kjcm Korean Journal of Clinical Microbiology Korean J Clin Microbiol 1229-0025 Korean Journal of Clinical Microbiology 10.5145/KJCM.2011.14.1.13 kjcm-14-13 Original Article Evaluation of Automated Blood Culture System for Body Fluids Culture Other Than Blood Choi Tae Yeal 1 Kang Jung Oak 1 Pai Hyun Joo 2 Department of Laboratory Medicine, Hanyang University Medical School, Seoul, Korea Department of Internal Medicine, Hanyang University Medical School, Seoul, Korea Correspondence: Tae Yeal Choi, Department of Laboratory Medicine, Hanyng University Hospital, 17 Haengdang-dong, Seongdong-gu, Seoul 133-792, Korea. (Tel) 82-2-2290-8974, (Fax) 82-2-2298-1735, (E-mail) tychoi@hanyang.ac.kr 32011 2132011 141 1317 04052010 28062010 20072010 Copyright © 2011 Korean Journal of Clinical Microbiology 2011 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background

We investigated whether culture using an automated blood culture system enhances the recovery of bacteria and fungi from body fluids other than blood when compared to conventional solid media culture methods.

 Methods

A total of 734 specimens [ascites (n=457), bile (n=5), CAPD (n=28), CSF (n=32), joint fluids (n= 165), pericardial fluid (n=17), and pleural fluid (n=30)] were included in the study. Half of the volume of each specimen was inoculated directly into automated blood culture bottles (bioMeriux, Marcy-I'Etoile, France). The remaining volume was inoculated onto conventional solid media (sheep blood agar, chocolate agar, and phenylethyl alcohol agar) after centrifuging at 3,000 rpm for 10 min.

 Results

Clinically significant microorganisms were isolated from 62 specimens (8.5%) by automated blood culture and 61 specimens (8.3%) by the conventional solid media culture (kappa index: 0.81, 95% confidence interval: 0.75∼0.89). Contamination was observed in 11 (1.8%) of the automated blood culture specimens and 3 (0.4%) of the solid media culture specimens. The mean turnaround times of the automated blood cultures and the conventional solid media cultures were 3.7 and 2.8 days, respectively (P＜ 0.0001).

 Conclusion

Compared with conventional culture methods, no improvement in the recovery of clinically significant microorganisms was noted with the use of the automated blood culture system for the culture of body fluids other than blood.

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Number of isolates by automatic blood culture system (BC) and solid media culture methods (SM)

Test Ascite BC/SM Bile BC/SM CAPD BC/SM CSF BC/SM JF BC/SM PcF BC/SM PF BC/SM Total BC/SM
Clinically significant issolates
 S. aureus 1/0   0/1 1/0 18/19   2/2 22/22
 Streptococcus spp.∗       0/1 6/7     6/8
 Enterococcus spp.† 0/1   1/1   1/1     2/3
 S. pneumoniae             1/1 1/1
 Enterobacteriaceae‡ 9/7 3/3 3/2 1/1 1/1   1/0 18/14
 P. aeruginosa 2/3       1/0   3/3 6/5
Fungus§   1/1 2/2 1/1       4/4
 Nocardia spp.         1/1     1/1
 M. abscessus         1/1     1/1
 Bacteroides spp.             1/1 1/1
 Subtotal 12/11 4/4 6/6 3/3 29/30   8/7 62/61
Contaminants                
 CNS∥ 1/0   3/1 2/0 3/1 1/0   10/2
 Gram+bacilli 1/1             1/1
 Subtotal 2/1   3/1 2/0 3/1 1/0   11/3
No growth 443/445 1/1 19/21 27/29 133/134 16/17 22/23 661/670
Total 457/457 5/5 28/28 32/32 165/165 17/17 30/30 734/734

S. pyogenes, S. agalactiae, Streptococcus β-hemolysis Group G

E. faecalis, E. faecium

E. coli, K. pneumonia, E. cloacae, P. mirabilis, S. marcescens, Aeromonas spp.

Candida spp., C. neoformans

S. epidermidis, S. capitis, S. cohnii, S. hominis. Abbreviations: CAPD, continuous ambulatory peritoneal dialysis; CSF, cerebrospinal fluid; JF, joint fluid; PcF, pericardial fluid; PF, pleural fluid; CNS, coagulase-negative staphylococci.

Discrepancy of results in automated blood culture system and solid media culture methods

Solid media
Liquid media Ascite Bile CAPD CSF JF PcF PF Total
+ − + − + − + − + − + − + − + −
+ 10 4 4 0 7 5 2 3 29 4 0 0 7 1 59 17
− 2 441 0 1 1 15 1 26 2 130 1 16 0 22 7 651

Abbreviations: CAPD, continuous ambulatory peritoneal dialysis; CSF, cerebrospinal fluid; JF, joint fluid; PcF, pericardial fluid; PF, pleural fluid; +, growth; −, no growth.

Agreement (Kappa index)∗ of automated blood culture system and solid media culture methods

Specimens (n) Kappa index .95 confidence interval
Ascite (457) 0.777 0.587∼0.967
Bile (5) 1.000 1.000∼1.000
CAPD (28) 0.576 0.204∼0.947
CSF (32) 0.632 0.1637∼1.000
Joint (165) 0.856 0.751∼0.960
Pericardial (17) NC NC
Pleural (30) 0.734 0.446∼1.000
Total (734) 0.814 0.736∼0.891

Kappa index/Agreement: ＜0.00/Less than chance, 0.00∼0.20/ Slight, 0.21∼0.40/Fair, 0.41∼0.60/Moderate, 0.61∼0.80/Substantial, 0.81∼1.00/Almost perfect. Abbreviation: NC, no calculation.