scholarly journals Evaluation of Optimal Blood Culture Incubation Time to Maximize Clinically Relevant Results from a Contemporary Blood Culture Instrument and Media System

2020 ◽  
Author(s):  
Eric M. Ransom ◽  
Zahra Alipour ◽  
Meghan A. Wallace ◽  
Carey-Ann D. Burnham
Keyword(s):  
Blood Culture ◽  
Incubation Time ◽  
Negative Impact ◽  
Culture Media ◽  
Detection System ◽  
Blood Cultures ◽  
Standard Interval ◽  
Media System ◽  
Blood Culture Positivity ◽  
Optimal Incubation

Timely diagnosis of microorganisms in blood cultures is necessary to optimize therapy. Although blood culture media and systems have evolved for decades, the standard interval for incubation prior to discard as negative has remained five days. Here, we evaluated the optimal incubation time for the BACT/ALERT VIRTUO blood culture detection system (bioMérieux) using FA Plus (aerobic) and FN Plus (anaerobic) resin culture bottles in routine clinical use. Following IRB approval, a retrospective review evaluated the outcomes of 158,710 bottles collected between November 2018 and October 2019. The number of positive blood bottles was 13,592 (8.6%); 99% of positive aerobic and anaerobic bottles flagged positive by 91.5 h and 108 h, respectively. The mean (median) time-to-positivity for Staphylococcus aureus was 18.4 h (15.6 h), Escherichia coli 12.3 h (9.5 h), Pseudomonas aeruginosa 22.2 h (15.9 h), and Candida spp. 48.9 h (42.9 h). Only 175 bottles (0.1% of all bottles) flagged positive after four days of incubation; 89 (51%) of these bottles grew Cutibacterium (Propionibacterium) species. Chart review of blood cultures positive after four days (96 h) rarely had clinical impact, and sometimes had a negative impact on patientcare. Finally, a seeded study of the HACEK group, historically associated with delayed blood culture positivity, demonstrated no benefit to extended incubation beyond four days. Collectively, these findings demonstrated that a four-day incubation time was sufficient for the VIRTUO system and media. Implementation of the four-day incubation time could enhance clinically relevant results by reducing recovery of contaminants and finalizing blood cultures one day earlier.

scholarly journals Neither Blood Culture Positivity nor Time to Positivity is Associated with Mortality among Patients Presenting with Severe Manifestations of Sepsis: The FABLED Cohort Study

2021 ◽  
Author(s):  
Katryn Paquette ◽  
David Sweet ◽  
Robert Stenstrom ◽  
Sarah N Stabler ◽  
Alexander Lawandi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Blood Culture ◽  
Blood Cultures ◽  
Cell Counts ◽  
Culture Positivity ◽  
Time To Positivity ◽  
Blood Culture Positivity ◽  
Normal White Blood Cell ◽  
Support Fund

Abstract Background Sepsis is a leading cause of morbidity, mortality, and health care costs worldwide. Methods We conducted a multi-center, prospective cohort study evaluating the yield of blood cultures drawn before and after empiric antimicrobial administration among adults presenting to the emergency department with severe manifestations of sepsis (ClinicalTrials.gov: NCT01867905). Enrolled patients who had the requisite blood cultures drawn were followed for 90 days. We explored the independent association between blood culture positivity and its time to positivity in relation to 90-day mortality. Findings 325 participants were enrolled; 90-day mortality among the 315 subjects followed-up was 25·4% (80/315). Mortality was associated with age (mean age in those who died was 72·5 ±15·8 vs. 62·9 ±17·7 years among survivors, p<0·0001), greater Charlson Comorbidity Index (2 (IQR 1,3) vs. 1 (IQR 0,3), p=0·008), dementia (13/80 (16·2%) vs. 18/235 (7·7%), p=0·03), cancer (27/80 (33·8%) vs. 47/235 (20·0%), p=0·015), positive qSOFA score (57/80 (71·2%) vs. 129/235 (54·9%), p=0·009), and normal white blood cell counts (25/80 (31·2%) vs. 42/235 (17·9%), p=0·02). The presence of bacteremia, persistent bacteremia after antimicrobial infusion, and shorter time to blood culture positivity were not associated with mortality. Neither the source of infection nor pathogen affected mortality. Interpretation Although severe sepsis is an inflammatory condition triggered by infection, its 90-day survival is not influenced by blood culture positivity nor its time to positivity. Funding Vancouver Coastal Health; St-Paul’s Hospital Foundation Emergency Department Support Fund; the Fonds de Recherche Santé – Québec (CPY); Intramural Research Program of the NIH, Clinical Center (AL); the Maricopa Medical Foundation

scholarly journals Effect of Antifungal Therapy Timing on Mortality in Cancer Patients with Candidemia

