Washington, John A.

An automated radiometric system (BACTEC, Johnston Laboratories) for detection of bacteremia was evaluated in parallel with a standard blood culture system in use in our laboratory. Of 1,445 blood cultures from 484 patients with possible bacteremia, 106 sets of cultures (excluding 39 presumed contaminated), representing 56 patients, were positive by both methods. The conventional system yielded 85 positive cultures from 48 patients, whereas the BACTEC system yielded 84 positive cultures from 43 patients. The BACTEC system failed to detect 22 cultures that were positive in the conventional system, and the conventional system failed to detect 21 cultures that were positive in the BACTEC system. The detection efficiency was generally equivalent in the two systems except for the lower detection rates of anaerobes and Enterobacter aerogenes by the BACTEC system and the lower detection rates of Torulopsis glabrata and, possibly, Pseudomonas sp. (group IVD) in the conventional system. The BACTEC system had a slight advantage over the conventional system in the time interval to detection of positivity. Approximately 20% of the positive cultures detected by the BACTEC system were detected on the first day of incubation compared with 7% by the conventional system. The recovery rates and detection times of anaerobes were less efficient by the BACTEC system than by the conventional system. It does not appear that the radiometric method has much advantage over available conventional methods.

The characteristics of 25 hydrogen sulfide-negative strains of Citrobacter were studied. The majority of isolates were from the respiratory tract and usually were of indeterminate clinical significance. All strains were highly susceptible to polymyxin B, gentamicin, kanamycin, nalidixic acid, and nitrofurantoin.

The in vitro activity of minocycline against 1,028 bacterial strains was determined in parallel in Mueller Hinton Agar and Trypticase Soy Agar. The broad antibacterial effect of minocycline against gram-positive cocci and gram-negative bacilli is confirmed. Minimal inhibitory concentrations for gram-positive bacteria in Mueller Hinton Agar were at least twofold less than in Trypticase Soy Agar. Minimal inhibitory concentrations for gram-negative bacilli in Mueller Hinton Agar were usually fourfold less than in Trypticase Soy Agar.

Comparison of an anaerobic brain heart infusion broth with tryptic soy broth and Thioglycollate medium failed to demonstrate significant differences in isolation rates of anaerobic bacteria from blood.

In a comparison of tryptic soy broth and Columbia broth, two blood culture media containing sodium polyanetholesulfonate, there were 589 positive cultures (excluding presumed contaminants). The two media were equivalent in performance except for lower detection rates for Staphylococcus aureus ( P < 0.01) and Pseudomonas aeruginosa ( P = 0.05) and a higher detection rate for Bacillus ( P < 0.01) in Columbia broth. No significant differences were noted in time intervals to detection of positivity. Routine subcultures on the 1st and 5th days of incubation provided the initial detection of 18.1% of the positive cultures.

The characteristics of an atypical group of the family Enterobacteriaceae resembling Enterobacter cloacae were studied. The urinary tract was the most common source of these organisms, and most strains represented infections of secondary clinical significance. In contrast to typical Enterobacter strains, the atypical strains were highly susceptible to the cephalosporins; otherwise, there was a high degree of susceptibility to five other antibiotics and resistance to ampicillin except in very high concentration.

In a paired, double-blind study, the modified (“Beckford tube”) R-B system was compared with conventional bacteriological procedures for the identification of members of the family Enterobacteriaceae from clinical isolates and stock cultures. The tests in the R-B system yielding positive reactions comparable to those predicted by Ewing's taxonomic classification of Enterobacteriaceae were production of hydrogen sulfide and presence of lysine and ornithine decarboxylasè activities. The test reactions in the R-B system found to be comparable to those in the conventional method were fermentation of glucose, hydrogen sulfide production, and lysine and ornithine decarboxylase activities. The production of gas from glucose was positive in the R-B system more often than in the conventional method; however, the motility test and the production of indole were positive less often in the R-B system. Adequate preliminary identification of the Enterobacteriaceae with the R-B system is enhanced if Simmons' citrate and Christensen's urea tests are used concomitantly. These findings emphasize the manufacturer's instructions that, in interpretation of results, colonial morphology and biochemical reactions must be used concurrently to make an accurate identification.

A study was performed with simulated blood cultures to evaluate the production of 14 CO 2 as an index of bacterial growth. With a range of inoculum sizes from 4 to 4,250 colony-forming units, it was not possible to detect 14 CO 2 within 6 hr after inoculation in 59 separate experiments. In a limited trial with patients' blood cultures, the radiometric method failed to provide any earlier evidence of bacteremia than did routine broth cultures.

The Enterotube system was evaluated, in parallel with conventional bacteriological procedures for the identification of members of the family Enterobacteriaceae , by using bacterial strains from a variety of clinical specimens and from stock cultures. Excellent agreement between the two test systems was obtained with the following reactions: hydrogen sulfide, indole, Simmons' citrate, glucose, and lactose. Agreement was not as good (<85%) with the urea, phenylalanine deaminase, and dulcitol reactions. The Enterotube lysine decarboxylase test was unsatisfactory. The Enterotube method will correctly identify strains of the family Enterobacteriaceae approximately 50% of the time; if identification only as Klebsiella-Enterobacter-Serratia group is needed, the method will be correct 85% of the time. On the basis of this evaluation, the Enterotube system appears to be both simple and rapid for the presumptive identification of these bacteria. Because of the limited usefulness of the lysine decarboxylase test, the results obtained by this test system are less reliable than those obtained by conventional methods.

The R-B system was evaluated in parallel with conventional bacteriological procedures for the identification of members of the family Enterobacteriaceae by using bacterial strains from a variety of clinical specimens and from stock cultures. The R-B tests found to be reliable were, in decreasing order, the reactions for phenylalanine deaminase, hydrogen sulfide, and indole, the production of gas from glucose, and the decarboxylation of ornithine. The reactions in the R-B system found to be unreliable were motility, the decarboxylation of lysine, and the fermentation of both glucose and lactose. In addition, the reactions of the R-B system were more difficult to read and interpret than those of the conventional system. On the basis of this evaluation, it was concluded that the R-B system is not an acceptable alternative to the conventional methods in the identification of the Enterobacteriaceae .