Clinical Evaluation of BacT/Alert FA Plus and FN Plus Bottles Compared with Standard Bottles

Abstract

The performance of the BacT/Alert FA Plus and FN Plus resin bottles was evaluated in comparison with that of standard aerobic (SA) and standard anaerobic (SN) bottles. Twenty milliliters of blood from adult patients was equally distributed into four types of bottles: FA Plus, FN Plus, SA, and SN. The detection of clinically significant organisms and the time to detection (TTD) were monitored for each bottle. Among the 3,103 blood culture sets that were requested, the blood volume of each bottle was over 4 ml in 1,481 sets (47.7%). Among these 1,481 sets, 158 cultures grew in the FA Plus and SA bottles, and 136 grew in the FN Plus and SN bottles. Growth in only one type of bottle was more commonly observed for the FA Plus (n ‫؍‬ 38) than for the SA (n ‫؍‬ 14) (P ‫؍‬ 0.001) bottles and for the FN Plus (n ‫؍‬ 27) than for the SN (n ‫؍‬ 10) (P ‫؍‬ 0.008) bottles. Gram-negative bacilli were more frequently isolated in the resin bottles (P < 0.05). The skin contamination rate was 1.2% in the resin bottles and the standard bottles. The mean TTD was 11.1 h in the FA Plus bottles versus 13.1 h in the SA bottles (P < 0.001) and 12.0 h in the FN Plus bottles versus 12.8 h in the SN bottles (P ‫؍‬ 0.083). Clinically significant bacteria, including Gram-negative bacilli, were isolated more frequently from the resin bottles than from the standard bottles. Clinically significant bacteria were detected faster using the aerobic resin bottles than using the standard aerobic bottles. This finding might not be applicable to the standard-practice 10-ml protocol for each bottle because the results from using a smaller volume (5 ml) might be less pronounced. Sepsis is a critical illness causing high morbidity and mortality, and blood culture is essential for diagnosing sepsis. Advancements in blood culture equipment and broth media have been made for several decades. Antibiotics are sometimes empirically administered to manage urgent septic conditions, even before collecting blood for a bacterial culture. Approximately 50% to 90% of inpatients are administered antibiotics at the time of blood collection for culture (1-3). The presence of these antibiotics in the culture bottle may inhibit the growth of microorganisms.Resin-based media are known to absorb antibiotics present in blood culture media, which is useful for the evaluation of sepsis patients who have already received antibiotics. Charcoal-based media have the same effect but might hinder the microscopic observation of Gram staining. These bottles are known to enhance the detection of microorganisms, even for sepsis patients who do not receive antibiotics, possibly by inhibiting the activities of antibodies, complement factors, or cytokines (4).We evaluated the resin-based media that were recently developed by bioMérieux Inc. (Durham, NC), namely, FA Plus and FN Plus, for patients who visited the emergency department (ED) or who were admitted to the cancer center, the surgical intensive care unit (SICU), or the medical intensive care unit (MICU).The early detection of microorg...

Performance of Two Resin-Containing Blood Culture Media in Detection of Bloodstream Infections and in Direct Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry (MALDI-TOF MS) Broth Assays for Isolate Identification: Clinical Comparison of the BacT/Alert Plus and Bactec Plus Systems

“…The BacT/Alert Plus system detected clinically relevant BSIs after a mean incubation of 16 h (IQR, 9 to 21 h), and for certain species, TTDs were frequently Ͻ12 h, which is consistent with previous reports (40)(41)(42). The TTDs for positive BacT/Alert and Bactec cultures drawn after antimicrobial drugs had been started were comparable, but the former system was faster for treatment-negative samples and those containing coagulase-negative staphylococci.…”

“…Three recent studies (40)(41)(42) have demonstrated the superiority of the new resin-containing BacT/Alert media (FA Plus, FN Plus, and PF Plus) over standard and charcoal particle-containing media of the same line. In our study, the performance displayed by BacT/Alert Plus media was similar to that of resin-containing media in the Bactec line.…”

“…In accordance with CLSI guidelines (45) and the recommendations of various other authors (43,44), each BC bottle in our study was inoculated with 10 ml of blood. Because the number of microorganisms circulating in the blood may be relatively small, inoculum volume strongly affects BC sensitivity and incubation time requirements (40,44,46). Increasing this volume from 5 to 10 ml has been shown to significantly improve the overall yields of standard BacT/ Alert aerobic BC bottles and accelerate the detection of pathogenic growth, especially that of E. coli and other Enterobacteriaceae (43).…”

“…Three recent studies (40)(41)(42) found that the new bioMérieux BacT/Alert FA Plus, FN Plus, and PF Plus BC media, which contain adsorbent polymeric beads, improve and accelerate the detection of bloodstream pathogens compared with standard BacT/Alert media and with BacT/Alert media containing charcoal particles. The present study represents the first attempt to evaluate the performance of the new BacT/Alert FA Plus and FN Plus media compared with Becton Dickinson's Bactec Plus Aerobic/F and Anaerobic/F media, which also contain antimicrobial-binding resins.…”

The Success Model for Laboratory Performance and Execution of Rapid Molecular Diagnostics in Patients with Sepsis

“…Current standard blood culture procedures consist of inoculating a blood culture bottle and placing it on an automated continuous monitoring and alert platform (8). Upon positivity, the contents are Gram stained, plated on appropriate media, and allowed to grow for 18 to 42 hours or longer, with subsequent subcultures and susceptibility testing as appropriate.…”