# Picking the right granularity in the LOINC Component **URL:** \ **Category:** General\ **Created:** [November 6, 2026, 2:06pm UTC](https://forum.loinc.org/t/picking-the-right-granularity-in-the-loinc-component/3197 "2026-11-06T14:06:16Z")\ **Posts on this page:** 3\ **Page:** 1
**Author:** ![rmerrick](https://forum.loinc.org/letter_avatar_proxy/v4/letter/r/90ced4/32.png) [@rmerrick](https://forum.loinc.org/u/rmerrick)\ **Post date:** [November 6, 2026, 2:06pm UTC](https://forum.loinc.org/t/picking-the-right-granularity-in-the-loinc-component/3197/1 "2026-11-06T14:06:16Z")
On the LabMCoP call we are trying to define the best way to report blood culture results (including quality issues like insufficient volume submitted or contamination detected). As part of that we obviously are looking at the correct LOINC to use to report the results (which is related to this other post, where Andrea mentions blood culture workflow: [Automatic culture - mapping problem](https://forum.loinc.org/t/automatic-culture-mapping-problem/3196) ). Most commonly blood cultures grow bacteria, so most labs will use [600-7](https://loinc.org/600-7) **Bacteria identified in Blood by Culture** (or they may use the repsective aerobe / anaerobe versions, if they track at that level), as evidenced by the high rank under the Common LOINCs. However it is not unusual to grow yeast (Candida, specifically) that is considered a pathogen, rather than an indicator for contamination, and also needs to be reported out. These are the options we discussed: #1 Report [https://loinc.org/600-7](https://loinc.org/600-7) as no growth and create a reportable reflex to a fungal culture to communicate those results #2 Use a different LOINC for blood culture, where the component is “Bacteria and Fungus (or Yeast)” or “Microorganism”, which whould have to be created, as it currently doesn’t exist and would require remapping by many labs #3 Just report fungal species using the [https://loinc.org/600-7](https://loinc.org/600-7), which means we accept that folks will occasionally report values that are different from the LOINC component @pitk0006 please expand as needed, where I am not detailed enough. @pdbanning also a topic for the Lab LOINC Committee? ---
**Author:** ![pitk0006](https://forum.loinc.org/letter_avatar_proxy/v4/letter/p/c89c15/32.png) [@pitk0006](https://forum.loinc.org/u/pitk0006)\ **Post date:** [November 6, 2026, 5:14pm UTC](https://forum.loinc.org/t/picking-the-right-granularity-in-the-loinc-component/3197/2 "2026-11-06T17:14:20Z")
Thanks for posting, Riki, Additional information follows In the discussion, you asked if LOINC 600-7 should be used if yeast (a fungus) grows as it really isn’t only a bacterial culture. We discussed there are limitations to LOINC codes as not all semantic meaning is contained within them. They don’t reflect IVD details and other information and there is context and meaning that is assumed when you look at how LOINCs are used in practice. Indeed, we see this LOINC is the 102nd most common LOINC utilized. It is also very common for a number of common testing processes to detect items that are typically found as a result of other tests like the Fungal Culture you mention. (See [Laboratory Diagnosis of Bacterial, Fungal, Viral, and Parasitic Pathogens - PMC](https://pmc.ncbi.nlm.nih.gov/articles/PMC7152026/) ) Fungus, specifically Yeast, maybe found in Urinalysis (and Urine Culture if present in urine), on rare occassion in tissue analyzed by pathology, Body Fluid analysis/cell count including CSF, and other specimens for other non culture testing. (See [STUDY OF YEAST SPECIES ISOLATED FROM CLINICAL SPECIMENS - PMC](https://pmc.ncbi.nlm.nih.gov/articles/PMC5531913/) ) It depends on the test on whether the specific species of yeast is identified, if only characteristics such as budding or branching yeast, and if the clinician decides to order the fungal culture for identification and sensitivities or decides it is not needed for patient care. They may decide to treat yeast reported as part of a urinalysis without ordering a fungal culture. It is true for many cultures, the goal is to isolate and identify any bacteria causing infections, but yeast can grow too. The issue is at the time of order entry neither the clinician nor laboratory would know if the specimen has bacteria, yeast, or no growth of any organism. However, if the clinician suspects a fungal culture, they are responsible for ordering a separate fungal culture as LabCorp indicates, “Yeast often are isolated from routine blood cultures; however, if yeast or other fungi are specifically suspected, a separate fungal blood culture should be drawn along with each of the routine blood culture specimens. See separate list for proper collection of [Fungus (Mycology) Culture [008482]](https://www.labcorp.com/tests/008482/fungus-mycology-culture).”- from [008300: Blood Culture, Routine Information | Labcorp](https://www.labcorp.com/tests/008300/blood-culture-routine) Option #1 wouldn’t occur in practice as something grew. There was discussion that the order would not be canceled and reordered as a fungal culture either. Also in the US, laboratories need to complete the report to communicate results to the ordering provider and bill for the work done. Additionally, as others mentioned, if the patient has been treated with antibiotics (which often occurs after the blood culture specimen/bottles are collected), then collection of a second set of specimens may result in no or less isolation of organisms. LabCorp’s Blood Culture Order lists limitations with “treatment of antimicrobial therapy.” What is reported depends on how much or little testing occurs as part of the culture and the laboratory process and practice. If no bacteria grow after 72 hours, and there is evidence of a fungal infection, either from budding or branching yeast identified as part of a gram stain which is reflexed, then results may indicate no bacterial growth, but the gram stain results would provide evidence of fungus. The culture could be finalized at this state if the practice is to leave it up to the clinician to order the fungal culture as indicated in the LabCorp documentation. (Other labs have similar requirements.) **Are any laboratories doing this?