Studies have demonstrated that large-volume culture methods for sterile body fluids other than blood increase recovery compared to traditional plated-medium methods. BacT/Alert is a fully automated blood culture system for detecting bacteremia and fungemia. In this study, we compared culture in BacT/Alert standard aerobic and anaerobic bottles, BacT/Alert FAN aerobic and FAN anaerobic bottles, and culture on routine media for six specimen types, i.e., continuous ambulatory peritoneal dialysate (CAPD), peritoneal, amniotic, pericardial, synovial, and pleural fluids. Specimen volumes were divided equally among the three arms of the study. A total of 1,157 specimens were tested, with 227 significant isolates recovered from 193 specimens. Recovery by method was as follows: standard bottles, 186 of 227 (82%); FAN bottles, 217 of 227 (96%); and routine culture, 184 of 227 (81%). The FAN bottles recovered significantly more gram-positive cocci (P < 0.001), Staphylococcus aureus(P = 0.003), coagulase-negative staphylococci (P = 0.008), gram-negative bacilli (P< 0.001), Enterobacteriaceae (P = 0.005), and total organisms (P < 0.001) than the routine culture. There were no significant differences in recovery between the standard bottles and the routine culture. The FAN aerobic bottle recovered significantly more gram-positive cocci (P < 0.001), S. aureus isolates (P < 0.001), coagulase-negative staphyococci (P = 0.003), and total organisms (P< 0.001) than the standard aerobic bottle, while the FAN anaerobic bottle recovered significantly more gram-positive cocci (P < 0.001), S. aureus isolates (P < 0.001), Enterobacteriaceae(P = 0.03), and total organisms (P < 0.001) than the standard anaerobic bottle. For specific specimen types, significantly more isolates were recovered from the FAN bottles compared to the routine culture for synovial (P < 0.001) and CAPD (P = 0.004) fluids. Overall, the FAN bottles were superior in performance to both the standard bottles and the routine culture for detection of microorganisms from the types of sterile body fluids included in this study.

Traditionally, a routine blood culture for adult patients consisted of paired aerobic and anaerobic bottles, but the routine use of an anaerobic blood culture bottle has been challenged in recent years. In this study, we compared the recovery of two FAN aerobic bottles with one FAN aerobic and one FAN anaerobic bottle. Each pair of bottles was collected by a separate collection procedure, and each bottle held a recommended 8-to 12-ml draw. A total of 704 clinically significant isolates were recovered from 8,620 sets (17,240 pairs), with 487 (69.2%) isolates recovered from one or both bottles in each pair of bottles, 86 isolates (12.2%) recovered only from the FAN aerobic-FAN aerobic pair, and 131 isolates (18.6%) recovered only from the FAN aerobic-FAN anaerobic pair. Significantly more total organisms (P ‫؍‬ 0.002), gram-positive cocci (P ‫؍‬ 0.03), Staphylococcus aureus (P ‫؍‬ 0.05), Enterobacteriaceae other than Escherichia coli (P ‫؍‬ 0.02), and anaerobes (P ‫؍‬ 0.01) were recovered from the FAN aerobic-FAN anaerobic pair than from the FAN aerobic-FAN aerobic pair. A separate analysis was performed on the 618 isolates that were recovered from the FAN aerobic-FAN anaerobic pair to compare recovery by bottle type. Significantly more S. aureus (P ‫؍‬ 0.005) and anaerobes (P < 0.001) were recovered from the FAN anaerobic bottle, while significantly more coagulase-negative staphylococci (P ‫؍‬ 0.01), Streptococcus pneumoniae (P ‫؍‬ 0.03), and other gram-negative bacilli (P ‫؍‬ 0.004) were recovered from the FAN aerobic bottle. These results support the routine use of a FAN anaerobic bottle for use in the culture of blood with the BacT/ALERT system in our institution. These results also suggest that the decision of whether to routinely utilize an anaerobic blood culture bottle should be influenced by the overall recovery of bacteria and yeast, the recovery of specific types of bacteria or yeast, the medium type, and the blood culture system utilized by the laboratory.Traditionally, in most clinical microbiology laboratories in the United States, a routine blood culture for adults has consisted of paired aerobic and anaerobic blood culture bottles. Depending upon the methodology and bottle type employed, the volume of blood placed into each bottle has generally ranged from 3 to 10 ml for adult patients.Beginning with a report by Sharp (11), a number of publications have challenged the need for the use of a routine anaerobic blood culture bottle, essentially asking whether the inoculation of the same volume of blood into two aerobic blood culture bottles, at least on a selective basis, would be more clinically beneficial than the use of the more traditionally employed aerobic-anaerobic pair (1,2,8,9,12).Implicit in the argument to restrict the use of anaerobic blood culture bottles is the premise that were the same amount of blood inoculated into a second aerobic bottle rather than an anaerobic bottle, the overall yield would be greater with two aerobic bottles than with the aerobic-anaerobic pair. The purpose of th...

