Comparison of 2 blood culture media shows significant differences in bacterial recovery for patients on antimicrobial therapy

Background. Antimicrobial removal devices in blood culture media are designed to remove antibiotics from the blood culture solution, thereby facilitating bacterial growth. How well these devices function clinically has not been established. Methods. All blood drawn for culture from adult inpatients and emergency department visitors in a level I trauma center was placed in paired BACTEC Plus and BacT/Alert FAN culture media and studied simultaneously, consecutively, and prospectively between 1 February and 30 September 2011. All cultures were processed per standard laboratory protocols. Results. Of 9395 total cultures collected, 1219 (13%) were positive, 831 were included, and 524 (33%) contained pathogens. BACTEC had a 4.5-hour faster detection time (P <. 0001), and isolated exclusively 182 of 524 (35%; P <. 001) pathogens, 136 of 345 (39%) of the gram-positive cocci (P <. 001), 48 of 175 (27%; P =. 02) of the gram-negative rods, 101 of 195 (52%) of Staphylococcus aureus (P <. 001), and 59 of 120 (49%; P =. 004) septic events. If active antibiotics had been dosed 0-4 or 4-48 hours prior to culture collection, the odds of that culture growing in BACTEC were 4.8- and 5.2-fold greater, respectively, than of growing in BacT/Alert (P <. 0001). Both were equivalent in the recovery of yeast and when no antimicrobials were dosed. Conclusions. BACTEC media has faster time to detection and increased bacterial recovery over the BacT/Alert media in the following categories: overall growth, pathogens, septic events, gram-positive cocci, gram-negative rods, Staphylococcus aureus, and cultures where antimicrobials were dosed up to 48 hours before culture collection.