperature. A maximum of three 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.
Additional Instructions:
• Fever of undetermined origin: obtain two separate blood cultures initially and two more 24-36 hours later, collected one hour before the expected temperature elevation.
• Acute endocarditis: obtain three separate blood cultures during the first 1-2 hours of evaluation and begin therapy.
• Subacute endocarditis: obtain three blood cultures on day 1. If all are negative 24 hours later, obtain three more.
• Filamentous fungus (e.g., Histoplasma or Aspergillus sp.) suspected: Collect 10mL into BD Myco AF/Lytic bottle for fungus blood culture (Fungus Culture, Blood).
• Mycobacterium sp. suspected: Collect 10mL into BD Myco AF/Lytic bottle for an AFB blood culture (AFB Culture, Blood).

Normal Volume
Adult: 8-10 mL per bottle.
Pediatric: 1 – 10 mL in accordance with “Pediatric blood culture volumes by patient weight” chart below
If sample volumes of 1–7 mL are used, culture sensitivity will not be as great as with larger volumes.
Do not overfill.


Pediatric Set:
If <2 kg, send 1mL in a single BD BACTEC Plus Aerobic/F (blue top) bottle.
If >2 kg, split recommended volume between a BD BACTEC Plus Aerobic/F bottle (blue top) and BD BACTEC Lytic/10 Anaerobic/F bottle (purple top)*.

*See chart below for pediatric weight-based guidance
Weight of Patient (kg) Total Culture Volume* (mL) Obtaining 1 culture set Obtaining 2 culture sets**
Aerobic
Bottle (mL) Anaerobic bottle (mL) Aerobic
Bottle #1 (mL) Anaerobic bottle #1 (mL) Aerobic bottle #2 (mL) Anaerobic bottle #2 (mL)
<2 1 1 -- -- -- -- --
2 - 4.9 2 1 1 -- -- -- --
5 - 9.9 4 2 2 1 1 1 1
10 - 14.9 8 4 4 2 2 2 2
15 - 22.9 12 6 6 3 3 3 3
23 - 44.9 20 10 10 5 5 5 5
≥45 40 -- -- 10 10 10 10

* Reference: PolicyStat ID 11190563, Blood Culture Collection In Pediatric Patients https://michmed-clinical.policystat.com/policy/11190563/latest#autoid-j7mnp
**Two sets are always recommended for pediatric patients ≥45 kg. See above policy for detailed guidance for patients <45 kg or patients with central lines.

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

The recommendation to split volume evenly between aerobic and anaerobic culture bottles is based on best available evidence to maximize culture yield and minimize time-to-positivity.
Minimum Volume
1 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