CONTEXT: The optimal use of dedicated fungal and mycobacterial blood culture bottles, such as the BACTEC Myco/F Lytic bottle, has not been well defined in clinical practice. OBJECTIVES: To compare the performance of Myco/F Lytic and standard blood culture in clinical practice in an urban tertiary care hospital setting and to implement a strategy for optimal use of Myco/F Lytic culture. DATA SOURCES: Retrospective review of laboratory records. RESULTS: Myco/F Lytic culture did not increase detection of yeasts. Nor did it decrease time to detection except for Candida glabrata, where mean time to positivity dropped from 2.6 +/- 1.1 days in standard to 1.8 +/- 0.8 days in Myco/F Lytic culture. Therefore, an algorithm was developed in which Myco/F Lytic culture was reserved primarily for detection of mycobacteria in patients with severely depressed CD4 counts. Implementation of this algorithm led to a sustained 3-fold reduction in Myco/F Lytic blood culture usage. CONCLUSIONS: Retrospective analysis suggests substantial clinical equivalence of standard blood and Myco/F Lytic culture for detection of yeast. A multifaceted educational approach based on this data led to a sustained change in physician ordering practices and more cost-effective use of resources.
CONTEXT: The optimal use of dedicated fungal and mycobacterial blood culture bottles, such as the BACTEC Myco/F Lytic bottle, has not been well defined in clinical practice. OBJECTIVES: To compare the performance of Myco/F Lytic and standard blood culture in clinical practice in an urban tertiary care hospital setting and to implement a strategy for optimal use of Myco/F Lytic culture. DATA SOURCES: Retrospective review of laboratory records. RESULTS: Myco/F Lytic culture did not increase detection of yeasts. Nor did it decrease time to detection except for Candida glabrata, where mean time to positivity dropped from 2.6 +/- 1.1 days in standard to 1.8 +/- 0.8 days in Myco/F Lytic culture. Therefore, an algorithm was developed in which Myco/F Lytic culture was reserved primarily for detection of mycobacteria in patients with severely depressed CD4 counts. Implementation of this algorithm led to a sustained 3-fold reduction in Myco/F Lytic blood culture usage. CONCLUSIONS: Retrospective analysis suggests substantial clinical equivalence of standard blood and Myco/F Lytic culture for detection of yeast. A multifaceted educational approach based on this data led to a sustained change in physician ordering practices and more cost-effective use of resources.
Authors: Ignacio Martin-Loeches; Massimo Antonelli; Manuel Cuenca-Estrella; George Dimopoulos; Sharon Einav; Jan J De Waele; Jose Garnacho-Montero; Souha S Kanj; Flavia R Machado; Philippe Montravers; Yasser Sakr; Maurizio Sanguinetti; Jean-Francois Timsit; Matteo Bassetti Journal: Intensive Care Med Date: 2019-03-25 Impact factor: 17.440
Authors: Frederic Lamoth; Cornelius J Clancy; Frederic Tissot; Kevin Squires; Philippe Eggimann; Ursula Flückiger; Martin Siegemund; Christina Orasch; Stefan Zimmerli; Thierry Calandra; Oscar Marchetti; Minh H Nguyen; Pierre-Yves Bochud Journal: Open Forum Infect Dis Date: 2020-02-27 Impact factor: 3.835