Clinical comparison of isolator and thiol broth with ESP aerobic and anaerobic bottles for recovery of pathogens from blood

Kellogg, James A.; Bankert, David A.; Manzella, John P.; Parsey, Kelly; Scott, Sharon L.; Cavanaugh, Sean

doi:10.1128/jcm.32.9.2050-2055.1994

Cited by 39 publications

(16 citation statements)

References 41 publications

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“…The proportion of VGS isolates categorized as significant, indeterminate, or not significant in our study is in keeping with the proportions generated by other studies of unselected VGS populations (25,30,31). That the use of a lysis-centrifugation culture method is associated with a higher rate of clinically insignificant isolates has been demonstrated previously (17,27).…”

Section: Discussionsupporting

confidence: 90%

E Test versus Agar Dilution for Antimicrobial Susceptibility Testing of Viridans Group Streptococci

et al. 1999

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Viridans group streptococci (VGS) are commonly isolated from the blood of hospitalized patients. The E test represents a convenient method for determining the MICs for VGS, but for this purpose it has not been well validated against reference methods. In this study, 180 unselected VGS isolates were identified to a species level, and the MICs of penicillin, cefuroxime, cefotaxime, and vancomycin were determined by both agar dilution and the E test. Available data regarding demographic and laboratory variables for each VGS bacteremic episode were collected, the significance of each VGS isolate was assessed, and the associations between and among laboratory and clinical variables were investigated. Among all VGS isolates, 68.3% (median of three runs) were found to be fully susceptible to penicillin by agar dilution. The E test and agar dilution showed average agreements (within ±1 dilution) of 92.2% for penicillin, 95.7% for cefuroxime 91.3% for cefotaxime, and 86.7% for vancomycin. Agreements over serial E tests and serial agar dilutions were excellent for β-lactam agents (intraclass correlation coefficients, >0.9) but less impressive for vancomycin. Very major error rates for the E test were ≤0.7%, and combined major and minor error rates were within acceptable limits for all antimicrobial agents tested. Lysis-centrifugation culture methods were more often associated with clinically insignificant VGS isolates; otherwise, no associations between clinical and laboratory variables were noted.

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Section: Discussionsupporting

confidence: 90%

E Test versus Agar Dilution for Antimicrobial Susceptibility Testing of Viridans Group Streptococci

et al. 1999

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“…Pathogens from 23% of the children with bacteremia were detected as only a single colony (Յ1 CFU/ml of blood) from Isolators inoculated with up to 10 ml of blood. The frequency of low-level bacteremia in our pediatric population is higher than that (up to 38%) in other similar populations, as previously reviewed (20), and only a little lower than the 73% which we have found in our predominantly adult population (18). The accuracy of the determination of the frequency of low-level bacteremia in any population is heavily dependent on the routine culturing of sufficient volumes of blood.…”

Section: Discussioncontrasting

confidence: 40%

“…The current study did not address the possibility of inoculating all of the blood into a single bottle. However, the combination of Isolators (or, in other laboratories, bottles with antibiotic-inactivating material) and conventional aerobic and/or anaerobic bottles in each blood culture set allows for adequate dilution of blood and maximizes the chances of recovery of pathogens such as S. pneumoniae (which may not be reliably recovered from Isolators [18]), pathogens from pretreated patients or patients with low-level bacteremia from other causes, and anaerobes. Since the conclusion of the study, because so few anaerobes were recovered, blood from lowbirth-weight (Յ1-kg) newborns is usually inoculated into aerobic bottles (in addition to Isolators) to maximize the detection of aerobic pathogens.…”

Section: Discussionmentioning

confidence: 99%

“…The centrifuged sediment from 10-ml Isolators and the entire specimen from Pediatric Isolators (1.5 ml) were inoculated onto two sheep blood and two chocolate agar plates exactly as specified by the Isolator manufacturer. The agar cultures were incubated for recovery of aerobic and facultatively anaerobic pathogens as previously described (18). Positive Isolator cultures were Gram stained and subcultured once daily.…”

Section: Methodsmentioning

confidence: 99%

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Frequency of Low-Level Bacteremia in Children from Birth to Fifteen Years of Age

