Normally Sterile Sites: Invasive Bacterial Diseases

Definition of normally sterile sites (and exceptions) for submission of clinical isolates to the Minnesota Department of Health Public Health Laboratory.

A normally sterile site is defined as:

• blood
  
• cerebrospinal fluid (CSF)
  
• pleural fluid
  • includes:
    • chest fluid
    • thoracentesis fluid
• peritoneal fluid
  • includes:
    • abdominal fluid
    • ascites
• pericardial fluid
  
• bone
  • includes:
    • bone marrow
• joint fluid
  • includes:
    • synovial fluid
    • fluid, needle aspirate, or culture of any specific joint:
      • knee
      • ankle
      • elbow
      • hip
      • wrist
• internal body sites
  • specimen obtained from surgery or aspirate from one of the following:
    • lymph node
    • brain
    • heart
    • liver
    • spleen
    • vitreous fluid
    • kidney
    • pancreas
    • ovary
    • vascular tissue

Exceptions:

• Group A Streptococcus if the source is:
  • Muscle
    • tissue or biopsy that is surgically obtained
    • any site (even non-sterile sites) in a case of toxic shock syndrome (TSS)
      or necrotizing fasciitis (NF).
• Group B Streptococcus if fetal death occurs:
  • placenta or amniotic fluid