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Bacteriology

Evaluation of Optimal Blood Culture Incubation Time To Maximize Clinically Relevant Results from a Contemporary Blood Culture Instrument and Media System

Eric M. Ransom, Zahra Alipour, Meghan A. Wallace, Carey-Ann D. Burnham
Patricia J. Simner, Editor
Eric M. Ransom
aDepartment of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
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Zahra Alipour
aDepartment of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
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Meghan A. Wallace
aDepartment of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
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Carey-Ann D. Burnham
aDepartment of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
bDepartment of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri, USA
cDepartment of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
dDepartment of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
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Patricia J. Simner
Johns Hopkins
Roles: Editor
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DOI: 10.1128/JCM.02459-20
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ABSTRACT

Timely diagnosis of microorganisms in blood cultures is necessary to optimize therapy. Although blood culture media and systems have evolved for decades, the standard interval for incubation prior to being discarded as negative has remained 5 days. Here, we evaluated the optimal incubation time for the BacT/Alert Virtuo blood culture detection system (bioMérieux) using FA Plus (aerobic) and FN Plus (anaerobic) resin culture bottles in routine clinical use. Following institutional review board (IRB) approval, a retrospective review evaluated the outcomes of 158,710 bottles collected between November 2018 and October 2019. The number of positive blood bottles was 13,592 (8.6%); 99% of positive aerobic and anaerobic bottles flagged positive by 91.5 and 108 h, respectively. The mean (median) times to positivity were 18.4 h (15.6 h) for Staphylococcus aureus, 12.3 h (9.5 h) for Escherichia coli, 22.2 h (15.9 h) for Pseudomonas aeruginosa, and 48.9 h (42.9 h) for Candida spp. Only 175 bottles (0.1% of all bottles) flagged positive after 4 days of incubation; 89 (51%) of these bottles grew Cutibacterium (Propionibacterium) species. Chart review of blood cultures positive after 4 days (96 h) rarely had a clinical impact and sometimes had a negative impact on patient care. Finally, a seeded study of the HACEK group (i.e., Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, and Kingella), historically associated with delayed blood culture positivity, demonstrated no benefit to extended incubation beyond 4 days. Collectively, these findings demonstrated that a 4-day incubation time was sufficient for the Virtuo system and media. Implementation of the 4-day incubation time could enhance clinically relevant results by reducing recovery of contaminants and finalizing blood cultures 1 day earlier.

FOOTNOTES

    • Received 22 September 2020.
    • Returned for modification 1 November 2020.
    • Accepted 23 November 2020.
    • Accepted manuscript posted online 25 November 2020.
  • Supplemental material is available online only.

  • Copyright © 2021 American Society for Microbiology.

All Rights Reserved.

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Evaluation of Optimal Blood Culture Incubation Time To Maximize Clinically Relevant Results from a Contemporary Blood Culture Instrument and Media System
Eric M. Ransom, Zahra Alipour, Meghan A. Wallace, Carey-Ann D. Burnham
Journal of Clinical Microbiology Feb 2021, 59 (3) e02459-20; DOI: 10.1128/JCM.02459-20

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Evaluation of Optimal Blood Culture Incubation Time To Maximize Clinically Relevant Results from a Contemporary Blood Culture Instrument and Media System
Eric M. Ransom, Zahra Alipour, Meghan A. Wallace, Carey-Ann D. Burnham
Journal of Clinical Microbiology Feb 2021, 59 (3) e02459-20; DOI: 10.1128/JCM.02459-20
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KEYWORDS

blood culture
Virtuo
time to positivity
BacT/Alert
FA Plus
FN Plus
Staphylococcus aureus
growth rate
Cutibacterium
Escherichia coli
Pseudomonas aeruginosa

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