This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowReprints and Permissions
Right arrow Copyright Information
Right arrow Books from ASM Press
Right arrow MicrobeWorld
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Horvath, L. L.
Right arrow Articles by Hospenthal, D. R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Horvath, L. L.
Right arrow Articles by Hospenthal, D. R.

 Previous Article  |  Next Article 

Journal of Clinical Microbiology, January 2004, p. 115-118, Vol. 42, No. 1
0095-1137/04/$08.00+0     DOI: 10.1128/JCM.42.1.115-118.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.

Direct Comparison of the BACTEC 9240 and BacT/ALERT 3D Automated Blood Culture Systems for Candida Growth Detection

Lynn L. Horvath,1* Benjamin J. George,1 Clinton K. Murray,1 Linda S. Harrison,2 and Duane R. Hospenthal1

Department of Medicine,1 Department of Pathology and Area Laboratory Support, Brooke Army Medical Center, Fort Sam Houston, Texas2

Received 13 August 2003/ Returned for modification 20 September 2003/ Accepted 11 October 2003


arrow
ABSTRACT
 
A direct comparison of two automated blood culture systems was conducted to compare their ability to detect Candida growth. The systems evaluated were the BACTEC 9240 (Bactec) and BacT/ALERT 3D (BacT). The aerobic, anaerobic, and mycology media for each system were evaluated: Bactec Plus Aerobic/F, Plus Anaerobic/F, and Myco/F Lytic bottles,, respectively, and BacT FA, SN, and MB bottles, respectively. Each blood culture bottle was inoculated with fresh blood from healthy donors. Fifty isolates of Candida spp. were used. The six different blood culture bottles were each inoculated with 1,000 yeasts per bottle and then incubated in the corresponding automated system. The BacT detected growth of 90% (135 of 150) of Candida pathogens, while Bactec detected 66% (100 of 150). Growth was detected in all BacT and Bactec mycology bottles, all BacT aerobic bottles, and by terminal subculture of all bottles. Sixty-five of 300 (22%) bottles had no growth detected; 50 from the Bactec (5 aerobic and 45 anaerobic) and 15 from the BacT (all anaerobic). Terminal subculture of "negative" bottles demonstrated viable yeast growth from all 65 bottles, representing 65 false-negatives. The mean time to growth detection in the BacT system was 25.62 h while the Bactec was 27.30 h (P < 0.01). Both automated blood culture systems detected all episodes of simulated candidemia when specialized mycology media were used. However, when only standard aerobic and anaerobic media were used, the BacT performed better than the Bactec in overall growth detection, time to growth detection, and number of false-negatives.


arrow
INTRODUCTION
 
Candida spp. are now the fourth most common pathogen isolated from the blood of hospitalized patients in the United States (5, 19). Unfortunately, candidemia is also associated with the highest mortality (40%) of all nosocomial bloodstream infections (5). Episodes of candidemia are most commonly detected with standard aerobic and anaerobic blood culture media in automated blood culture systems. Multiple studies have demonstrated effective recovery of Candida spp. with the BACTEC 9240 (Bactec) (BD Diagnostic Systems, Sparks, Md.) (7, 18, 20, 27) and BacT/ALERT 3D (BacT) (bioMérieux, Inc., Durham, N.C.) (3, 4, 6, 8, 13, 24, 28) automated blood culture systems. Several studies also exist that compare the BacT and Bactec automated blood culture systems (10, 12, 14, 17, 21, 23, 26, 29). However, these studies address only a small number of candidemia episodes, primarily secondary to Candida albicans. The predominant cause of candidemia had been C. albicans until recently (1), but now Candida species other than C. albicans, collectively termed "non-albicans Candida" (NAC), species, particularly Candida glabrata, Candida parapsilosis, and Candida tropicalis, account for approximately one-half of all nosocomial bloodstream Candida isolates recovered from patients in the United States (5, 11, 16, 19, 25).

The ability of automated blood culture systems to detect growth of NAC species has not been thoroughly evaluated. The growth requirements and characteristics may be different than C. albicans and therefore may alter the ability of automated blood culture systems to detect NAC growth. In the course of performing a separate study on simulated candidemia in the Bactec, we noted some difficulty in growth detection and time to growth detection among both C. albicans and NAC species (9). We therefore performed this study to directly compare the ability of two automated blood culture systems in the detection of the five most common species implicated in candidemia, specifically evaluating growth detection, time to growth detection, and the utility of terminal subcultures with a simulated candidemia model.