bioMerieux, Inc., has recently introduced plastic bottles to replace glass bottles for use in the BacT/ALERT blood culture system. We compared the performance of the plastic to the glass bottles in a large clinical evaluation. Two blood cultures were collected from each patient, one using glass FA (aerobic) and FN (anaerobic) bottles and one using plastic FA and FN bottles. Of the 4,040 sets of four bottles collected, 3,110 contained the recommended 8 to 12 ml of blood, yielding 524 microorganisms with 359 judged to be clinically significant. Of the 359 significant organisms, 255 were recovered in either one or two bottles from both pairs of bottles in a set while 56 organisms were recovered only from the glass bottles and 48 were recovered only from the plastic bottles (P, not significant [NS]). Of the 286 significant organisms recovered only in the FA bottles (glass and plastic), 180 were recovered in both bottles, 57 in the plastic bottles only, and 49 in the glass bottles only (P, NS). Of the 303 significant organisms recovered in the FN bottles only (glass and plastic), 212 were recovered in both bottles, 46 in the plastic bottles only, and 45 in the glass bottles only (P, NS). For individual organisms, the only significant difference in recovery was obtained for Escherichia coli, with more isolates recovered in the FN plastic than in the FN glass bottles (P ‫؍‬ 0.02). These data suggest that recovery of microorganisms with plastic FA/FN bottles is at least equal to that with glass FA/FN bottles while offering greater safety for users.bioMerieux, Inc. (Durham, NC), recently introduced plastic blood culture bottles to replace the previously utilized glass blood culture bottles. This change was made to reduce or eliminate the possibility of breakage. The purpose of this study was to compare the performance of the glass and plastic aerobic (FA) and anaerobic (FN) bottles with a full 10-ml blood draw in each bottle. MATERIALS AND METHODSThe standard of care for adult patients at Geisinger Medical Center is two pairs of blood cultures collected sequentially via separate venipunctures or separate line access. For this study, sets of four BacT/ALERT blood culture bottles were specially prepared in the laboratory. Sets included one each of a plastic FA (PFA), plastic FN (PFN), glass FA (GFA), and glass FN (GFN) blood culture bottle. Each pair of PFA-PFN or GFA-GFN bottles was labeled with the number one or two in order to facilitate collecting first into the PFA-PFN pair for approximately one-half of the patients while the remainder of the patient draws were collected first into the GFA-GFN pair. The standard Geisinger Medical Center protocol was followed for skin preparation prior to collection. Blood volumes were verified (8 to 12 ml) by the use of a visual standard.For the sake of clarity, the following terminology is consistently utilized in this report: the term "set" refers to all four bottles collected during a patient episode, the term "pair" refers to two bottles collected by a single collection procedure,...

The GeneOhm MRSA assay detects nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA). We compared the use of seeded swabs with liquid Stuart's medium and that of seeded swabs with Amies gel for the assay. Overall, the swabs with liquid Stuart's medium detected significantly greater numbers of MRSA than the swabs with Amies gel ( P = 0.0003).

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