Effects of preincubation temperature on the detection of fastidious organisms in delayed-entry samples in the BacT/ALERT 3D blood culture system

This study evaluates the effect of preincubation on delayed-entry samples for fastidious organisms including the HACEK group, Streptococcus species, Neisseria meningitidis, Haemophilus species and Corynebacterium species for the BacT/ALERT 3D System (bioMérieux) using the FA (aerobic) medium.Bottles were inoculated with two different concentrations (0.5 McFarland and a 1:100,000 dilution) of each organism and either loaded into the system immediately or stored at 4 °C, room temperature (RT) or 37 °C for 24 hours (h) prior to loading.The detection rate (DR) was 92.5% for bottles loaded immediately for both concentrations with a mean time to detection (TTD) of 26.7 h (standard deviation (SD): 14.7 h) for the low concentration and 9.21 h (SD: 5.3 h) for the high concentration. Preincubation at 4 °C did not affect the DR for either of the two concentrations in comparison to no preincubation. The DR at RT was 90.0% for the low concentration and 83.6% for the high concentration. At 37 °C the DR was 76.3% and 66.3% for the low and the high concentrations respectively. The average TTD was inversely correlated with the preincubation temperature. An incubation of four days was sufficient, with the exception of Eikenella corrodens and Gemella sanguinis. The serotype of Streptococcus pneumoniae or Neisseria meningitidis did not influence the TTD. Kingella kingae remained undetected.For the retrieval of the above mentioned bacteria we recommend storage of bottles at room temperature. In case of erroneous storage at 37 °C subcultivation is advisable.All cases with a negative result on day four should be reevaluated and eventually new material for alternative diagnostic procedures should be retrieved.