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HelpTest ID: BRBPS Broad Range Bacterial PCR and Sequencing, Varies
Useful For
Detecting and identifying bacteria (including mycobacteria) from normally sterile sources, including synovial fluid; body fluids such as pleural, peritoneal, and pericardial fluids, cerebrospinal fluid; and both fresh and formalin-fixed paraffin-embedded tissues
This test is not recommended as a test of cure because nucleic acids may persist for long periods of time after successful treatment.
Reflex Tests
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| ISBA | Bacterial Ident by Sequencing | No, (Bill Only) | No |
| ISNGS | Ident by Next Generation Sequencing | No, (Bill Only) | No |
| SPID2 | Specimen Identification by PCR | No, (Bill Only) | No |
| CSFME | Meningitis Encephalitis Panel, PCR | Yes | No |
Testing Algorithm
If polymerase chain reaction (PCR) testing is negative, no sequencing is performed, and the test resulted as negative.
If PCR testing is positive, sequencing is performed. Strong positive results are first submitted to Sanger sequencing, which can yield results in as few as 4 days. Weak positive results, or Sanger sequencing results that are mixed, are submitted to next-generation sequencing (ie, targeted metagenomics testing).
The following algorithms are available:
-Infective Endocarditis: Diagnostic Testing for Identification of Microbiological Etiology
Method Name
Polymerase Chain Reaction (PCR) followed by Sequencing
Reporting Name
Broad Range Bacteria PCR+SequencingSpecimen Type
VariesNecessary Information
Specimen source is required.
Specimen Required
Fresh tissue is preferred over formalin-fixed, paraffin-embedded tissue.
Submit only 1 of the following specimens:
Preferred Specimen Type:
Specimen Type: Fresh tissue or biopsy
Sources: Normally sterile tissue such as bone, lymph node, joint, heart valve, brain, viscera, organ, lung, prostate
Container/Tube: Sterile container
Specimen Volume: Entire collection or 5 mm(3)-approximately the size of a pencil eraser
Collection Instructions:
1. Collect fresh tissue specimen.
2. Submit tissue only, do not add fluid to tissue.
3. Freeze specimen.
Specimen Stability Information: Frozen <21 days (preferred)/Refrigerated <21 days
Alternate Specimen Type:
Preferred: Paraffin-embedded tissue block
Supplies: Tissue Block Container (T553)
Specimen Type: Formalin-fixed, paraffin-embedded (FFPE) tissue block
Sources: Normally sterile or deep tissues such as bone, lymph node, joint, heart valve, brain, viscera, organ, lung, prostate
Container/Tube: Tissue block
Collection Instructions: Submit a formalin-fixed, paraffin-embedded tissue block to be cut and returned.
Specimen Stability Information: Ambient (preferred)/Refrigerated
Acceptable: Paraffin-embedded tissue block
Specimen Type: Section (scrolls) of FFPE tissue block
Sources: Normally sterile or deep tissues such as bone, lymph node, joint, heart valve, brain, viscera, organ, lung, prostate
Container/Tube: Sterile container for each individual cut section (scroll)
Collection Instructions: Perform microtomy and prepare five separate 10-micron sections. Each section (scroll) must be placed in a separate sterile container for submission.
Specimen Stability Information: Ambient (preferred)/Refrigerated
Specimen Type: Fluid
Sources: Normally sterile body fluids such as cerebrospinal, vitreous humor, pleural, abdominal, peritoneal, ascites, pericardial, pelvic, prostatic
Container/Tube: Screw-capped, sterile container
Specimen Volume: 1 mL
Collection Instructions:
1. Collect fresh fluid specimen.
2. Freeze specimen.
Specimen Stability Information: Frozen <21 days(preferred)/Refrigerated <21 days
Specimen Type: Synovial fluid
Container/Tube:
Preferred: Red top or sterile container
Acceptable: Lavender top (EDTA), pink top (EDTA), royal blue top (EDTA), or sterile vial containing EDTA-derived aliquot
Specimen Volume: 1 mL
Collection Instructions: Send specimen in original tube (preferred).