** This is very similar to what I encountered in my practice when bacteria or fungus were identified in nonculture pathology or other laboratory specimens (e.g. tissue, bone marrow, blood, urine, Wet Prep swabs for Trichomonas and Yeast). However, given this is from a culture order, many laboratories continue with the reflex for identification of the organism isolate(s) found in the specimen, whether bacterial or fungal as is normal practice. For identification, we see BioMerieux IVD devices do identify from an isolate whether is it bacterial or fungal in origin (See [VITEK® MS PRIME](https://www.biomerieux.com/corp/en/our-offer/clinical-products/vitek-ms-prime.html?anchor=tabs-c37e490306-item-826d3d1404) ) Bruker, another IVD vendor, also advertises identification of both with its products. Once the organism is identified, sensitivities may be reflexed. The appropriate “card” or IVD device is selected based on the identification results. Many IVD vendors offer sensitivity devices for antimicrobial panels for gram negative sensitivity panels, gram positive sensitivites, fungal sensitivities, etc. Essentially the same overall process occurs across cultures, depending on what is needed as organism identification progresses. We see the same blood culture bottle can be used for bacterial and fungal culture per this public health lab too: [Fungal culture | Solano County, California](https://www.solanocounty.gov/fungal-culture) This would be more desireable in the event that the patient has already been treated by antimicrobials as indicated above. It is also provides more cost effective and safer patient care, faster turn around time, and other benefits, if additional patient specimens do not have to be collected and the original blood culture bottles are used for bacterial or fungal culture. That covers most of the workflow. We see the general blood culture order and result, as well as genercal identification, but specific distinctions on sensitivities between bacterial and fungal processes. These would be reflected in the test order and result builds and result value reporting which culminate in the final culture report provided by the performing laboratory. That brings us to the terminology/coding questions Riki posed. #1 is to keep using the same blood culture order and result with LOINC 600-7 as we see in global practice. #2 Create a new LOINC code for Blood culture for bacteria and fungus (or the generic microorganism as she proposes). This approach would require users to remap to this new code if created. One person mentioned this would not be a trivial task given the widespread use of this 102nd most common code across clinical, public health, research, etc. systems. It can be done if this option is chosen. If adopted, it would also necessitate queries to consider both codes to avoid missing any results from one or the other depending on how far back in time queries occur. (e.g. historic data could be missed if only the new code is used) #3 is addressed in the workflow details above. Indeed whether bacterial or fungal species are identified in the workflow, 600-7 is utilized for both the order and results reported by global laboratories today. It’s expected that would continue. Even if #2 is decided upon, it requires laboratories and information systems to make that change. If they do not, then the current practice would continue. If some do and some do not, then it adds the layer of complexity as mentioned in #2 both codes need to be considered for queries, analytics, public health reporting, etc. to avoid missing one or the other. #4 I’m adding this option/decision point. Depending on the outcome of the specific decision for the blood culture, many other LOINC code updates may be needed by the LOINC team as this issue Riki brought up isn’t limited to just blood cultures. In other words, if option #2 is decided on the path forward, then additional analysis and LOINC code updates will be needed for other impacted tests/codes such as Urine Culture, Wound Culture, Respiratory Culture, BAL, etc. so that a LOINC editorial change like this is applied consistently. #5 Adding another point that LOINC codes may need to be added for items identified in this review. Riki and I were looking at gram stain testing as part of the Blood Culture workflow. We were both expecting a panel/reflex order with optional results that can be reported depending on how many organisms/morphology are identified (e.g. one result to describe one with gram pos cocci and another result with a value of gram negative rods and perhaps another with a value of budding or branching yeast.) It also despends on where in the workflow the gram stain is performed. [https://loinc.org/87969-2](https://loinc.org/87969-2) could be used on the reflex order item if done on the blood before culturing or on the positive blood culture bottle as both are blood specimens. If the positive blood culture bottle is plated manually, then isolates from those plates may have a gram stain and [https://loinc.org/87975-9](https://loinc.org/87975-9) utilized to reflect that specimen. However, if yeast are identified, the only LOINCs are qualitative and couldn’t be mapped to a result with a nom/narr response. [https://loinc.org/74759-2](https://loinc.org/74759-2) could be utilized, but there are no blood specimen LOINCs for yeast gram stain results either. May need some LOINCs to be created. Where the specimen for the gram stain occurs after a blood culture bottle is “pos”, then to be consistent with other LOINCs such as [https://loinc.org/104553-3](https://loinc.org/104553-3), then gram stain on Bld.pos.growth may be needed. @pdbanning Can this topic be added to the Lab LOINC Committee as Riki mentions? It would be good to have a wider discussion. Before then, it would be very helpful for laboratories to report their practice to have knowledge sharing amongst us all and aid in decision making. Please chime in @jwsnyder @jwsnyder1 While this is mostly a lab order and result issue, SNOMED CT is used for the values/organisms identified, as well as for lab orders and results in countries that use SCT for one or both. Are there additional SNOMED CT considerations from your perspective? Thank you again, Riki for raising this issue! ---
**Author:** ![pdbanning](https://forum.loinc.org/letter_avatar_proxy/v4/letter/p/9f8e36/32.png) [@pdbanning](https://forum.loinc.org/u/pdbanning)\ **Post date:** [November 6, 2026, 8:35pm UTC](https://forum.loinc.org/t/picking-the-right-granularity-in-the-loinc-component/3197/3 "2026-11-06T20:35:59Z")
@rmerrick @pitk0006 We will get this added to the Lab committee agenda. Thank you!