A Retrospective Analysis of Joint Cultures: Only Time Will Tell (Or Will It?)

Introduction/Objective

Multiple textbooks and guidelines, including CLSI, recommend holding joint cultures for 14 days. This prevents false negative results from “slower growers” which include Actinomyces species and Propionibacterium acnes. Holding of these cultures can be a burden for small microbiology labs.

Methods

A retrospective analysis of three years of joint cultures held for 14 days was reviewed. The length of time for the culture to turn positive and the organism that grew was noted.

Results

A total of 67 positive joint cultures were evaluated, which covered a period of 3 years at our institution. Of these, only 1 culture turned positive following day 5 (Propionibacterium acnes grew on day 6). The average time to positive for Propionibacterium acnes was 4 days. In comparison, the average growth time for Staphylococcus aureus and Proteus was 1 day, Pseudomonas aeruginosa was 1.2 days, all Streptococcus species was 2.4 days and Staphylococcus epidermidis was 2.7 days. No cultures grew Actinomyces during our study.

Conclusion

The consequences of missing a positive culture can be grave. In general, culture media has improved and provided increased growth rates. With resources becoming more limited, it may be time to revisit guidelines. This study is too small to be conclusive; a larger study may provide confirmation of the findings.

Evaluation of a commercial radiochromatography module as an arterial blood activity monitor

Input functions required for positron emission tomography (PET) tracer kinetic modeling are often obtained from arterial blood. In some situations, using short-lived radiotracers, e.g. [(15)O]water, rapid sample handling is required. A method used at several facilities is to pump blood through a detector system at a constant rate. We investigate the suitability of a commercial radiochromatography module (IN/US Posi-RAM) for this new use. The Posi-RAM consists of two 2.5 cm (length) x 2.5 cm (diameter) cylindrical bismuth germanate (BGO) detectors that can operate in coincidence mode. Arterial blood is transported through the system via a length of tubing with flow rate controlled by a peristalsis pump. A custom-counting loop and support frame were designed for the Posi-RAM for PET studies. System sensitivity was determined to be 1.1 x 10(4) cps/(MBq ml(-1)). Dead time as a function of count-rate was found to be less than 1% for concentrations below 3.5 MBq ml(-1), a range encompassing all human-study values. In a human study, the performance of the device was found to be similar to that of the facility's current blood monitor (Siemens Fluid Monitor). We conclude that the Posi-RAM has the necessary sensitivity and count-rate capabilities to be used as a real-time blood activity monitor.