(This work was presented in part at the 103rd Annual Meeting of the American Society for Microbiology, Washington, D.C., 2003 [L. L. Horvath, B. J. George, C. K. Murray, L. S. Harrison, and D. R. Hospenthal, Abstr. 103rd Annu. Meet. Am. Soc. Microbiol., abstr. F-089, p. 289].)


arrow
MATERIALS AND METHODS
 
Two automated blood culture systems were evaluated in this study, the BACTEC 9240 (Bactec) and the BacT/ALERT 3D (BacT). Aerobic, anaerobic, and mycology media were evaluated in each automated blood culture system. The media used with the Bactec system were the Plus Aerobic/F (aerobic), Plus Anaerobic/F (anaerobic), and Myco/F Lytic (mycology), while FA (aerobic), SN (anaerobic), and MB (mycology) were used with the BacT system. The Myco/F Lytic and MB media can be used to recover either fungal or mycobacterial pathogens from the blood.

This protocol was approved by the institutional review board at Brooke Army Medical Center. Fresh, whole blood was drawn from healthy volunteers after obtaining written informed consent. All aerobic and anaerobic bottles were inoculated with 10 ml of blood, while mycology bottles were inoculated with 5 ml of blood, per the manufacturer's recommendations. Prior to inoculation with blood, the MB bottles were also inoculated with 1 ml of enrichment fluid as recommended by the manufacturer for use with this medium.

Fifty clinical isolates of Candida were used in this study, including 10 isolates of each of the following species: C. albicans, C. glabrata, Candida krusei, C. parapsilosis, and C. tropicalis. Frozen yeast isolates, originally isolated from clinical specimens, and subsequently maintained at -70°C, were subcultured twice onto solid medium (yeast extract peptone dextrose agar) to ensure isolation of pure colonies. A suspension of each specimen was made in 5 ml of normal saline and adjusted to a 0.5 McFarland standard (BD Diagnostic Systems, Sparks, Md.) at 530-nm transmittance (Spectronic 20D, Milton Roy, Rochester, N.Y.). The resulting suspension contained approximately 106 yeast cells/ml (15). A 1:100 dilution of each yeast suspension was then performed to produce a density of 104 yeast cells/ml. A 0.1-ml aliquot of each final suspension was introduced into each of the six bottles (Aerobic/F, Anaerobic/F, Myco/F Lytic, FA, SN, and MB) to produce a final inoculum density of approximately 1,000 yeast cells/bottle. Inoculum densities were verified by culturing serial dilutions on solid medium, incubating at 30°C, and performing colony counts after 48 h of incubation.

After the addition of 0.1 ml of yeast suspension, inoculated bottles were immediately placed in the appropriate automated blood culture system. Each system incubates specimens at 35°C with continuous agitation and tracks the quantity and rate of CO2 production, indicative of microbial growth. Individual blood culture bottles were removed from the automated blood culture systems when growth was detected and time to detection was recorded. A 0.1-ml aliquot was withdrawn from each positive bottle and plated onto solid medium, incubated at 30°C, and read daily for up to 3 days to confirm growth.

Blood culture bottles in which no growth was detected were removed from the automated system after 12 days, seven days after the last bottle had growth detected in either automated blood culture system. Terminal subculture was performed on all bottles in which no growth was detected; a 0.1-ml aliquot was removed from each bottle and then plated on solid medium. Each plate was incubated at 30°C and read daily for up to 3 days.

Statistical analysis of data was performed with SPSS (Chicago, Ill.) software version 11.5. Multifactor analysis of variance was followed by Student-Newman-Keuls tests. Additional tests included Fisher's exact test, McNemar tests, and Cohen's Kappa when necessary.


arrow
RESULTS
 
Of the 300 blood culture bottles inoculated in this study, 235 (78%) had Candida growth detected by the automated blood culture systems. All 235 bottles were subcultured and demonstrated heavy growth of pure yeast colonies and were therefore true positives. Overall, the BacT system detected growth in 135 of 150 (90%) bottles while the Bactec system detected growth in 100 of 150 (66%) bottles. Three of the six types of media were able to detect growth of all 50 Candida isolates. These included the two specialized mycology media (Bactec Myco/F Lytic and BacT MB) and the BacT aerobic medium (FA). The three remaining types of media detected less Candida growth; 45 of 50 (90%) isolates were detected in Bactec aerobic medium, 35 of 50 (70%) in BacT anaerobic medium, and 5 of 50 (10%) in Bactec anaerobic medium. Growth detection results for each Candida spp. in the six different types of media are depicted in Table 1.


