MDL Form AST - Antimicrobial Susceptibility Testing
Electronic Submittal Form Instructions
Use Lab Form AST - Antimicrobial Susceptibility Testing to provide information when submitting culture isolates for antimicrobial susceptibility testing (such as carbapenemase detection or N. gonorrhoeae E-test). Use the following steps to enter information for the submission of each specimen.
NOTE: We are unable to process samples with inadequate information.
On page one, under “Select Test Requisition”, use the pull-down menu to select Lab Form AST, select “Antimicrobial Susceptibility Testing-AST”. Provide all necessary information on page 1. For directions on how to fill out the fields on page 1, please refer to the “General Specimen Submission Page 1
2. For MDL form AST, it is REQUIRED that the following fields be filled in:
2.1. Field 39 (Test(s) Requested).
2.2. Field 40 (Submitter’s identification of Organisms).
2.3. Field 41 (Clinical History).
3. Follow the instructions below to provide additional information on page 2 of Lab Form AST.
"Antimicrobial Susceptibility Testing-AST - Submitter’s Laboratory Findings":
3.1. REQUIRED Check box(es) to indicate the test(s) requested. An abbreviation of the selected test(s) will appear in the Requested Test field on page 1 at the time of printing. If the “Test Requested” is not listed, check the “Other” box and type in requested test.
3.2. REQUIRED Record the original healthcare facility from which the isolate was obtained.
3.3. Check box to indicate if the culture made from the original sample was pure or mixed. If mixed list the other organisms present.
3.4. Record the colony count if applicable (e.g. urine).
3.5. Record the number of times the organism was submitted and isolated from the patient.
3.6. Record the medium on which primary growth was obtained
3.7. Record the medium on which the organism is being submitted.
3.8. Record the date inoculated for the organism being submitted and include the incubation temperature, atmosphere, and time, prior to mailing.
3.9. Method for Identification Used:
Use the pull down menu to record the method used for identification. If the appropriate “Method used Identification” is not listed in the dropdown menu, enter the results in the box below. Please attach a copy of microbial identification test results if it is available.
3.10. Method used for Antimicrobial Susceptibility Testing:
3.10.1. REQUIRED Use the pull down menu to select the method used for antimicrobial susceptibility testing. If the appropriate “Antimicrobial Susceptibility Testing” is not listed in the dropdown menu, enter the results in the box below.
3.10.2. REQUIRED - Attach a copy of antimicrobial susceptibility test results.
3.11. Other Test or Comments.
3.12. Record any other tests or comments. Please also attach a copy of all additional test results, including molecular results.
4. Print the completed Lab Form AST front to back. The document is formatted for 2-sided printing.
5. Packaging and shipping: The submitter is responsible for making sure that all samples are packaged and shipped according to the current federal and state packaging and shipping regulations for “Infectious substance, Category A” and/or “Biological substance, Category B”.
6. Additional considerations when submitting samples for AST testing:
6.1. Culture isolate should be pure.
6.2. Use a tubed solid agar medium that supports good growth of the organisms. Do not submit cultures on plated agar media.
6.3. Label sample tube with at least two identifiers (i.e. the patient’s name, submitter lab number, date of birth) and the date inoculated.
6.4. Do not submit Enterobacteriaceae on TSI slants. The preferred medium is without carbohydrates.
6.5. For safety, all submitted culture tubes must have a tightened screw cap secured in place using tape.
6.6. Before shipment, insert the completed Lab Form AST and all attachments between the inner and outer shipping containers.
6.8. If you have any questions regarding sample submission, call the MDL for guidance – 510-412-3700.