Ann Clin Microbiol.  2023 Dec;26(4):125-137. 10.5145/ACM.2023.26.4.125.

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

• Kim J
• Sung H
• Kim MN

• KMID: 2550664
• DOI: http://doi.org/10.5145/ACM.2023.26.4.125

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 first 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.

Keyword

Anaerobic bacteria; Blood culture; Fungi; Incubation; Times to positivity

Figure

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  Fig. 1. Cumulative percentages of positive blood cultures according to time-to-positivity.

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  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.

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  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.

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