Culture, Tissue (Aerobic and Anaerobic) w Gram Stain
ID: LAB898
Last Review: 09/23/2025
Components
Culture Tissue
Gram Stain
 
Specimen Sources
Biopsy
Bone
Bone Marrow
Bursa
Cranial Bone
Cyst
Endometrium
Eye
Eye, Left
Eye, Right
Finger
Finger, Left
Finger, Right
Gallbladder
Graft
Hand
Hand, Left
Hand, Right
Heart
Hip
Joint, Elbow
Joint, Finger
Joint, Knee
Joint, Left Elbow
Joint, Left Finger
Joint, Left Hip
Joint, Left Knee
Joint, Left Shoulder
Joint, Left Wrist
Joint, Loose Body
Joint, Other
Joint, Right Elbow
Joint, Right Finger
Joint, Right Hip
Joint, Right Knee
Joint, Right Shoulder
Joint, Right Wrist
Joint, Shoulder
Joint, Wrist
Line, Arterial
Lung
Lymph Node
Misc Source
Node
Other
Pancreas
Peritonsillar
Placenta
Skin Biopsy
Tissue
Wound
Collection Requirements
ACCEPTABLE SPECIMENS:  Tissue including bone, bone marrow, endometrial biopsy, sinus, pericardium, placenta, wound.

Collect specimen as follows: 
TISSUE:
1. Aseptically obtain 5-10 cubic mm piece of  tissue. Avoid collecting tissue contaminated with flora from adjacent mucosal membranes.  
2. Do not allow tissue to dry out.
3. Submit in an Anaerobe Systems Transport Tube (AS Tube) or screw-capped, sterile specimen container  (if tissue is too large for AS Tube). 

BONE MARROW
1. Decontaminate skin with povidone iodine.
2. Aseptically aspirate bone marrow using needle and heparinized syringe.  
3. Send bone marrow in an Anaerobic Transport Tube (AS Tube), a screw-capped, sterile tube or specimen container.
Note: Use of heparin should be minimized as it is inhibitory to some bacteria. 

ENDOMETRIAL BIOPSY: 
1. Use speculum to visualize the cervix.
2. Prep the cervical os with appropriate disinfectant (e.g., Betadine).
3. Using Pipelle collection device, collect specimen. Avoid contact with vaginal wall during collection.
4. Send tissue specimen in an Anaerobe Systems Transport Tube (AS Tube).

1. Indicate source of tissue on request form.
2. Bacterial, acid-fast bacilli, and fungal cultures may be ordered on a single specimen if sufficient volume is submitted.
3. Few viable organisms may be present in a lesion, especially if it is chronic.  Specimen must be large enough to permit their recovery. 
4. Bone Marrow is appropriate for culture to detect Salmonella typhi or Brucella when peripheral blood cultures are negative. Routine bacterial cultures of bone marrow are inappropriate unless peripheral blood cultures are negative and these unusual pathogens are suspected. "
Shipping And Handling
Anaerobic specimen containers (AS Tubes) transported via the pneumatic tube station are prone to breaking.  Do not place more than one tube per bag.  Use additional packing material (foam sleeve) for transport in the pneumatic tube station otherwise send via a courier.  
DO NOT REFRIGERATE
DELIVER IMMEDIATELY TO MICROBIOLOGY IN A TIGHTLY SEALED CONTAINER WITH NO EXTERNAL SPILLAGE.
Turn Around Time (TATs for Specific Labs Below May Differ)
Turn Around Time:
  • ASAP: 9 Day(s)
  • STAT: 9 Day(s)
  • ROUTINE: 9 Day(s)
Performing Labs, Collection Containers and TATs
▷  DHLN Clinical Laboratory
▷  Duke Microbiology Laboratory
Clinical Indications
Used to aid in the diagnosis of infection involving tissue.

Bone Marrow culture is used to detect Salmonella typhi or Brucella when peripheral blood cultures are negative.  Routine bacterial cultures of bone marrow are inappropriate unless peripheral blood cultures are negative and unusual pathogens are suspected (Salmonella typhi or Brucella).

Communication with Clinical Microbiology is necessary when Brucella, Legionella, Nocardia, or Actinomyces is suspected as special culture conditions and prolonged incubation are required. Contact the Clinical Microbiology Laboratory if Bartonella infection is suspected to request PCR Assay for Bartonella from a Reference Laboratory.
Clinical Significance
Infection may occur in any organ or tissue of the body, and the types of infectious processes are many. These include the following: brain abscess, chronic otitis media and sinusitis, dental and oral infections, aspiration pneumonia, lung abscess, thoracic empyema, breast abscess, liver, subphrenic, and other intra-abdominal abscesses, appendicitis and diverticulitis and their complications, peritonitis, wound infections following bowel surgery or trauma, puerperal or postabortal sepsis, endometritis, tubo-ovarian abscess, perirectal abscess, necrotizing skin and soft tissue infections, gas-forming cellulitis, gas gangrene (anaerobic myonecrosis), and bacteremia. 

Infections in these sites may be caused by aerobic or anaerobic bacteria or a mixture of both. Interpretation of heavily mixed cultures may be difficult. Guidelines for identification and susceptibility testing of isolates are based on specimen source, method of collection, and numbers of different isolates and specific potential pathogens present. 

Antral or gastric biopsy tissue may be submitted for culture for Helicobacter pylori.  Culturing is recommended when treatment has failed and susceptibility testing is warranted.  Tissue must be transported in an AS tube and received in Clinical Microbiology within 3 hours of collection for optimal recovery.  Notify Clinical Microbiology prior to collecting the tissue.
Methodology
Gram stain and culture for recovery of aerobic and anaerobic bacteria.

Includes identification and susceptibility testing when appropriate at additional charges.  Susceptibility testing of anaerobe isolates requires consultation with the Infectious Diseases Service.  CPT coding cannot be determined before the culture is completed.
Critical Values
No Critical Values