Must include patient name, MRN, date/time of collection and collector's initials.
ACCEPTABLE SPECIMEN: Spinal fluid collected by lumbar puncture, ventricular or suboccipital tap, or through shunt.
Collect specimen as follows: Spinal Fluid 1. Decontaminate skin with povidone iodine. 2. Perform sterile lumbar puncture; ventricular or suboccipital tap. 3. Send 1 - 5 mL of spinal fluid in a screw-capped, sterile collection tube. 4. DO NOT REFRIGERATE.
Shunt Fluid 1. Decontaminate skin and catheter with povidone iodine. 2. Aseptically aspirate fluid through shunt. 3. Send 1 - 5 mL of shunt fluid in a screw-capped, sterile collection tube. 4. DO NOT REFRIGERATE.
Notes: 1. Indicate if patient has shunt and label specimen appropriately (spinal fluid or shunt fluid).
2. False-negative results may occur when: a) insufficient volume of CSF is sent for culture; b) specimen is delayed in transit; c) specimen is collected post antimicrobial therapy.
3. False-positive cultures may occur with skin flora when sterile technique is not strictly followed.
4. BLOOD SHOULD ALSO BE CULTURED FROM PATIENTS SUSPECTED OF HAVING MENINGITIS. COLLECT TWO VENIPUNCTURES AT SEPARATE SITES, A MINIMUM OF 20-30 mL FOR ADULTS.
DO NOT REFRIGERATE. DELIVER IMMMEDIATELY TO MICROBIOLOGY IN A TIGHTLY SEALED CONTAINER WITH NO EXTERNAL SPILLAGE.
Causes for Rejection
1. Specimen not labeled with patient's name, MRN, date and time of collection, and collector's initials. 2. Specimen container leaking. 3. Specimen delayed in transit. 4. Insufficient volume of CSF for ordered tests.
Turn Around Time -Routine:
Gram stain: 2-4 hours, Culture: 2-3 days, Shunt fluid Culture: 7 days
Gram stain: 1 hour
CPT Codes - 87070, 87205
Gram stain: No organisms seen, No/Rare WHITE BLOOD CELLS. Culture: No growth. First positive Gram stain or positive culture results are reported immediately via phone call and reported via HIS. Negative preliminary results in 1 day via HIS. Negative final report in 2-3 days via HIS. Negative final report in 7 days on shunt fluid via HIS .
Gram Stain and Aerobic Culture on solid media. Culture of shunt fluid includes anaerobic culture. Includes identification and susceptibility testing when appropriate at additional charges. CPT coding cannot be determined before culture is completed.
Clinical Significance and Interpretive Data
CSF is a normally sterile body fluid in which any organism is capable of causing disease. Bacterial agents capable of initiating central nervous system (CNS) infections, vary with age, and underlying disease. Neonatal CNS disease is caused primarily by agents that are a part of the maternal genital tract flora at the time of birth. Most common agents of neonatal infection are Escherichia coli, group B streptococci (Streptococcus agalactiae), and Listeria monocytogenes. Other Enterobacteriaceae and enterococci also may be encountered occasionally in neonatal infections.
Infants and children under the age of 4 years typically experience disease caused by Haemophilus influenzae type b and, less frequently, disease caused by Neisseria meningitidis and Streptococcus pneumoniae. Older children and adults most commonly experience disease caused by the latter two agents.
Immunodeficient or immunosuppressed patients or those with anatomic defects encounter somewhat different agents.
Listeria monocytogenes is a frequent agent of disease in patients with lymphoma or patients receiving steroid therapy. Severely leukopenic patients may develop disease caused by a variety of organisms that include Nocardia sp. and Pseudomonas aeruginosa.
Diphtheroids, Propionibacterium and S. epidermidis and other established saprophytes can be pathogens in patients with CNS shunts.
Notes: 1. False-negative results may occur when: a) insufficient volume of CSF is sent for culture; b) specimen is delayed in transit; and c) specimen is collected post antimicrobial therapy.
2. False-positive cultures may occur with skin flora when sterile technique is not strictly followed.
Used to culture and identify bacterial agents of meningitis.