View this table:
[in this window]
[in a new window]
  		TABLE 1. Detection of Candida spp. growth in automated blood culture systemsa

Sixty-five (22%) of the 300 bottles had no growth detected despite 12 days of incubation. Terminal subculture was performed on all 65 of the bottles that had no growth detected by the automated blood culture systems; all of these cultures demonstrated heavy growth of pure yeast colonies, representing 65 false-negatives. Sixty of the 65 (92%) bottles without growth detected were anaerobic media, 45 Bactec and 15 BacT. Only five of the "negative" bottles were aerobic media, all Bactec aerobic medium.

The time to growth detection varied widely depending on the automated blood culture system, type of medium, and Candida spp. (Table 2). The mean time to growth detection for all Candida spp. was overall faster in the BacT (25.62 ± 8.90 h) than the Bactec (27.30 ± 21.18 h) automated blood culture system (P < 0.01). Bactec Myco/F Lytic was the individual medium with the fastest mean time to growth detection, 21.15 ± 3.55 h.


View this table:
[in this window]
[in a new window]
  		TABLE 2. Time to Candida spp. growth detection in automated blood culture systemsa

Most of the Candida spp. had growth detected within 24 h (Table 2). However, C. glabrata isolates demonstrated very different growth rates, particularly in aerobic media. The mean time to growth detection of C. glabrata in aerobic media was significantly longer than in the corresponding automated blood culture system's anaerobic media (Bactec: 106.00 ± 18.99 versus 34.03 ± 10.59 h, and BacT: 51.82 ± 9.93 versus 25.73 ± 3.30 h, P < 0.01). The mean time to growth detection of C. glabrata was also significantly longer in Bactec compared to BacT aerobic media (106.00 ± 18.99 versus 51.82 ± 9.93 h, P < 0.01). Time to growth detection for C. glabrata isolates in aerobic media was also significantly longer than any of the other Candida spp. in both the Bactec and BacT aerobic media (Bactec: 106.00 ± 18.99 versus 22.23 ± 5.78 h, and BacT: 51.82 ± 9.93 versus 23.33 ± 5.58 h, P < 0.05).


arrow
DISCUSSION
 
The mycology media for both the BacT and Bactec automated blood culture systems demonstrated excellent ability to detect Candida growth with 100% detection of all fifty Candida isolates. However, few institutions routinely utilize a mycology bottle as a part of all blood culture sets, secondary to the requirement for extra blood and laboratory space. Additionally, the routine use of mycology media adds a substantial expense; each mycology bottle is approximately three times more expensive than an aerobic or anaerobic blood culture bottle. Unfortunately, candidal and bacterial sepsis can have identical clinical presentations; in order to use the mycology media in a cost-effective manner, the clinician needs to have a high clinical suspicion of candidemia or rely on standard aerobic and anaerobic media for the detection of candidemia.

Aerobic media performed well overall, detecting 95% of Candida pathogens; the BacT detected 100% and the Bactec detected 90%. Candida spp. are generally regarded as obligate aerobes (27), and it is somewhat disturbing to have any missed detection of Candida growth in aerobic media. It is interesting that the five isolates not detected by the Bactec aerobic media were all NAC species, including one C. krusei and four C. glabrata isolates. This potentially poses a problem for many American hospitals where C. glabrata is now the second most common Candida sp. isolated, causing between 24 and 42% of all cases of candidemia (5, 16, 19, 25).

Candida growth detection in anaerobic media was suboptimal in both of the evaluated automated blood culture systems, detecting 40% of Candida pathogens; the BacT detected 70% and the Bactec detected 10%. Interestingly, the only Candida sp. detected in the Bactec anaerobic medium was C. glabrata, and only 50% of the tested C. glabrata isolates were detected. Conversely, all Candida spp. tested had at least some isolates detected in the BacT anaerobic medium, including 10 C. albicans, 9 C. krusei, 8 C. glabrata, 7 C. tropicalis, and 1 C. parapsilosis isolate.