2009 ◽  
Vol 54 (1) ◽  
pp. 184-190 ◽  
Author(s):  
Ying Taur ◽  
Nina Cohen ◽  
Sarah Dubnow ◽  
Alla Paskovaty ◽  
Susan K. Seo
Keyword(s):  
Blood Culture ◽  
Hospital Mortality ◽  
Cancer Patients ◽  
Incubation Period ◽  
Antifungal Therapy ◽  
Incubation Time ◽  
Culture Collection ◽  
Diagnostic Methods ◽  
Apache Iii ◽  
Blood Culture Positivity

ABSTRACT Prior studies have shown that delays in treatment are associated with increased mortality in patients with candidemia. The purpose of this study was to measure three separate time periods comprising the diagnosis and treatment of candidemia and to determine which one(s) is associated with hospital mortality. Patients with blood cultures positive for Candida spp. were identified. Subjects were excluded if no antifungal therapy was given or if there was preexisting antifungal therapy. Collected data included the time from blood culture collection to positivity (incubation period), the time from blood culture positivity to provider notification (provider notification period), and the time from provider notification to the first dose of antifungal given (antifungal initiation period). These times were assessed as predictors of inpatient mortality. A repeat analysis was done with adjustments for age, sex, race, underlying cancer, catheter removal, APACHE III score, acute renal failure, neutropenia, and non-Candida albicans species. A total of 106 episodes of candidemia were analyzed. The median incubation time was 32.1 h and was associated with mortality (univariate hazard ratio per hour, 1.025; P = 0.001). The median provider notification and antifungal initiation periods were 0.3 and 7.5 h, respectively, and were not associated with mortality. Adjusted analysis yielded similar results. For cancer patients with candidemia, the incubation period accounts for a significant amount of time, compared with the provider notification and antifungal initiation times, and is associated with in-hospital mortality. Strategies to shorten the incubation time, such as utilizing rapid molecularly based diagnostic methods, may help reduce in-hospital mortality.

scholarly journals The Addition of Anaerobic Blood Cultures for Pediatric Patients with Concerns for Bloodstream Infections: Prevalence and Time to Positive Cultures

2020 ◽  
Vol 58 (9) ◽  
Author(s):  
Jennifer Dien Bard ◽  
Todd P. Chang ◽  
Rebecca Yee ◽  
Keya Manshadi ◽  
Nhan Lichtenfeld ◽  
...  
Keyword(s):  
Blood Culture ◽  
Pediatric Patients ◽  
Bloodstream Infections ◽  
Pediatric Emergency ◽  
Blood Cultures ◽  
Secondary Outcome ◽  
Culture Positivity ◽  
Blood Culture Positivity ◽  
Anaerobic Bottle ◽  
Clinically Significant

ABSTRACT Anaerobes are an important but uncommon cause of bloodstream infections (BSIs). For pediatric patients, routine inclusion of an anaerobic blood culture alongside the aerobic remains controversial. We implemented automatic anaerobic blood culture alongside aerobic blood cultures in a pediatric emergency department (ED) and sought to determine changes in recovery of obligate and facultative anaerobes. This was a cohort study in a pediatric ED (August 2015 to July 2018) that began in February 2017. Blood culture positivity results for true pathogens and contaminants were assessed, along with a secondary outcome of time to positivity (TTP) of blood culture. A total of 14,180 blood cultures (5,202 preimplementation and 8,978 postimplementation) were collected, with 8.8% (456) and 7.1% (635) positive cultures in the pre- and postimplementation phases, respectively. Of 635 positive cultures in the postimplementation phase, aerobic blood cultures recovered 7.6% (349/4,615), whereas anaerobic blood cultures recovered 6.6% (286/4,363). In 211/421 (50.0%) paired blood cultures, an organism was recovered in both cultures. The number of cases where organisms were only recovered from an aerobic or an anaerobic bottle in the paired cultures were 126 (30.0%) and 84 (20.0%), respectively. The TTP was comparable regardless of bottle type. Recovery of true pathogens from blood cultures was approximately 7 h faster than recovery of contaminants. Although inclusion of anaerobic blood cultures only recovered 2 (0.69%) obligate anaerobes, it did allow for recovery of clinically significant pathogens that were negative in aerobic blood cultures and supports the routine collection of both bottles in pediatric patients with a concern of bloodstream infections.

