Comparison of the <scp>B</scp>actec <scp>F</scp>x <scp>P</scp>lus, <scp>M</scp>ycosis <scp>IC</scp>/<scp>F</scp>, <scp>M</scp>ycosis/<scp>F</scp> Lytic Blood Culture Media and the <scp>B</scp>ac<scp>T</scp>/<scp>A</scp>lert 3<scp>D FA</scp> Media for Detection of <i>Candida</i> species in Seeded Blood Culture Specimens Containing Therapeutic Peak Levels of Fluconazole

Jekarl, Dong Wook; Lee, So‐Young; Lee, Seungok; Park, Yeon-Joon; Lee, Jehoon; Baek, Sun Mi; An, Yeon Ju; Ock, Sun Myeong; Lee, Mi-Kyung

doi:10.1002/jcla.21535

Cited by 16 publications

(11 citation statements)

References 21 publications

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“…Complete neutralization of fluconazole in Bactec Plus Aerobic/F bottles was demonstrated in a recent seeded study involving Candida spp., which was similar to our findings using the new BacT/Alert Plus bottles (26).…”

Section: Discussionsupporting

confidence: 92%

Neutralization of Antimicrobial Substances in New BacT/Alert FA and FN Plus Blood Culture Bottles

et al. 2013

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Time to detection (TTD) in automated blood culture systems is delayed for sensitive microorganisms in the presence of antimicrobial substances and has been associated with worse outcomes for sepsis patients on inadequate empirical therapy. While resin addition removes antimicrobial substances to various degrees from blood culture media, media formulations and the blend of resins may influence performance. The BacT/Alert 3D system (bioMérieux) was investigated using the new resin-containing medium types FA Plus (aerobic) and FN Plus (anaerobic). TTD was compared between control and test bottles containing relevant bacteria or Candida albicans, with and without defined concentrations of antimicrobials. Failure of neutralization was defined as a negative blood culture on day 3. In general, growth delay was nonlinear, concentration dependent, bottle type specific, and reciprocally associated with MICs. Substance-specific serum drug concentrations corresponding to a predefined, clinically relevant 3-h delay of TTD were calculated. Where appropriate, a time interval allowing for drug elimination below this critical level was obtained by pharmacokinetic modeling. Clarithromycin, clindamycin, gentamicin, linezolid, tigecycline, vancomycin, and fluconazole were neutralized. For ciprofloxacin and piperacillin-tazobactam, which were only incompletely neutralized in combination with the most sensitive test strains, a maximum waiting time for blood draw of 1 h was determined based on pharmacokinetics. One or more test strains did not grow in bottles containing either amoxicillin-clavulanate, cefepime, cefotaxime, meropenem, or metronidazole, and we thus recommend particular caution in timing of blood draws if patients have been pretreated with these agents.

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Section: Discussionsupporting

confidence: 92%

Neutralization of Antimicrobial Substances in New BacT/Alert FA and FN Plus Blood Culture Bottles

et al. 2013

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“…Data regarding the performance of blood culture containing an adsorbing agent in the presence of antifungals are scarce, however. An in vitro study by Jekarl et al found that fluconazole at concentrations of 1.9, 4.7, and 6.7 g/ml (equivalent to the peak plasma levels achieved with oral doses of 100 mg, 200 mg, and 400 mg, respectively) had no impact on the TTD or the sensitivity of two types of blood culture media containing an adsorbing agent (Bactec FX Plus and BacT/Alert FA) and that the TTD was delayed by 20.5 to 27.7 h for blood culture media not containing an adsorbing agent (Bactec Mycosis IC/F and Bactec Mycosis/F Lytic) (11). In contrast, an in vitro study by Riedel et al found that peak concentrations of the most commonly used antifungals (amphotericin B deoxycholate, caspofungin, fluconazole, and voriconazole) reduced the sensitivity of Bactec FX blood culture bottles (containing an adsorbing resin) by 18.8% and increased the TTD by 5.67 h overall (12).…”

Section: Discussionmentioning

confidence: 96%

“…Antifungals have been shown in several in vitro studies to reduce blood culture sensitivity by 17% to 50% and to increase the TTD of Candida spp. by 6 to 22 h, depending on the specific brand and type of blood culture media tested (11,12). As such, new formulations of blood culture media which contain an adsorbing agent (such as charcoal, resins, or polymeric beads) that binds antimicrobials have been developed and are increasingly utilized in routine practice.…”

Section: Discussionmentioning

confidence: 99%

In Vitro Evaluation of BacT/Alert FA Blood Culture Bottles and T2Candida Assay for Detection of Candida in the Presence of Antifungals