Sixty-five (22%) bottles, predominantly anaerobic, had no growth detected by the automated blood culture systems, despite the fact that each bottle was seeded with approximately 1,000 yeasts and incubated for up to 12 days. All were determined to be false-negatives upon terminal subculture. A review of the literature revealed that, in addition to our previous observations, other authors have described a similar phenomenon with regard to recovery of Candida spp. on terminal subculture with use of both the Bactec (9, 17, 22, 29) and the BacT (2) automated blood culture systems.

There is no consensus in the literature concerning the optimal incubation period required for recovery of yeasts from automated blood culture systems (3, 18, 20). Most clinical laboratories will incubate blood cultures in automated systems for five days and then discard "negative" bottles without performing terminal subculture, following the recommendations of the College of American Pathologists. However, there is data to suggest that a 3-day incubation period is sufficient for isolation of clinically relevant bacterial and fungal pathogens, and laboratories may adopt a 3-day incubation period in the future (3). Therefore, time to detection of Candida growth is an important consideration.

In this study, the mean time to Candida growth detection in the BacT was faster than the Bactec automated blood culture system (P < 0.01), although growth detection with Bactec mycology medium was faster than with BacT mycology medium (P < 0.01). The overall difference in time to detection between the two systems can be solely attributed to the delayed time to growth detection of C. glabrata in Bactec aerobic medium. We feel these statistical differences do not likely represent clinically significant differences. However, the mean time to aerobic growth detection is strikingly slower for C. glabrata than all other Candida spp. (Table 2; P < 0.05). C. glabrata anaerobic growth detection was significantly faster than C. glabrata aerobic detection in both automated blood culture systems (P < 0.01). The aerobic detection of C. glabrata in the BacT (51.82 ± 9.93 h) was faster than in the Bactec (106.00 ± 18.99 h) (P < 0.01), a difference that is not only statistically significant but also clinically relevant. The BacT aerobic medium detected C. glabrata isolates a full 2 days sooner than the Bactec aerobic medium.

A closer review of the data also reveals an important finding. The C. glabrata range for time to growth detection in the BacT aerobic media was 39.30 to 64.80 h; all 10 isolates had times to detection under a three or five day incubation period. The corresponding time to growth detection of C. glabrata in the Bactec aerobic medium ranged from 72.43 to 126.51 h; this included all six isolates detected exceeding a 3-day incubation period and two isolates exceeding a 5-day incubation period.

Is it actually important for both the aerobic and anaerobic media to detect Candida growth? After all, as long as one bottle of a standard aerobic and anaerobic blood culture set detects Candida growth, the clinician will be able to treat the patient appropriately. It is therefore important to also look at the overlap of missed isolates to determine if there were any missed episodes of simulated candidemia. The Bactec detected growth of 47 (94%) Candida isolates in at least one bottle of the aerobic or anaerobic media. Though this may seem adequate, three episodes of candidemia were missed, one C. krusei and two C. glabrata, resulting in potentially serious morbidity or mortality. The BacT system missed no episodes of candidemia. Recall, though, that our isolates were all incubated for a total of 12 days. If a standard 5-day incubation period were employed, the Bactec would have missed an additional episode of C. glabrata candidemia secondary to the prolonged time to growth detection in Bactec aerobic media. If the incubation period were decreased to only 3 days, two more episodes of C. glabrata candidemia would be missed. If a 3-day incubation period was employed and specialized mycology medium was not used, the Bactec system detected growth of 44 (88%) Candida isolates in at least one bottle of the aerobic or anaerobic media, resulting in six episodes of missed candidemia, one C. krusei and five C. glabrata. The BacT system missed no episodes of candidemia, even with the above criteria.

Both the BACTEC 9240 and BacT/ALERT 3D automated blood culture systems detected all Candida pathogens in at least one bottle when aerobic, anaerobic, and mycology media were used. However, most clinical laboratories do not routinely use mycology media for all blood cultures. Under these circumstances, when only aerobic and anaerobic media are used, the BacT performed better than the BACTEC in overall detection, time to detection, number of false-negatives, and missed episodes of simulated candidemia. With the increasing prevalence of candidemia among hospitalized patients, particularly secondary to NAC, further investigation is necessary to improve the recovery of all Candida spp. in automated blood culture systems. Until improvements in these systems are made, we may need to encourage clinical microbiology laboratories to routinely use mycology media and terminally subculture negative bottles to ensure that episodes of candidemia are not missed.


arrow
ACKNOWLEDGMENTS
 
We thank the Brooke Army Medical Center Microbiology Laboratory for the use of BACTEC 9240 and BacT/ALERT 3D automated blood culture systems with the assistance of the laboratory technicians under the direction of Linda Harrison. We also thank Walter Mika for assistance with phlebotomy and John A. Ward for assistance with statistical analysis of the data.

