TABLE 2.
Summary of reported studies which compared blood culture techniques to standard agar- and/or broth-based methods for isolation of microorganisms from synovial fluid
| Author (reference) | Blood culture system used | Patient demographics | No. of specimens positive/total specimens evaluated (%) | Results | Secular microorganism trendsa |
|---|---|---|---|---|---|
| von Essen (4) | Hemobact system (Orion Diagnostica, Espoo, Finland) or Signal (Oxoid, Basingstroke, United Kingdom) | Mean age, 42 ± 21 yr; patients with prosthetic (secondary) and natural (primary) infections included | NAb; information presented on 155 culture-positive specimens; no information available on culture-negative specimens | One-third of specimens from patients not receiving antibiotics and one-half of specimens from patients receiving antibiotics were positive by blood culture method only vs culture on conventional solid media (sheep blood, chocolate, anaerobic, and thioglycolate agars) | Natural: (i) S. aureus; (ii) Staphylococcus species, coagulase-negative; and (iii to v) beta-hemolytic streptococci, Streptococcus pneumoniae, Salmonella spp. Prosthetic joint infection: (i) S. aureus; (ii) Staphylococcus species, coagulase-negative; (iii) beta-hemolytic streptococci; and (iv, v) Escherichia coli, other streptococci (not specified) |
| Yagupsky et al. (6) | BACTEC 460 aerobic blood bottles (Becton Dickinson Diagnostic Instrument Systems) | All pediatric patients (age, <18 years) | 63/216 (29.2) | BACTEC bottles equivalent to solid media (sheep blood, chocolate, MacConkey, and/or New York City agar) and/or thioglycolate broth, except BACTEC bottles recovered more K. kingae isolates. | Natural: (i) S. aureus, (ii) K. kingae, (iii) Brucella melitensis, (iv) Streptococcus pyogenes, and (v) S. pneumoniae |
| Fuller et al. (2) | BACTEC Plus 26 and 27 system (Becton Dickinson Diagnostic Instrument Systems) | NA | 1,101 sterile body fluids specimens evaluated; no. of synovial fluid specimens not specified; overall rate of recovery of bacteria, 21% | BACTEC Plus 26 and 27 system recovered statistically significantly more isolates than solid media (chocolate, sheep blood, and anaerobic agar) and thioglycolate and tryptic soy broth | NA |
| Yagupsky and Press (5) | Isolator system (Wampole Laboratories) | Pediatric to adult patients; ratio, 2:1 | 31/144 (21.5) | Isolator system recovered statistically significantly more isolates than culture with solid media (chocolate and Trypticase soy-sheep blood agar) | Natural and prosthetic infections combined: (i) S. aureus, (ii) S. pneumoniae, (iii) Streptococcus group G, (iv) K. kingae, and (v) Salmonella enterica serovar Enteritidis |
| Bourbeau et al. (1) | BacT/Alert system (Organon Teknika) | NA | 50/361 (13.8) | BacT/Alert bottles recovered statistically significantly more isolates than solid media (blood, chocolate agar) and thioglycolate broth; BacT/Alert FAN aerobic and anaerobic bottles superior to BacT/Alert standard aerobic and anaerobic bottles | NA |
| von Essen and Holtta (3) | Hemobact Aerobe and Hemobact Anaerobe system (Orion Diagnostica) | 37 adult patients and 3 pediatric patients | 47/201 (23.4) | 10 more cases of infection diagnosed by blood culture method than by culture with solid media (sheep blood, chocolate, and brucella agar [brucella agar with anaerobic incubation]) | (i) S. aureus; (ii) Staphylococcus epidermidis; and (iii to v) Streptococcus group G, Enterococcus spp., and S. pneumoniae |
a
The top five pathogens are ranked in descending order except for the study by von Essen (4), in which the organisms ranked iii to v occurred at equal frequencies for natural joint infections and organisms ranked iv and v occurred at equal frequencies for prosthetic joint infections, and the study by von Essen and Holtta (3), in which the organisms ranked iii to v occurred at equal frequencies.
b
NA, not available.