BD BACTEC FX system을 이용한 혈액배양에서 배양기간의 수행능 평가
Performance evaluation of 4-day versus 5-day blood cultures using the BD BACTEC FX system
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배경: 혈액배양 시스템은 높은 민감도와 신속한 결과 보고를 위해 발전해 왔다. 이 연구에서는 BDBACTEC FX 시스템(Becton, Dickinson and Company, USA)에서 4일과 5일 간의 혈액배양의 유용성을 평가하였다. 방법: 3개월간 2,700병상 규모의 3차 의료기관에 의뢰된 37,379쌍의 혈액배양을 대상으로 하였으며, 혈액배양 양성 검체의 time-to-positivity (TTP) 및 분리 균종에 대한 정보를 분석하였다. 호기성혈액배양은 BD BACTEC Plus Aerobic F 또는 Peds Plus/F, 혐기성은 BD BACTEC Lytic Anaerobic 배지로 배양하였다. 결과: 14,899회의 혈액배양이 의뢰되어 회당 평균 2.51쌍이 의뢰되었다. 총 1,398회(9.38%)에서양성이 검출되었으며, 1,465주의 균이 동정되었다. TTP가 12시간 미만인 경우가 48.87%, 12-24가31.40%, 24-48가 13.38%, 48-72가 3.28%, 72-96가 1.43%, 96가 1.64%였다. 검출빈도가 가장 높은 E. coli와 Klebsiella spp. 균종은 12시간 이내에 각각 88.75%와 78.90%가 검출되었다. E. coli, Klebsiellaspp., E. faecalis 및 E. faecium, S. aureus의 median TTP (T50)은 각각 9.24, 9.60, 13.75, 14.20시간이었으며 혐기병이 호기병에 비해 T50이 유의하게 짧았다. 96시간 이후 검출된 양성결과 24건 중, 96시간이후에 처음으로 검출된 건은 단 4건으로, 이는 모두 혐기성균과 곰팡이에 해당하였다. 결론: BD BACTEC FX 시스템에서 4일 배양은 우수한 민감도를 나타내기 때문에 비용 효과적일수 있지만, 검사실 공간이 충분하고 드문 감염의 위험이 높은 환자가 많은 의료기관에서는 느리게 자라는 드문 균까지 검출하기 위해서 5일 배양이 유용하다.
Abstract
Background: Blood culture (BC) systems have evolved to increase sensitivity and reduceturnaround times. This study compared the performance of a 4-day versus a 5-day BCincubation period using the BD BACTEC™ FX (Becton, Dickinson and Company, USA). Methods: A total of 37,379 consecutive sets of BC were evaluated over a 3-month period in a2,700-bed tertiary care hospital. Positive BC results were reviewed to assess time-to-positivity(TTP) and species identification of the isolates. The BCs were performed in pairs of vials,utilizing either BD BACTEC Plus Aerobic/F or Peds Plus/F with BD BACTEC Lytic Anaerobicmedia. Results: A total of 14,899 episodes, averaging 2.51 sets per episode, were analyzed. Of these,1,398 (9.38%) were positive, yielding 1,465 isolates. TTP (hours) were < 12 in 48.87%, 12-24in 31.40%, 24-48 in 13.38%, 48-72 in 3.28%, 72-96 in 1.43%, and >96 in 1.64%. The two mostprevalent organisms, Escherichia coli and Klebsiella spp. were detected within 12 hours in88.75% and 78.90%, respectively. The respective median TTP (T50) values for E. coli, Klebsiellaspp., Enterococcus faecalis/E. faecium, and Staphylococcus aureus were 9.24, 9.60, 13.75,and 14.20. T50 values for these species were significantly shorter in anaerobic bottles than inaerobic bottles. Of 24 BCs with TTP > 96, only 4 containing anaerobic bacteria or molds werefirst detected after 96 hours. Conclusion: A 4-day incubation has demonstrated excellent sensitivity. However, a 5-dayincubation may be beneficial for hospitals caring for patients at high risk for infections withslow-growing fungi or fastidious bacteria.
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