scholarly journals Gelatin neutralization of the inhibitory effect of sodium polyanethol sulfonate on Neisseria meningitidis in blood culture media

1977 ◽  
Vol 6 (1) ◽  
pp. 1-3 ◽  
Author(s):  
J Eng ◽  
E Holten
Keyword(s):  
Blood Culture ◽  
Neisseria Meningitidis ◽  
Growth Medium ◽  
Solid Medium ◽  
Culture Media ◽  
Inhibitory Effect ◽  
Blood Cultures ◽  
Nutrient Broth

The inhibitory effect of sodium polyanethol sulfonate (0.05%) upon growth of Neisseria meningitidis was found to be neutralized by adding gelatin (l.1%) to the growth medium. The neutralizing effect was demonstrated in solid medium, as well as in nutrient broth for blood cultures. The findings parallel those of Wilkins and West (6) regarding gelatin neutralization of the inhibitory effect of sodium polyanethol sulfonate on Peptostreptococcus anaerobius.

scholarly journals Central Line–Associated Bloodstream Infections in Adult Hematology Patients with Febrile Neutropenia An Evaluation of Surveillance Definitions Using Differential Time to Blood Culture Positivity

2013 ◽  
Vol 34 (1) ◽  
pp. 89-92 ◽  
Author(s):  
Joshua T. Freeman ◽  
Anna Elinder-Camburn ◽  
Catherine McClymont ◽  
Deverick J. Anderson ◽  
Mary Bilkey ◽  
...  
Keyword(s):  
Blood Culture ◽  
Febrile Neutropenia ◽  
Positive Predictive Value ◽  
Bloodstream Infections ◽  
Central Line ◽  
Blood Cultures ◽  
National Healthcare ◽  
Culture Positivity ◽  
National Healthcare Safety Network ◽  
Blood Culture Positivity

We used differential time to positivity between central and peripheral blood cultures to evaluate the positive predictive value (PPV) of the National Healthcare Safety Network central line–associated bloodstream infection (CLABSI) surveillance definition among hematology patients with febrile neutropenia. The PPV was 27.7%, which suggests that, when the definition is applied to this population, CLABSI rates will be substantially overestimated.

scholarly journals 2178. Sensitivity of Blood Cultures in Detection of Bacteremia in Febrile Neutropenia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S739-S739
Author(s):  
Vanisha Patel ◽  
Jose Amadeo A Ferrolino ◽  
Randall Hayden ◽  
Randall Hayden ◽  
Aditya H Gaur
Keyword(s):  
Blood Culture ◽  
Febrile Neutropenia ◽  
Positive Blood Culture ◽  
Culture Media ◽  
Febrile Episode ◽  
Advisory Board ◽  
Blood Cultures ◽  
Coagulase Negative Staphylococcus ◽  
Media Type ◽  
Time To Detection

Abstract Background Febrile neutropenia (FN) secondary to bacteremia is a treatable complication of chemotherapy that increases mortality if not promptly recognized and managed. Methods The sensitivity of blood cultures collected in pediatric oncology patients with FN was assessed and stratified based on the day of FN episode, culture media type, and the source of blood culture draw at a single US center between 2013 and 2018. Paired aerobic and lytic media bottles were inoculated with each culture draw using a weight-based volume of blood; anaerobic cultures were included with initial cultures starting in September of 2015. Results In a retrospective analysis of 10,596 patients, a total of 3,039 episodes of FN were identified. Of the FN episodes, 17.7% had at least one positive blood culture; 84.5%, 1.3%, 0.9% and 13.3% of positive cultures were collected on day 0, day 1, day 2 and ≥ day 3 of a febrile episode. Among the positive day 0 cultures, the median time to detection of an organism was 14.1 hours. Host characteristics of blood culture-positive FN episodes are summarized in Table 1. Bacteremia was identified in 537 FN cases; 18.1%, 11.9% and 2.6% of cultures were positive in only aerobic, lytic or anaerobic media cultures, respectively. The most commonly isolated organisms were Escherichia coli, coagulase-negative Staphylococcus, viridans group streptococcus, Klebsiella pneumoniae and Pseudomonas aeruginosa. Fifteen percent of infectious episodes with a positive blood culture were polymicrobial. Conclusion In summary, the study findings have important clinical implications such as emphasizing the value of day 0 cultures and highlighting the importance of routinely collecting blood cultures in more than one media type. Despite an optimized blood culture approach, less than a fifth of FN episodes had a blood culture-based diagnosis. Disclosures Randall Hayden, MD, Abbott Molecular: Advisory Board; Quidel: Advisory Board; Roche Diagnostics: Advisory Board.

