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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.
Useful For
Screening for colonization of extended-spectrum beta-lactamase (ESBL)-producing organisms in stool
Screening fecal microbiota transplant donor feces for ESBL-producing organisms.
This test is not intended for medicolegal use.
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
Reporting Name
ESBL GNB Surveillance Culture, FSpecimen Type
FecalSpecimen Minimum Volume
See Specimen Required
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| 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
Interpretation
Exclusion of feces from use in fecal microbiota transplantation is recommended if extended-spectrum beta-lactamase -producing bacteria are detected. Refer to US Food and Drug Administration guidance for details.(3)
Cautions
Not all extended-spectrum beta-lactamase-producing organisms may be detected by this method.
Method Description
Remel vancomycin, amphotericin B, ceftazidime, and clindamycin (VACC) primary selective media is used to isolate extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales from stool. This media contains antimicrobials which inhibit normal intestinal microbiota. Colonial morphologies consistent with Gram-negative bacilli are screened with oxidase reagent and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) is utilized to identify oxidase negative gram-negative bacilli. ESBL confirmatory disk testing is performed on any isolate identified as Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca, or Proteus mirabilis. Confirmatory disk diffusion testing is performed using cefotaxime and ceftazidime with and without the addition of clavulanic acid. ESBLs show an increased zone of inhibition in the presence of clavulanate.(Clinical and Laboratory Standards Institute [CLSI]. Performance Standards for Antimicrobial Susceptibility Testing. 31st ed. CLSI supplement M100.CLSI; 2021)
Day(s) Performed
Monday through Sunday
Report Available
4 to 6 daysPerforming Laboratory
Mayo Clinic Laboratories in Rochester
Test Classification
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
87081-ESBL GNB surveillance culture
87077-Ident by MALDI-TOF mass spec (if appropriate)
87184-ESBL SUS test charge (if appropriate)
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| ESBLS | ESBL GNB Surveillance Culture, F | 102121-1 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| ESBLS | ESBL GNB Surveillance Culture, F | 102121-1 |