The views expressed are those of the authors and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the U.S. Government.


arrow
FOOTNOTES
 
* Corresponding author. Mailing address: Brooke Army Medical Center, Infectious Disease Service (MCHE-MDI), 3851 Roger Brooke Drive, Fort Sam Houston, TX 78234. Phone: (210) 916-4355. Fax: (210) 916-0388. E-mail: Lynn.Horvath{at}amedd.army.mil. Back


arrow
REFERENCES
 
    1
  1. Beck-Sagué, C. M., W. R. Jarvis, and the National Nosocomial Infections Surveillance System. 1993. Secular trends in the epidemiology of nosocomial fungal infections in the United States, 1980-1990. J. Infect. Dis. 167:1247-1251.[Medline]
    2. 2
  2. Borst, A., M. Leverstein-Van Hall, J. Verhoef, and A. Fluit. 2000. Value of terminal subculture of automated blood cultures in patients with candidaemia. Eur. J. Clin. Microbiol. Infect. Dis. 19:803-805.[CrossRef][Medline]
    3. 3
  3. Bourbeau, P. P., and J. K. Pohlman. 2001. Three days of incubation may be sufficient for routine blood cultures with BactT/Alert FAN blood culture bottles. J. Clin. Microbiol. 39:2079-2082.[Abstract/Free Full Text]
    4. 4
  4. Doern, G. V., A. Barton, and S. Rao. 1998. Controlled comparative evaluation of BacT/Alert FAN and ESP 80A aerobic media as means for detecting bacteremia and fungemia. J. Clin. Microbiol. 36:2686-2689.[Abstract/Free Full Text]
    5. 5
  5. Edmond, M. B., S. E. Wallace, D. K. McClish, M. A. Pfaller, R. N. Jones, and R. P. Wenzel. 1999. Nosocomial bloodstream infections in United States hospitals: a three year analysis. Clin. Infect. Dis. 29:239-244.[Medline]
    6. 6
  6. Frank, U., D. Malkotsis, D. Mlangeni, and F. D. Daschner. 1999. Controlled clinical comparison of three commercial blood culture systems. Eur. J. Clin. Microbiol. Infect. Dis. 18:248-255.[CrossRef][Medline]
    7. 7
  7. Fricker-Hidalgo, H., F. Chazot, B. Lebeau, H. Pelloux, P. Ambroise-Thomas, and R. Grillot. 1998. Use of simulated blood cultures to compare a specific fungal medium with a standard microorganism medium for yeast detection. Eur. J. Clin. Microbiol. Infect. Dis. 17:113-116.[Medline]
    8. 8
  8. Hardy, D. J., B. A. Hulbert, and P. C. Migneault. 1992. Time to detection of positive BacT/Alert blood cultures and lack of need for routine subculture of 5- to 7-day negative cultures. J. Clin. Microbiol. 30:2743-2745.[Abstract/Free Full Text]
    9. 9
  9. Horvath, L. L., D. R. Hospenthal, C. K. Murray, and D. P. Dooley. 2003. Detection of simulated candidemia by the BACTEC 9240 with plus aerobic/f and anaerobic/f blood culture bottles. J. Clin. Microbiol. 41:4714-4717.[Abstract/Free Full Text]
    10. 10
  10. Jorgensen, J. H., S. Mirrett, L. C. McDonald, P. R. Murray, M. P. Weinstein, J. Fune, C. W. Trippy, M. Masterson, and L. B. Reller. 1997. Controlled clinical laboratory comparison of BACTEC Plus aerobic/F resin medium with BacT/Alert aerobic FAN medium for detection of bacteremia and fungemia. J. Clin. Microbiol. 35:53-58.[Abstract]
    11. 11
  11. Krcmery, V., and A. J. Barnes. 2002. Non-albicans Candida spp. causing fungaemia: pathogenicity and antifungal resistance. J. Hosp. Infect. 50:243-260.[CrossRef][Medline]
    12. 12
  12. McDonald, L. C., M. P. Weinstein, J. Fune, S. Mirrett, L. G. Reimer, and L. B. Reller. 2001. Controlled comparison of BacT/ALERT FAN aerobic medium and BACTEC fungal blood culture medium for detection of fungemia. J. Clin. Microbiol. 39:622-624.[Abstract/Free Full Text]
    13. 13
  13. Mirrett, S., R. J. Everts, and L. B. Reller. 2001. Controlled comparison of original vented aerobic FAN medium with new nonvented BacT/ALERT FA medium for culturing blood. J. Clin. Microbiol. 39:2098-2101.[Abstract/Free Full Text]
    14. 14
  14. Mirrett, S., L. B. Reller, C. A. Petti, C. W. Woods, B. Vazirani, R. Sivadas, and M. P. Weinstein. 2003. Controlled clinical comparison of BacT/ALERT standard aerobic medium with BACTEC standard aerobic medium for culturing blood. J. Clin. Microbiol. 41:2391-2394.[Abstract/Free Full Text]
    15. 15