scholarly journals Comparison of microorganism detection and time-to-positivity in pediatric and standard media from three major commercial continuously monitored blood culture systems

2021 ◽  
Author(s):  
Melanie L. Yarbrough ◽  
Meghan A. Wallace ◽  
Carey-Ann D. Burnham
Keyword(s):  
Blood Culture ◽  
Detection Rate ◽  
Culture Media ◽  
Blood Cultures ◽  
Kingella Kingae ◽  
Packed Red Blood Cells ◽  
Culture Systems ◽  
Time To Positivity ◽  
Species Specific ◽  
Blood Volumes

New blood culture instrumentation and media formulations have led to improved time-to-positivity (TTP) for positive blood cultures. Data regarding the necessity of pediatric blood culture bottles with contemporary blood culture systems are sparse. We compared performance of three commercial blood culture systems, evaluating impact of blood volumes in standard and pediatric blood culture media across systems. Simulated blood cultures with packed red blood cells and three Gram-positive, four Gram-negative, and one anaerobic organism (final concentrations ranging from 0.5-19 CFU/mL blood) on the VIRTUO, VersaTREK, and Bactec FX were evaluated with FAN Plus, REDOX, and BACTEC Plus media, respectively. For each media/instrument/organism combination 1, 3, 5, and 10 mL blood volumes were evaluated in triplicate. Detection rate was not affected by blood volume. Aerobic organisms that demonstrated variable detection were Kingella kingae, Haemophilus influenzae and Neisseria meningitidis. Bacteroides fragilis was detected in 83%, 100%, and 100% of VIRTUO, VersaTREK, and Bactec anaerobic bottles. Average TTP of standard media for aerobic organisms detected on VIRTUO was decreased compared to VersaTREK (-2.3 h) and Bactec (-4.9 h). Compared to standard media, detection rate and TTP was unchanged on VIRTUO, while TTP was reduced with pediatric media for 2/8 organisms tested on Bactec and 7/8 organisms on VersaTREK, illustrating the potential benefit of pediatric media on VersaTREK or BACTEC when low blood volumes (<5 mL) are collected. These results demonstrate that TTP is decreased on the VIRTUO compared to VersaTREK and Bactec for many microorganisms associated with BSI but may have species-specific limitations.

scholarly journals Rapid automated disgnosis of bacteremia by impedance detection

1977 ◽  
Vol 5 (1) ◽  
pp. 51-57
Author(s):  
R L Kagan ◽  
W H Schuette ◽  
C H Zierdt ◽  
J D MacLowry
Keyword(s):  
Blood Culture ◽  
Detection Efficiency ◽  
Detection System ◽  
Blood Cultures ◽  
Automated Detection ◽  
Culture Bottle ◽  
System A ◽  
Blood Lysis ◽  
Filtration Technique ◽  
New System

Lysis and filtration of blood culture specimens were combined with impedance detection of bacterial growth to facilitate the diagnosis of bacteremia. A blood lysis-filtration technique (Zierdt et al., 1976) was coupled to a simple, inexpensive automated detection system. The practical and technical aspects of the impedance detection system are discussed. This new blood culturing system was compared to a conventional system for 264 aerobic blood cultures. A 30-ml sample of the blood-broth mixture was withdrawn from the conventional aerobic blood culture bottle and processed in parallel. Excluding the isolation of the commonly recognized contaminants, the detection efficiency was 36% greater in the new system. A total of 53 blood cultures from 107 patients were positive by one or both methods. The new system detected 92% of the total number of positive cultures, compared with 56% detected by the routine method. The explanation of the differences is discussed.

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