Paratyphoid fever A (PA) is a systemic infection caused by Salmonella enterica serotype Paratyphi A (SPA) [1]. Although blood cultures are considered to be the ‘gold standard’ for the detection of bloodstream pathogens, there is little information on the controlled clinical comparison of the paired aerobic and anaerobic bottles in the automated continuously monitoring instrument systems, and bacterial counts in the blood of patients with bloodstream infections [2, 3]. Yuxi City is the most severe endemic area of PA in China [4]. In order to determine the factors determining the yields from blood cultures, we have performed broth blood cultures (BBC) by the BacT/ALERT 3D automated blood culture system (bioMerieux, Inc., Durham, NC) and quantitative whole-blood culture (QWBC) for a large series of patients with suspected PA between 1999 and 2008. A total of 13,500 patients admitted with suspected PA to our institutions between June 1999 and June 2008 were studied. The available blood samples were obtained with vacuum system blood collection tubes. A blood culture set included one aerobic bottle (AEB) and one anaerobic bottle (ANB) (bioMerieux), and one QWBC plate (Columbia agar, bioMerieux). A 13-ml quantity of blood from each patient for one test set was considered to be the maximum amount to obtain from a single venipuncture and was distributed as follows: 5 ml to one AEB, 5 ml to one ANB, and 3 ml to one plate (only for 1,000 probable cases of PA). The culture bottles contained 5 ml of blood sample and 40 ml of culture media. Each bottle was monitored with the BacT/ALERT 3D system at 37°C for a standard 5-day protocol or until the instrument signaled a positive result [5]. Any bottle with a positive signal was immediately removed from the instrument, and an aliquot of the blood– broth mixture was taken from the bottle with a sterile needle and swab for subculture on sheep blood nutrient agar and XLD agar (Oxoid, England); the time-to-detection of bacteria causing PA was taken as the incubation time required before the instrument gave a positive signal. All bottles were treated independently until the end of the 7-day incubation and testing period. Both BBC and QWBC were performed for 1,000 probable cases of PA. QWBC were carried out by a pour plate method and the blood bacterial counts were estimated [3]. In brief, 3 ml of blood was drawn aseptically from each patient and injected into a sterile heparinized tube. Three milliliters of heparinized blood was mixed well with 19 ml of molten (50°C) Columbia agar in a sterile Petri dish, allowed to set for solidification, and then incubated at 37°C. After 2 to 4 days, colonies were identified, counted, and recorded as colony-forming units (CFU) per milliliter. The number of SPA bacteria per milliliter of blood was estimated from the number of CFU on each pour plate. The minimum volume of whole blood used for QWBC from any one patient was 3 ml. This gives a lower limit of Eur J Clin Microbiol Infect Dis (2009) 28:1259–1261 DOI 10.1007/s10096-009-0766-9
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