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Kim, Sung, and Kim: Performance evaluation of 4-day versus 5-day blood cultures using the BD BACTEC FX system
Original article

Ann Clin Microbiol 2023;26(4):125-137.

Published online: 20 December 2023

DOI: https://doi.org/10.5145/ACM.2023.26.4.125

Performance evaluation of 4-day versus 5-day blood cultures using the BD BACTEC FX system

Jiyeon Kim, Heungsup Sung, Mi-Na Kim

Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Corresponding author: Mi-Na Kim E-mail: mnkim@amc.seoul.kr

Received 26 October 2023       Revised 1 December 2023       Accepted 4 December 2023

© Korean Society of Clinical Microbiology. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Blood culture (BC) systems have evolved to increase sensitivity and reduce turnaround times. This study compared the performance of a 4-day versus a 5-day BC incubation period using the BD BACTEC™ FX (Becton, Dickinson and Company, USA). Methods: A total of 37,379 consecutive sets of BC were evaluated over a 3-month period in a 2,700-bed tertiary care hospital. Positive BC results were reviewed to assess time-to-positivity (TTP) and species identification of the isolates. The BCs were performed in pairs of vials, utilizing either BD BACTEC Plus Aerobic/F or Peds Plus/F with BD BACTEC Lytic Anaerobic media. Results: A total of 14,899 episodes, averaging 2.51 sets per episode, were analyzed. Of these, 1,398 (9.38%) were positive, yielding 1,465 isolates. TTP (hours) were < 12 in 48.87%, 12-24 in 31.40%, 24-48 in 13.38%, 48-72 in 3.28%, 72-96 in 1.43%, and >96 in 1.64%. The two most prevalent organisms, Escherichia coli and Klebsiella spp. were detected within 12 hours in 88.75% and 78.90%, respectively. The respective median TTP (T50) values for E. coli, Klebsiella spp., Enterococcus faecalis/E. faecium, and Staphylococcus aureus were 9.24, 9.60, 13.75, and 14.20. T50 values for these species were significantly shorter in anaerobic bottles than in aerobic bottles. Of 24 BCs with TTP > 96, only 4 containing anaerobic bacteria or molds were f irst detected after 96 hours. Conclusion: A 4-day incubation has demonstrated excellent sensitivity. However, a 5-day incubation may be beneficial for hospitals caring for patients at high risk for infections with slow-growing fungi or fastidious bacteria.

Keywords: Anaerobic bacteria, Blood culture, Fungi, Incubation, Times to positivity

[in Korean]

Ethics statement

The obtainment of informed consent was waived since it is a retrospective chart review.

Conflicts of interest

No potential conflicts of interest relevant to this article were reported.

Funding

None.

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Fig. 1.
Cumulative percentages of positive blood cultures according to time-to-positivity.
ACM-2604-05-f1.png
Fig. 2.
Number of isolates by time to positivity in aerobic and anaerobic bottles. The white, black, and gray arrow head denoted T50 of aerobic bottles, anaerobic bottles, both bottles, respectively. T50, median time-to-positivity.
ACM-2604-05-f2.png
Table 1
Cumulative incidence of twelve most frequent species according to time-to-positivity of blood cultures
ACM-2604-05-t1.png

*Skin normal flora were often detected at ≥ 48 h as contaminants of blood cultures.

Abbreviation: T50, median time-to-positivity; IQR, interquartile range.

Table 2
Number (%) of six most frequent organisms isolated from only aerobic bottles, only anaerobic bottles and both bottles
ACM-2604-05-t2.png
Fig. 3.
The time to positivity (TTP) of aerobic and anaerobic bottles among six most frequent organisms. Each of the white and black arrow heads denoted T50 of aerobic bottles and anaerobic bottles, respectively. The TTP for P. aeruginosa displayed only for aerobic bottles. CNS, coagulase-negative staphylococci; T50, median time-to-positivity.
ACM-2604-05-f3.png
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