Beyda

Amadio

Rodríguez³

et al. 2018

J Clin Microbiol

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The T2Candida assay is a novel, non-culture-based assay for the diagnosis of candidemia directly from whole blood. The impact of antifungals on the performance of the T2Candida assay and blood culture bottles has not been well described. In this study, the performance of the T2Candida assay was compared to that of blood culture in detecting spp. in spiked blood cultures with or without the presence of antifungals. Clinical bloodstream isolates of spp. were inoculated into human whole blood at low (1 to 5 cells/ml) and high (10 to 50 cells/ml) concentrations with or without the presence of caspofungin and fluconazole. Time to detection (TTD) was assessed for prepared samples using BacT/Alert FA aerobic blood culture bottles or the T2Candida assay. In the absence of antifungals, T2Candida assay sensitivity was comparable to that of blood culture at both the low inoculum and the high inoculum (95% versus 97.5% and 100% versus 100%, respectively) and the assay had an average TTD that was significantly shorter (5.1 h versus 27.2 to 30 h, respectively). Neither caspofungin nor fluconazole was observed to impact the sensitivity or TTD of the T2Candida assay, while fluconazole reduced the overall blood culture sensitivity by 7.5% to 12.5% (at the low inoculum and high inoculum, respectively) and significantly increased the TTD of ,, and by 14.8 to 67 h. Neither caspofungin nor fluconazole impacted the performance of the T2Candida assay, and the assay may be useful for the diagnosis of candidemia in patients receiving antifungal therapy.

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“…It has previously been shown that the type of BC bottle used has a substantial impact on the microbiological diagnosis of bloodstream infections (6)(7)(8)(9)(10), as these media are complex formulations that provide nutrients and neutralizing antimicrobials in clinical blood samples (11). In addition, the BC system affects workflow and microbiological performance (11,12).…”

mentioning

confidence: 99%

Controlled Evaluation of the New BacT/Alert Virtuo Blood Culture System for Detection and Time to Detection of Bacteria and Yeasts

et al. 2016

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cWe compared the newly approved BacT/Alert Virtuo blood culture system to the BacT/Alert 3D system using 115 clinical bacterial and fungal isolates in 784 simulated blood culture bottles. The time to detection was reduced by roughly 20% in the Virtuo system (P < 0.0001) while the detection rate did not differ. Bloodstream infections remain a leading cause of death and are associated with high mortality and morbidity (1, 2). Early intervention and initiation of appropriate treatment have been shown to improve patient outcome (3-5). Rapid detection and identification of the causing pathogen are therefore essential in the diagnosis of these invasive diseases.Blood culture (BC) is the gold standard for detection of bacteria and fungi from blood or other normally sterile body fluids. It has previously been shown that the type of BC bottle used has a substantial impact on the microbiological diagnosis of bloodstream infections (6-10), as these media are complex formulations that provide nutrients and neutralizing antimicrobials in clinical blood samples (11). In addition, the BC system affects workflow and microbiological performance (11,12). To date, the most widely distributed BC systems are the BacT/Alert 3D (bioMérieux; referred to as 3D hereafter), BD Bactec (Becton Dickinson), and VersaTREK (Thermo Scientific). bioMérieux has recently introduced a new BC system with automatic loading and unloading of BC bottles, the BacT/ Alert Virtuo (Virtuo), for bacterial and fungal detection in BC. Enhanced colorimetric technology to detect microbial growth and improved temperature stability suggest improved culture conditions in the Virtuo compared to the 3D system. However, the microbiological performance of Virtuo has not been evaluated.In this study, the Virtuo system was tested in direct comparison with the 3D system by parallel incubation of a total of 115 clinical bacterial and fungal isolates (Table 1). All isolates were originally collected from clinical BC samples sent for microbiological diagnosis to Karolinska University Laboratory (Stockholm, Sweden) from three tertiary care hospitals in the greater Stockholm area. Isolates were recovered from frozen stocks and were cultured overnight on appropriate agar medium. Approximately 15 CFU in phosphate-buffered saline was inoculated into each BC bottle with 8 ml defibrinated horse blood, and all BC bottles were incubated until positivity was reached or for a maximum of 5 days. We and others have previously demonstrated that the use of horse blood does not significantly influence the performance of BC systems (13-17). Growth was assessed in aerobic (FA and FA Plus) and anaerobic (FN and FN Plus) BacT/Alert BC bottles, except for Acinetobacter spp. and Candida spp., which were cultured under aerobic conditions only. While the CE-approved version of the Virtuo system is intended to operate with resin-based BC bottles (FA Plus and FN Plus) only, charcoal-based BC bottles (FA and FN) were evaluated in the 3D system and in the investigational-use-only version of Virtuo emplo...

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Comparison of the Bactec Fx Plus, Mycosis IC/F, Mycosis/F Lytic Blood Culture Media and the BacT/Alert 3D FA Media for Detection of Candida species in Seeded Blood Culture Specimens Containing Therapeutic Peak Levels of Fluconazole

Cited by 16 publications

References 21 publications

Neutralization of Antimicrobial Substances in New BacT/Alert FA and FN Plus Blood Culture Bottles

Neutralization of Antimicrobial Substances in New BacT/Alert FA and FN Plus Blood Culture Bottles

In Vitro Evaluation of BacT/Alert FA Blood Culture Bottles and T2Candida Assay for Detection of Candida in the Presence of Antifungals

Controlled Evaluation of the New BacT/Alert Virtuo Blood Culture System for Detection and Time to Detection of Bacteria and Yeasts

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