Wilson M L, Davis T E, Mirrett S, Reynolds J, Fuller D, Allen S D, Flint K K, Koontz F, Reller L B
Clinical Microbiology Laboratory, Duke University Medical Center, Durham, North Carolina 27710.
J Clin Microbiol. 1993 Apr;31(4):865-71. doi: 10.1128/jcm.31.4.865-871.1993.
The BACTEC high-blood-volume fungal medium (HBV-FM) (Becton Dickinson Diagnostic Instrument Systems, Sparks, Md.) was compared with the Isolator (IS) tube and the BACTEC Plus 26 (BP26) blood culture bottle for the ability to recover fungi from the blood of adult patients suspected of having fungemia. A total of 6,836 blood culture sets that fulfilled criteria for inclusion in the study were received. Three separate comparisons were performed: 4,907 HBV-FM versus IS, 4,886 BP26 versus HBV-FM, and 4,949 BP26 versus IS. For the HBV-FM versus IS comparison, 218 isolates were recovered: 125 (57.3%) were bacteria and 93 (42.7%) were fungi. HBV-FM was comparable to IS for recovery of yeasts, but IS was superior for recovery of Histoplasma capsulatum (25 versus 0 isolates recovered [P < 0.001]). Growth of Torulopsis glabrata was detected earlier (P < 0.05) in HBV-FM bottles. For the BP26 versus HBV-FM comparison, 229 isolates were recovered: 161 (70.3%) were bacteria, and 68 (29.7%) were fungi. HBV-FM was superior for recovery of T. glabrata (P < 0.025) and all fungi combined (P < 0.025). There were no statistically significant differences in the speed of detection of microbial growth. For the BP26 versus IS comparison, 251 isolates were recovered: 165 (65.7%) were bacteria, and 86 (34.2%) were fungi. IS was superior for recovery of H. capsulatum (P < 0.001), T. glabrata (P < 0.05), and fungi other than H. capsulatum (P < 0.025). BP26 was superior for recovery of all bacteria combined (P < 0.001) and viridans group streptococci (P < 0.01). Growth of T. glabrata (P < 0.05) was detected earlier in IS tubes. Growth of Staphylococcus aureus (P < 0.01), viridans group streptococci (P < 0.01), Pseudomonas aeruginosa (P < 0.05), and all microorganisms combined (P < 0.05) was detected earlier in BP26 bottles. For yeast, 57 of 59 (96.6%), 79 of 80 (98.7%), and 64 of 67(95.5%) were recovered from BP26 bottles, HBV-FM bottles, and IS tubes, respectively, by day 14; for H. capsulatum, 14 of 36 (38%) isolates were recovered from IS tubes by day 14. Mean times of recovery were similar for BACTEC bottles and IS. We conclude that (i) for recovery of fungi from blood cultures, HBV-FM is equivalent to IS (with the exception of H. capsulatum); (ii) for recovery of bacteria, BP26 is superior to IS; (iii) BP26 bottles are inferior to both HBV-FM bottles and IS tubes for recovery of T. glabrata; and (iv) HBV-FM bottles must be paired with another blood culture bottle or system to optimize detection of bacteremia.
将BACTEC高血容量真菌培养基（HBV - FM）（Becton Dickinson诊断仪器系统公司，马里兰州斯帕克斯）与Isolator（IS）管以及BACTEC Plus 26（BP26）血培养瓶进行比较，以评估从疑似患有真菌血症的成年患者血液中分离真菌的能力。共收到6836套符合研究纳入标准的血培养样本。进行了三项独立比较：4907份HBV - FM与IS的比较、4886份BP26与HBV - FM的比较以及4949份BP26与IS的比较。在HBV - FM与IS的比较中，共分离出218株菌株：125株（57.3%）为细菌，93株（42.7%）为真菌。HBV - FM在酵母菌分离方面与IS相当，但IS在荚膜组织胞浆菌分离方面更具优势（分别分离出25株和0株[P < 0.001]）。在HBV - FM瓶中光滑假丝酵母菌的生长检测更早（P < 0.05）。在BP26与HBV - FM的比较中，共分离出229株菌株：161株（70.3%）为细菌，68株（29.7%）为真菌。HBV - FM在光滑假丝酵母菌分离（P < 0.025）以及所有真菌总体分离方面更具优势（P < 0.025）。在微生物生长检测速度方面无统计学显著差异。在BP26与IS的比较中，共分离出251株菌株：165株（65.7%）为细菌，86株（34.2%）为真菌。IS在荚膜组织胞浆菌分离（P < 0.001）、光滑假丝酵母菌分离（P < 0.05）以及除荚膜组织胞浆菌外的其他真菌分离方面更具优势（P < 0.025）。BP26在所有细菌总体分离方面更具优势（P < 0.001）以及在草绿色链球菌分离方面更具优势（P < 0.01）。在IS管中光滑假丝酵母菌的生长检测更早（P < 0.05）。在BP26瓶中金黄色葡萄球菌（P < 0.01）、草绿色链球菌（P < 0.01）、铜绿假单胞菌（P < 0.05）以及所有微生物总体的生长检测更早（P < 0.05）。对于酵母菌，到第14天时，分别从BP26瓶、HBV - FM瓶和IS管中分离出59株中的57株（96.6%）、80株中的79株（98.7%）和67株中的64株（95.5%）；对于荚膜组织胞浆菌，到第14天时，36株中的14株（38%）从IS管中分离出。BACTEC瓶和IS的平均分离时间相似。我们得出结论：（i）对于从血培养中分离真菌，HBV - FM与IS相当（荚膜组织胞浆菌除外）；（ii）对于细菌分离，BP26优于IS；（iii）在光滑假丝酵母菌分离方面，BP26瓶不如HBV - FM瓶和IS管；（iv）HBV - FM瓶必须与另一种血培养瓶或系统配对，以优化菌血症的检测。
