Bloodstream infections are an important cause of morbidity and mortality. Physician orders for blood cultures often specify that blood specimens be collected at or around the time of a temperature elevation, presumably as a means of enhancing the likelihood of detecting significant bacteremia. In a multicenter study, which utilized retrospective patient chart reviews as a means of collecting data, we evaluated the timing of blood culture collection in relation to temperature elevations in 1,436 patients with bacteremia and fungemia. The likelihood of documenting bloodstream infections was not significantly enhanced by collecting blood specimens for culture at the time that patients experienced temperature spikes. A subset analysis based on patient age, gender, white blood cell count and specific cause of bacteremia generally also failed to reveal any associations.Bloodstream infections (BSIs) occur more than 200,000 times annually in the United States, with associated mortality rates of 35 to 60% (20,33,34). Prompt administration of appropriate antimicrobial therapy plays an important role in reducing the mortality associated with this condition (9,12,14, 15,16,18,22,26,31). In patients with bacteremia, the optimization of therapy is ultimately predicated on rapid documentation of positive blood cultures, expeditious performance of in vitro antimicrobial susceptibility tests, and timely reporting of results (2,23,33). Numerous factors influence the likelihood of detecting bacteremia. These factors include the volume of blood specimens cultured and the number of blood cultures performed (1,8,10,11,17,21,25,27,29). The conventional practice has been to obtain blood specimens at or around the time of a temperature elevation as a means of enhancing the likelihood of documenting bacteremia (5, 32). This practice is based on the principle that the presence of organisms in the intravascular space leads to the elaboration of cytokines, which in turn causes body temperatures to rise.The value of attempting to time the collection of blood for culture around temperature elevations is complicated by the fact that many patients with bacteremia, especially those that are elderly, may be hypothermic at the time that they are bacteremic or may be unable to mount a febrile response to infection (7). Furthermore, there are numerous causes of fever other than bacteremia, e.g., ischemia, drug reactions, immunological conditions, and malignancy (4). This issue is further complicated by the observation made more than 50 years ago by Bennett and Beeson: bacteremia actually precedes temperature elevations by 1 or 2 h (3). These researchers noted that blood cultures were frequently negative at the time of the temperature spike and concluded that, ideally, blood cultures should be drawn some time prior to elevations in temperature. More recently, Jaimes et al. found that fever was not a useful independent predictor of bacteremia and needed to be considered in light of other factors, such as hypotension, white blood cell (WBC) counts, an...

Many laboratories are experiencing growing shortages of trained microbiology technologists and technicians. Consequently, there is considerable interest in new automation that could potentially lessen labor demands for specimen processing. In this study, we present the first published evaluation of a new microbiology instrument, the Walk Away Specimen Processor (WASP), manufactured by Copan, Inc., in which we evaluated cross-contamination, the accuracy of plating, and the quality of the results. The absence of cross-contamination was demonstrated by plating a total of 200 alternating inoculated and sterile specimen tubes. The ability of the WASP to subculture enrichment broths was evaluated with 106 Lim broth specimens, with the results being identical to those obtained by testing by routine methods. Plating of urine specimens with the WASP was compared to plating with the Dynacon Inoculab instrument. Three hundred specimens were plated in duplicate on both instruments with 1-l loops, and 293 specimens were plated in duplicate on both instruments with 10-l loops. The results of duplicate plating with the same instrument (replicate plating) and of the consensus agreement between the two instruments were compared. The replicate plating results were comparable for both instruments, while the WASP had more specimens with significant results than the Inoculab with the 1-l loop only. Lastly, for the plating of 113 specimens in ESwab tubes, the manual method and WASP plating each yielded 90 potential pathogens. In summary, we report the first evaluation of a new microbiology specimenplating instrument, the WASP, which offers opportunities for the automated plating of microbiology specimens to an extent that has not been possible to date.Clinical microbiology laboratories have largely been bypassed by the advances in automation that have benefitted other areas of the clinical laboratory in recent years. Continuously monitoring blood culture systems as well as automated microbial identification and susceptibility testing systems are widely utilized. However, specimen processing and culture workup specifically remain manual tasks, and few changes to the methods used to perform these tasks have been made in the recent past. While some larger laboratories utilize urineplating instrumentation, most microbiology laboratories have no automation in their processing areas. In this report, we present the results of a preliminary evaluation of a new microbiology plating instrument that offers the potential to automate the plating of a variety of liquid-based microbiology specimens. MATERIALS AND METHODSOverview of WASP. The Walk Away Specimen Processor (WASP) is a new instrument manufactured in Italy for Copan Diagnostics (Murrieta, CA) and is designed to plate liquid specimens from a variety of different transport devices ( Fig. 1 and 2). The WASP utilizes two Toshiba selective compliant assembly robot arm (SCARA) robots. The first robot moves specimens and plated media and takes specimens to the decapping device, while the secon...

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