AFB MDDR Susceptibility Testing  

IMPORTANT! Pre-approval needed from state or local health department. Local or State Health Department. Send approval to or call (402) 559-9444.

NPHL has moved to an electronic ordering system, NUlirt, and it is now the preferred method to order all tests. Once ordered, print a "batch list" (see NUlirt Guide).

Forms Required - Nulirt batch list or NPHL Test Request Form (completed in entirety) must accompany the specimen to include the following information: symptoms and date of onset, pregnancy status, travel and vaccine history. Testing will not be performed without all required information.

Please call NPHL Client Services at (402) 559-2440 or toll free at (800) 334-0459 for further clarification.


Test: AFB MDDR Susceptibility Testing Supplemental Forms Required – Mycobacterium tuberculosis (MTB) Supplemental  
Synonym: MTB DST, TB, Tuberculosis, MTBC  
Method: Targeted DNA Sequencing (Pyrosequencing or Sanger sequencing based on submission criteria provided by submitter), Agar Proportion DST, MGIT 960 Pyrazinamide (PZA) also performed for sediments and isolates,  
Availability: Monday - Thursday  
Specimen: Nucleic Acid Amplification positive (NAA+) sediment; pure culture isolate on solid medium or in broth culture; Mixed cultures known to contain MTBC; DNA  
Collection Device: Sediment in centrifuge tube or leak-proof container. Isolate on Lowen-Stein Jensen media Specimen Labeling: Test subject to CLIA regulations and required 2 patient identifiers on specimen container and requisition forms  
Volume: 0.5 mL (sediment)  

Prior to and during shipment: Refrigerated at 2-8 °C. Place each individual specimen in a sealed bag.

Shipping instructions, including specimen-handling requirements during transport: Sender must contact the NPHL by email or phone before shipping. All screw-top tubes must be sealed with parafilm or tape. Vacutainer tubes do not require parafilm or tape to seal, Fluids that have potential to be Category A must be packaged UN 2814 Infectious Substances, affecting humans (Category A) and shipped via FedEx. Omaha & Lincoln laboratories can ship via NPHL ground courier by calling client services (866) 290-1406 to request exclusive Category A courier.

See instructions and shipping address:

Unacceptable: Sediment should not be shipped frozen.  
Specimen Stability: Sediment should be refrigerate at 2-8°C, keep isolate at room temperature.  
Reference Interval: Susceptible or Resistant  
Reportable Disease: MTB susceptibilities will be reported immediately to local or state health department. Refer to Nebraska DHHS Title 173, Communicable Diseases.  
Comments: Pre-approval is required for this test using the Molecular Detection of Drug Resistance Request Form Samples with low numbers of MTBC may not amplify; Heteroresistance may not be detected; the results of MDDR assay should not be used to rule out the presence of MTBC in a sample. TAT ranges from 1-6 calendar days Molecular Detection of Drug Resistance Request Form (CDC-002-00220) . Provide the following Specimen Information on the CDC 50.34 Specimen Submission Form.  
Revised: 9/4/2020 
If you have questions about proper specimen collection, please call NPHL Client Services at (402) 559-2440 or toll free at (800) 334-0459.