Effect of atmosphere and duration of incubation on primary isolation of group A streptococci from throat cultures.

The optimal incubation conditions for isolation of group A streptococci from throat cultures are controversial. Therefore, we compared the effects of aerobic and anaerobic incubations after 24 and 48 h on the recovery of group A streptococci. Throat swabs submitted to the clinical laboratory were inoculated onto duplicate 5% sheep blood agar plates, incubated aerobically or anaerobically (GasPak jar) at 35 degrees C, and examined semiquantitatively after 24 and 48 h. Group A streptococci were identified by the fluorescent-antibody technique. Of 1,040 specimens, 506 (48.6%) grew beta-hemolytic streptococci, including 200 (19.2%) group A streptococci. Group A streptococci were recovered significantly more often with anaerobic incubation than with aerobic incubation after 24 h (182 versus 138; P less than 0.001) and after 48 h (193 versus 174; P less than 0.05). Non-group A beta-hemolytic streptococci also were recovered significantly more often with anaerobic incubation after 24 and 48 h (P less than 0.001). Colony counts were not affected by the incubation atmosphere. We conclude that incubation of throat cultures in an anaerobic atmosphere is superior to incubation in air for detection of group A streptococci. The greater sensitivity of anaerobic incubation, however, may not justify the extra laboratory effort and cost required to differentiate group A streptococci from the non-group A streptococci detected as a result of anaerobic incubation. Throat cultures should be examined after 24 and 48 h, especially if plates are incubated aerobically.