Best Clinical Microbiology Laboratories in the United States
For diagnostic testing requiring specialized expertise, large public health and reference laboratories are more reliable than community laboratories, with the CDC Division of Parasitic Diseases and state/local public health laboratories representing the highest-quality options for esoteric testing. 1
Recommended Laboratory Types by Testing Complexity
Tier 1: Public Health Laboratories
- CDC laboratories - Specifically the Division of Parasitic Diseases (https://www.cdc.gov/dpdx/)
- Offers telediagnostic consultation services accessible to both laboratorians and clinicians
- Provides testing for organisms and conditions of public health concern
- Part of the Laboratory Response Network (LRN) with capability to respond to high-priority biological agents 2
- State and local public health laboratories - Work in coordination with CDC
- Subspecialized to track and respond to public health threats
- Direct phone or email communication can expedite specimen processing, especially in urgent clinical situations 1
Tier 2: Large Reference Laboratories
Large public health and reference laboratories are more likely than community laboratories to have the experience and volume of specimens to properly validate esoteric tests. 1 The evidence emphasizes that results are only as reliable as the experience, resources, and expertise of the laboratory performing the tests.
Key Quality Indicators
When selecting a laboratory, prioritize those with:
- High specimen volume - Greater experience leads to better validation of esoteric tests
- Specialized expertise - Particularly for parasitic, rare bacterial, or complex molecular diagnostics
- Rapid communication channels - Direct phone/email access to expedite urgent cases
- Regulatory compliance - CLIA-licensed facilities (approximately 260,000 in the US) 2
Important Caveats
Testing location significantly impacts turnaround time. Research demonstrates that in-house testing provides median turnaround times of 1.0 days compared to 2.25 days for within-system testing and 3.0 days for outside laboratory testing (P = .0003) 3. However, most hospitals do not perform esoteric testing in-house, with fewer than 11% performing in-house testing for diseases beyond routine bacterial cultures 3.
Small hospitals (≤100 beds) are more likely to send specimens for outside testing compared to large hospitals (>250 beds), which may result in substantial delays in receiving results with adverse implications for patient care 3.
The laboratory ecosystem includes approximately 14 billion laboratory tests performed annually across nearly 260,000 CLIA-licensed laboratories, but quality varies significantly based on expertise and volume 2.
Practical Recommendations
For routine testing: Use your institution's in-house laboratory when available to minimize turnaround time.
For esoteric testing (parasitic diseases, rare pathogens, specialized serology): Contact CDC laboratories or large state public health laboratories directly rather than relying on commercial reference laboratories with less specialized expertise 1.
For urgent cases: Establish direct communication with the reference laboratory via phone or email to expedite processing 1.
The evidence does not provide specific commercial laboratory names but consistently emphasizes that laboratory quality depends on experience, volume, and specialized expertise rather than brand recognition 1.