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HelpMayo Test ID MMLNS Antimicrobial Susceptibility, Nocardia species and other Aerobic Actinomycetes, Varies
Infectious
Ordering Guidance
This test is intended for assessing antimicrobial susceptibility of Nocardia species and other pathogenic aerobic actinomycetes which include the more commonly isolated genera of Rhodococcus, Streptomyces, Gordonia, Dietzia, Tsukamurella, and Williamsia species, as well as the lesser isolated genera which include Actinomadura, Amycolatopsis, Dermatophilus, Kroppenstedtia, Nocardiopsis, Nonomuraea, Pseudonocardia, Saccharomonospora, and Saccharopolyspora species.
Certain genera of aerobic actinomycetes will not be accepted for susceptibility testing. Aerobic actinomycetes genera that will not be tested include the following: Actinoallomurus, Actinocatenispora, Actinoplanes, Aeromicrobium, Croceifilum, Hazenella, Intrasporangium, Kineosphaera, Kitasatospora, Kribella, Kutzneria, Laceyella, Marinactinospora, Microbispora, Micromonospora, Nocardioides (not Nocardia), Phycicoccus, Piscicoccus, Prauserella, Risungbinella, Saccharothrix, Sphaerimonospora, Spirillospora, Streptosporangium, Terracoccus, and Thermoactinomyces.
Additional Testing Requirements
If organism identification is not provided, CTB / Mycobacteria and Nocardia Culture, Varies or CTBID / Culture Referred for Identification, Mycobacterium and Nocardia, Varies must also be ordered and will be charged separately.
Shipping Instructions
1. For shipping information see Infectious Specimen Shipping Guidelines.
2. Place specimen in a large infectious container and label as an etiologic agent/infectious substance.
Necessary Information
1. Specimen source is required.
2. Organism identification is required unless either CTB / Mycobacteria and Nocardia Culture, Varies or CTBID / Culture Referred for Identification, Mycobacterium and Nocardia, Varies is also ordered.
Specimen Required
Specimen Type: Organism in pure culture
Supplies: Infectious Container, Large (T146)
Container/Tube:
Preferred: Middlebrook 7H10 agar slant without antimicrobials
Acceptable: Sabouraud's dextrose agar slant or similar media without antimicrobials (eg, 7H11 agar slant, LJ, MGIT [7H9] broth media)
Specimen Volume: Isolate
Collection Instructions: Organism must be in pure culture, actively growing.
Useful For
Determining the resistance of species of Nocardia and other aerobic actinomycetes to antimicrobial agents.
This test is not useful for determining resistance of aerobic actinomycetes species of the following genera: Actinoallomurus, Actinocatenispora, Actinoplanes, Aeromicrobium, Croceifilum, Hazenella, Intrasporangium, Kineosphaera, Kitasatospora, Kribella, Kutzneria, Laceyella, Marinactinospora, Microbispora, Micromonospora, Nocardioides (not Nocardia), Phycicoccus, Piscicoccus, Prauserella, Risungbinella, Saccharothrix, Sphaerimonospora, Spirillospora, Streptosporangium, Terracoccus, or Thermoactinomyces.
Additional Tests
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| SSNS | Susceptibility Nocardia species | No, (Bill Only) | Yes |
Reflex Tests
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| MIC | Susceptibility, MIC | No, (Bill Only) | No |
Testing Algorithm
When this test is ordered, susceptibility for Nocardia species will be performed at an additional charge.
When the organism identification is Rhodococcus equi the additional reflex test will be performed at an additional charge for the additional antimicrobials vancomycin and rifampin.
Special Instructions
Method Name
Minimum Inhibitory Concentration (MIC)
Reporting Name
Susc, Aerobic ActinomycetesSpecimen Type
VariesSpecimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Varies | Ambient (preferred) | ||
| Refrigerated | |||
Reject Due To
| Agar plate | Reject |
Clinical Information
Nocardia species and other aerobic actinomycetes can cause significant disease, often in immunocompromised patients. Clinical presentation can include, but is not limited to, pneumonia, skin abscess, bacteremia, brain abscess, eye infection, and joint infection.
Antimicrobial susceptibility testing may aid with selection of appropriate antimicrobial agents for patient care.
Reference Values
Interpretive criteria and reporting guidelines are followed using the Clinical Laboratory Standards Institute (CLSI) M24S document.
Interpretation
Interpretive values for susceptibility testing of Nocardia species using a broth microdilution method are included in the report, as appropriate.
For Rhodococcus equi, the interpretive values for vancomycin and rifampin will also be included.
See Reference Values for additional information.
Cautions
No significant cautionary statements
Clinical Reference
1. Duggal SD, Chugh TD. Nocardiosis: A neglected disease. Med Princ Pract. 2020;29(6):514-523. doi:10.1159/000508717
2. Conville PS, Brown-Elliott BA, Smith T, Zelazny AM. The complexities of Nocardia taxonomy and identification. J Clin Microbiol. 2017;56(1):e01419-17
Method Description
A standardized inoculum made from a pure culture of aerobic actinomycete is prepared and inoculated into wells of a microtiter plate containing different concentrations of antimicrobial agents.
Growth at specified breakpoints is indicative of resistance.(Clinical and Laboratory Standards Institute (CLSI). Susceptibility Testing of Mycobacteria, Nocardia spp., and Other Aerobic Actinomycetes. CLSI standard M24. Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Susceptibility Testing of Mycobacteria, Nocardia spp., and Other Aerobic Actinomycetes. CLSI supplement M24S)
Day(s) Performed
Monday through Sunday
Report Available
12 to 28 daysPerforming Laboratory
Mayo Clinic Laboratories in Rochester
Test 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
87186
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| MMLNS | Susc, Aerobic Actinomycetes | 29577-4 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| MMLNS | Susc, Aerobic Actinomycetes | 29577-4 |
Specimen Minimum Volume
See Specimen Required