  15. National Committee for Clinical Laboratory Standards. 2002. Reference method for broth dilution antifungal susceptibility testing of yeasts; approved standard. NCCLS document M27-A2. National Committee for Clinical Laboratory Standards, Wayne, Pa.
    16. 16
  16. Pappas, P. G., J. H. Rex, J. Lee, R. J. Hamil, R. A. Larsen, W. Powderly, C. A. Kauffman, N. Hyslop, J. E. Mangino, S. Chapman, H. W. Horowitz, J. E. Edwards, W. E. Dismukes, for the NIAID Mycoses Study Group. 2003. A prospective observational study of candidemia: epidemiology, therapy, and influences on mortality in hospitalized adult and pediatric patients. Clin. Infect. Dis. 37:634-643.[CrossRef][Medline]
    17. 17
  17. Pohlman, J. K., B. A. Kirkley, K. A. Easley, B. A. Basille, and J. A. Washington. 1995. Controlled clinical evaluation of BACTEC plus aerobic/F and BacT/Alert FAN bottles for detection of bloodstream infections. J. Clin. Microbiol. 33:2856-2858.[Abstract]
    18. 18
  18. Prevost-Smith, E., and N. Hutton. 1992. Value of extended agitation and subculture of BACTEC NR 660 aerobic resin blood culture bottles for clinical yeast isolates. J. Clin. Microbiol. 30:3239-3242.[Abstract/Free Full Text]
    19. 19
  19. Rangel-Frausto, M. S., T. Wiblin, H. M. Blumberg, L. Saiman, J. Patterson, M. Rinaldi, M. Pfaller, J. E. Edwards, Jr., W. Jarvis, J. Dawson, R. P. Wenzel, and the NEMIS Study Group. 1999. National epidemiology of mycoses survey (NEMIS): variations in rates of bloodstream infections due to Candida species in seven surgical intensive care units and six neonatal intensive care units. Clin. Infect. Dis. 29:253-258.[Medline]
    20. 20
  20. Reisner, B. S., and G. L. Woods. 1999. Times to detection of bacteria and yeasts in BACTEC 9240 blood culture bottles. Clin. Infect. Dis. 37:2024-2026.
    21. 21
  21. Riest, G., H. J. Linde, and P. M. Shah. 1997. Comparison of BacT/Alert and BACTEC NR 860 blood culture systems in a laboratory not continuously staffed. Clin. Microbiol. Infect. 3:345-351.[Medline]
    22. 22
  22. Shigei, J. T., J. A. Shimabukuro, M. T. Pezzlo, L. M. De La Maza, and E. M. Peterson. 1995. Value of terminal subcultures for blood cultures monitored by BACTEC 9240. J. Clin. Microbiol. 33:1385-1388.[Abstract]
    23. 23
  23. Smith, J. A., E. A. Bryce, J. H. Ngui-Yen, and F. J. Roberts. 1995. Comparison of BACTEC 9240 and BacT/Alert blood culture systems in an adult hospital. J. Clin. Microbiol. 33:1905-1908.[Abstract]
    24. 24
  24. Spanjaard, L., E. J. Kuijper, and J. Dankert. 2000. Clinical comparison of two commercial blood culture systems. Eur. J. Clin. Microbiol. Infect. Dis. 19:881-885.[CrossRef][Medline]
    25. 25
  25. Trick, W. E., S. K. Fridkin, J. R. Edwards, R. A. Hajjeh, R. P. Gaynes, and the National Nosocomial Infections Surveillance System Hospitals. 2002. Secular trend of hospital-acquired candidemia among intensive care unit patients in the United States during 1989-1999. Clin. Infect. Dis. 35:627-630.[CrossRef][Medline]
    26. 26
  26. Vigano, E. F., E. Vasconi, C. Agrappi, and P. Clerici. 2002. Use of simulated blood cultures for time to detection comparison between BacT/ALERT and BACTEC 9240 blood culture systems. Diagn. Microbiol. Infect. Dis. 44:235-240.[CrossRef][Medline]
    27. 27
  27. Weinstein, M. P., S. Mirrett, L. B. Reller, L. G. Reimer, and M. L. Wilson. 1996. Value of terminal subcultures for blood cultures monitored by BACTEC 9240. J. Clin. Microbiol. 34:234-235.[Medline]
    28. 28
  28. Weinstein, M. P., S. Mirrett, L. G. Reimer, M. L. Wilson, S. Smith-Elekes, C. R. Chuard, K. L. Joho, and L. B. Reller. 1995. Controlled evaluation of BacT/Alert standard aerobic and FAN aerobic blood culture bottles for detection of bacteremia and fungemia. J. Clin. Microbiol. 33:978-981.[Abstract]
    29. 29
  29. Ziegler, R., L. Johnscher, P. Martus, D. Lenhardt, and H. M. Just. 1998. Controlled clinical laboratory comparison of two supplemented aerobic and anaerobic media used in automated blood culture systems to detect bloodstream infections. J. Clin. Microbiol. 36:657-661.[Abstract/Free Full Text]