Specimen Stability Information: Frozen <21 days (preferred)/ Refrigerated <21 days
Specimen Minimum Volume
Fluid: 0.5 mL; Fresh tissue or biopsy: 5 mm(3); Paraffin-embedded tissue block: two 10-micron sections
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Varies | Varies | ||
Clinical Information
Cultures from patients with suspected bacterial infection involving normally sterile sites may fail to provide bacterial (including mycobacterial) growth for identification due to the presence of fastidious or slow-growing bacteria or as a result of antecedent antimicrobial chemotherapy. Polymerase chain reaction amplification of a portion of the 16S ribosomal RNA (rRNA) gene followed by sequencing of the amplified product can be used to detect bacterial (including mycobacterial) nucleic acids in such situations, enabling a diagnosis. Sterile sources accepted for testing may have more than one bacterial species present or the presence of copy variants of the 16S rRNA gene within a single bacterial species, confounding Sanger sequencing analysis. Next-generation sequencing can be useful in such cases. Ideal specimens are those in which bacteria (includes mycobacteria) are visualized by microscopy. Heart valves from patients with endocarditis with positive Gram stains are, for example, especially suitable.
Reference Values
No bacterial DNA detected
Interpretation
A positive broad-range polymerase chain reaction (PCR)/sequencing result indicates that bacterial nucleic acid of the specified organism was detected, which may be due to bacterial infection or environmental or contaminating nucleic acids in the specimen.
A negative broad-range PCR/sequencing result indicates the absence of detectable bacterial (including mycobacterial) nucleic acids in the specimen but does not rule out false-negative results that may occur due to sampling error, sequence variability underlying the primers, the presence of bacterial nucleic acids in quantities less than the limit of detection of the assay, or inhibition of PCR. If PCR testing appears to be negative but there is evidence of PCR inhibition, testing will be repeated. If inhibition is again detected, the result will be reported as "PCR inhibition present."
Clinical Reference
1. Virk A, Pritt B, Patel R, et al. Mycobacterium lepromatosis Lepromatous leprosy in US citizen who traveled to disease-endemic areas. Emerg Infect Dis. 2017;23(11):1864-1866. doi:10.3201/eid2311.171104
2. Liesman RM, Pritt BS, Maleszewski JJ, Patel R. Laboratory diagnosis of infective endocarditis. J Clin Microbiol. 2017;55(9):2599-2608. doi:10.1128/JCM.00635-17
3. Ramakrishna JM, Libertin CR, Yang JN, Diaz MA, Nengue AL, Patel R. 16S rRNA gene PCR/sequencing of cerebrospinal fluid in the diagnosis of post-operative meningitis. Access Microbiology. 2020;2(2):acmii.0.000100
4. Alvarez Otero J, Mandrekar J, Wolf MJ, et al. Pleural space infection microbiology as assessed using a clinically targeted sequencing-based assay: Fusobacterium nucleatum group, Streptococcus intermedius, and oral normal microbiota are the most common bacteria identified in community-acquired pleural space infections. J Clin Microbiol. 00694-24-s0001
5. Azad MA, Wolf MJ, Strasburg AP, et al. Comparison of the BioFire Joint Infection Panel to 16S ribosomal RNA gene-based targeted metagenomic sequencing for testing synovial fluid from patients with knee arthroplasty failure. J Clin Microbiol. 2022;60(12):e0112622. doi:10.1128/jcm.01126-22
6. Fowler VG, Durack DT, Selton-Suty C, et al. The 2023 Duke-International Society for Cardiovascular Infectious Diseases criteria for infective endocarditis: Updating the modified Duke criteria [published correction appears in Clin Infect Dis. 2023 Oct 13;77(8):1222. doi: 10.1093/cid/ciad510]. Clin Infect Dis. 2023;77(4):518-526. doi:10.1093/cid/ciad271
7. Flurin L, Wolf MJ, Mutchler MM, Daniels ML, Wengenack NL, Patel R. Targeted metagenomic sequencing-based approach applied to 2146 tissue and body fluid samples in routine clinical practice. Clin Infect Dis. 2022 Nov 14;75(10):1800-1808. doi:10.1093/cid/ciac247
8. Hong HL, Flurin L, Greenwood-Quaintance KE, et al. 16S rRNA gene PCR/sequencing of heart valves for diagnosis of infective endocarditis in routine clinical practice. J Clin Microbiol. 2023;61(8):e0034123. doi:10.1128/jcm.00341-23
Day(s) Performed
Monday through Friday
Report Available
14 to 28 daysTest Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.CPT Code Information
87801-Broad Range Bacterial PCR and Sequencing
87798-Bacterial Ident by Sequencing (if appropriate)
87798-Specimen Identification by PCR (if appropriate)
87798-Ident by Next Generation Sequencing (if appropriate)
87483-Meningitis Encephalitis Panel, PCR (if appropriate)
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| BRBPS | Broad Range Bacteria PCR+Sequencing | 76575-0 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| BRBPS | Broad Range Bacteria PCR+Sequencing | 76575-0 |
Special Instructions
Forms
If not ordering electronically, complete, print, and send a Microbiology Test Request (T244) with the specimen.