Kellogg¹,

Manzella

Bankert³

2000

J Clin Microbiol

146

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A single blood culture inoculated with a small volume of blood is still frequently being used for the diagnosis of bacteremia in children because of the continued belief by many that bacteria are usually found in high concentrations in the blood of pediatric patients with sepsis. To determine the importance of both blood volume cultured and the number of culture devices required for the reliable detection of pathogens in our pediatric population, blood from children from birth to 15 years of age and with suspected bacteremia at York Hospital (a 500-bed community hospital) was inoculated into at least a Pediatric Isolator (Wampole Laboratories; 1.5 ml of blood) or a standard Isolator (10 ml of blood) and a bottle of ESP anaerobic broth (Trek Diagnostic Systems; 0.5 to 10 ml of blood). The use of a second Isolator and additional aerobic and anaerobic bottles and the total blood volume recommended for cultures (2 to 60 ml) depended on the weight and total blood volume of each patient. One hundred forty-seven pathogens were recovered from the blood of 137 (3.6%) of 3,829 children for whom culturing was done. Of 121 septic episodes for which the concentration of pathogens in the blood could be determined using Isolators, 73 (60.3%) represented low-level bacteremia (<10 CFU/ml of blood), including 28 pathogens (23.1%) which were detected at concentrations of only <1.0 CFU/ml. Of 144 septic episodes for which two or more culture devices (Isolators and/or bottles) were inoculated, 85 (59%) were associated with false-negative results from one or more of the culture devices. Of the 128 children for whom antibiotic therapy records were complete, therapy was either started or changed for 88 (68.8%) following notification of positive blood cultures. Low-level bacteremia was common in our pediatric population, requiring the culturing of up to 4 or 4.5% of a patient's total blood volume for the reliable detection of pathogens and appropriate, timely changes in empiric therapy.

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“…A concern about the Isolator blood culture system has been its relatively high rate of recovery of contaminating microorganisms, which is likely the result of the additional processing steps required for the Isolator system compared to broth systems (1,4). Contaminated blood cultures significantly increase resource utilization and therefore add unnecessarily to the cost of medical care (1).…”

Section: Discussionmentioning

confidence: 99%

Clinical comparison of BACTEC 9240 plus aerobic/F resin bottles and the isolator aerobic culture system for detection of bloodstream infections

et al. 1997

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The Plus Aerobic/F resin bottle of the BACTEC 9240 automated blood culture system (Becton Dickinson Diagnostic Instrument Systems, Sparks, Md.) was compared with aerobic culture of the Isolator system (Wampole Laboratories, Cranbury, N.J.) for the detection of bloodstream microorganisms from 6,145 blood cultures collected from adult patients with suspected septicemia. The BACTEC resin bottles were incubated for 7 days, and the sediment from the Isolator tube was inoculated to sheep blood and chocolate agars which were incubated for 72 h and to inhibitory mold, brain heart infusion, and Sabouraud agars which were incubated for 21 days. A total of 622 microorganisms were recovered from 583 blood cultures. The BACTEC resin bottle recovered statistically significantly more pathogens overall than the Isolator system (P ‫؍‬ 0.0006). When individual pathogens isolated from either system for a 7-day study period were assessed, it was determined that the BACTEC resin bottle detected statistically significantly more isolates of Staphylococcus aureus (P ‫؍‬ 0.0113) and coagulase-negative Staphylococcus spp. (P ‫؍‬ 0.0029) than the Isolator system. The BACTEC resin bottle also detected statistically significantly more bloodstream infections (septic episodes) caused by coagulasenegative Staphylococcus spp. (P ‫؍‬ 0.0146). The Isolator system recovered statistically significantly more contaminants overall (P < 0.0001), and among this group of microorganisms, recovered statistically significantly more Bacillus spp. (P < 0.0001), coagulase-negative Staphylococcus spp. (P < 0.0001), and viridans group Streptococcus spp. (P ‫؍‬ 0.0156). The Isolator system detected statistically significantly more isolates of Histoplasma capsulatum (P ‫؍‬ 0.004), but all of these isolates were detected at >7 days of incubation of fungal plates, i.e., after the system to system comparison study period (7 days). In blood culture sets which produced growth of the same pathogen in both systems, there was a statistically significant difference in median time to detection for all pathogens combined favoring the BACTEC resin bottle over the Isolator tube (P < 0.05). When assessing individual microorganisms, the median times for detection of S. aureus, Enterococcus spp., and Pseudomonas spp. were all statistically significantly less for the BACTEC system (P < 0.05). The BACTEC instrument had 79 (1.3%) false positive signals. The BACTEC system required less processing time than the Isolator system and eliminates the hands-on time for detection of positive cultures required with the Isolator system.

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Clinical comparison of isolator and thiol broth with ESP aerobic and anaerobic bottles for recovery of pathogens from blood

Cited by 39 publications

References 41 publications

E Test versus Agar Dilution for Antimicrobial Susceptibility Testing of Viridans Group Streptococci

E Test versus Agar Dilution for Antimicrobial Susceptibility Testing of Viridans Group Streptococci

Frequency of Low-Level Bacteremia in Children from Birth to Fifteen Years of Age

Clinical comparison of BACTEC 9240 plus aerobic/F resin bottles and the isolator aerobic culture system for detection of bloodstream infections

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