Journal of Clinical Microbiology, January 2004, p. 115-118, Vol. 42, No. 1
0095-1137/04/$08.00+0     DOI: 10.1128/JCM.42.1.115-118.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.



This article has been cited by other articles:

  • Chiarini, A., Palmeri, A., Amato, T., Immordino, R., Distefano, S., Giammanco, A. (2008). Detection of Bacterial and Yeast Species with the Bactec 9120 Automated System with Routine Use of Aerobic, Anaerobic, and Fungal Media. J. Clin. Microbiol. 46: 4029-4033 [Abstract] [Full Text]  
  • Horvath, L. L., George, B. J., Hospenthal, D. R. (2007). Detection of Fifteen Species of Candida in an Automated Blood Culture System. J. Clin. Microbiol. 45: 3062-3064 [Abstract] [Full Text]  
  • Pfaller, M. A., Diekema, D. J. (2007). Epidemiology of Invasive Candidiasis: a Persistent Public Health Problem. Clin. Microbiol. Rev. 20: 133-163 [Abstract] [Full Text]  
  • Sandven, P., Bevanger, L., Digranes, A., Haukland, H. H., Mannsaker, T., Gaustad, P., the Norwegian Yeast Study Group, (2006). Candidemia in norway (1991 to 2003): results from a nationwide study.. J. Clin. Microbiol. 44: 1977-1981 [Abstract] [Full Text]  
  • George, B. J., Horvath, L. L., Hospenthal, D. R. (2005). Effect of Inoculum Size on Detection of Candida Growth by the BACTEC 9240 Automated Blood Culture System Using Aerobic and Anaerobic Media. J. Clin. Microbiol. 43: 433-435 [Abstract] [Full Text]  
  • Fricker-Hidalgo, H., Lebeau, B., Pelloux, H., Grillot, R., Horvath, L. L., Hospenthal, D. R. (2004). Use of the BACTEC 9240 System with Mycosis-IC/F Blood Culture Bottles for Detection of Fungemia. J. Clin. Microbiol. 42: 1855-1856 [Full Text]  

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowReprints and Permissions
Right arrow Copyright Information
Right arrow Books from ASM Press
Right arrow MicrobeWorld
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Horvath, L. L.
Right arrow Articles by Hospenthal, D. R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Horvath, L. L.
Right arrow Articles by Hospenthal, D. R.

Copyright © 2009 by the American Society for Microbiology.   For an alternate route to Journals.ASM.org, visit: http://intl-journals.asm.org | More Info»