Washington, John A.

To deterimine the incidence of bacteremia in healty adults, blood cultures were obtained from 240 patients who had no demonstrable foci of infection. Five patients (2.1%) had positive blood cultures. Staphylococcus epidermidis was isolated from four patients and Alcaligenes faecalis from one. In each of these patients, the organism isolated probably represented contamination rather than bacteremia.

Eight strains of an unclassified, oxidase-negative, lactose-fermenting, urease-producing, gram-negative bacillus were isolated from clinical material. With the exception of urease production, the biochemical characteristics of these organisms resembled those of Escherichia coli .

The value of a routine 48-h anaerobic subculture of blood cultures was assessed in our laboratory over a 4-month period. Excluding presumed contaminants, anaerobes represented 51 (6.9%) of the total number of 734 positive cultures. Sixteen isolates (all Bacteroides ) from six patients were detected by the anaerobic subculture. All but one of these were also detected macroscopically. Excluding the one isolate, the routine anaerobic subculture hastened the identification of anaerobic organisms by only 1 day in two patients. We conclude that a routine anaerobic subculture is not indicated for the detection of anaerobic bacteremia.

An automated and computerized system (Automicrobic System [AMS]) for the detection of frequently encountered bacteria in clinical urine specimens was tested in a collaborative study among six laboratories. The sensitivity, specificity, reliability, and reproducibility of the AMS were determined, and the system was compared with conventional detection and identification systems. In this study, pure cultures and mixtures of pure cultures were used to simulate clinical urine specimens. With pure cultures, the sensitivity of the AMS in identifying the nine groups of organisms most commonly found in urine averaged 92.8%. The specificity averaged 99.4%, and the reliability of a positive result averaged 92.1%. The latter value was strongly influenced by a relatively high occurrence of false positive Escherichia coli results. The AMS was capable of detecting growth of most organisms, including those which it was not designed to identify. However, it identified some of these incorrectly as common urinary tract flora. Reproducibility of results, both within laboratories and among different laboratories, was high. Fast-growing organisms, such as E. coli and Klebsiella/Enterobacter species, were detected often at cell populations well below the AMS enumeration threshold of 70,000/ml. In mixed culture studies, high levels of sensitivity and specificity were maintained but when Serratia species were present in mixtures with other organisms, there was often a false positive report of E. coli. The overall performance of the AMS was considered satisfactory under the test conditions used.

An analysis of 3,795 positive blood cultures obtained from 1,718 patients in a 2.5-year evaluation of Tryptic Soy Broth (TSB) and Thiol Broth is reported. Isolation rates of Actinobacillus and Pseudomonas were significantly greater in TSB, whereas isolation rates of Streptococcus and Corynebacterium (aerobic and anaerobic) were significantly greater in Thiol. Otherwise, the two media were similar. Disregarding contaminants, anaerobic bacteria represented 11% of positive cultures and 20% of patients with bacteremia. Eleven per cent of the patients had polymicrobial bacteremia.

Regression lines were calculated for cephalothin, cephalexin, and cephaloridine by relating zone diameters of inhibition to minimal inhibitory concentrations (MIC) obtained in Mueller-Hinton agar and in Trypticase Soy Agar. A regression line was calculated for cephaloglycin by obtaining MIC values in Trypticase Soy Agar at p H 6.6. Regression lines calculated from MIC values in Mueller-Hinton agar were practically superimposable on those based on MIC values in Trypticase Soy Agar. Organisms susceptible by disc testing to cephalothin were usually susceptible to cephalexin and cephaloridine.

Analysis of the results of 13,162 blood cultures during a 9-month interval has shown that Pseudomonas aeruginosa statistically was recovered more frequently from Trypticase soy broth (TSB) than from Thioglycollate-135C and that contaminants, including Staphylococcus epidermidis and aerobic and anaerobic Corynebacterium species, were isolated with statistically greater frequency from Thioglycollate-135C than from TSB. No other statistically significant differences were found.

Two liquid blood culture media, Tryptic soy broth (TSB) and Thiol broth, containing sodium polyanetholsulfonate were compared in 8,654 cultures. Pseudomonas and Corynebacterium (including Propionibacterium ) were isolated significantly more frequently ( P < 0.001) from TSB than from Thiol. Escherichia coli, Haemophilus , and Bacteroidaceae were isolated more frequently in TSB; however, the differences were not statistically significant. In no instance was Thiol superior to TSB in detecting bacteremia. In an additional 2,977 cultures, aerobic and anaerobic Vacutainer culture tubes with supplemented peptone broth were inoculated in parallel with TSB and Thiol. Significantly greater rates of detection ( P < 0.01) in TSB or Thiol were noted with Pseudomonas, E. coli, Enterobacter , viridans, and group A streptococci, Bacteroidaceae, and staphylococci.