Effect of Clinically Meaningful Antibiotic Concentrations on Recovery of Escherichia coli and Klebsiella pneumoniae Isolates from Anaerobic Blood Culture Bottles with and without Antibiotic Binding Resins

Blood cultures are routinely collected in pairs of aerobic and anaerobic bottles. Artificial sterilization of Gram-negative bacteria in aerobic bottles containing clinically meaningful antibiotic concentrations has previously been observed. This study assessed recovery from anaerobic bottles with and without antibiotic binding resins. ABSTRACT Blood cultures are routinely collected in pairs of aerobic and anaerobic bottles. Artificial sterilization of Gram-negative bacteria in aerobic bottles containing clinically meaningful antibiotic concentrations has previously been observed. This study assessed recovery from anaerobic bottles with and without antibiotic binding resins. We studied the recovery of Escherichia coli and Klebsiella pneumoniae when exposed to meropenem, imipenem, cefepime, cefazolin, levofloxacin, and piperacillin-tazobactam in resin-containing BacT/Alert FN Plus and BD Bactec Plus anaerobic/F bottles as well as resin-free BacT/Alert SN and BD Bactec standard anaerobic bottles. Bottles were inoculated with bacteria and whole blood containing peak, midpoint, or trough concentrations and incubated for up to 120 hours in their respective detection systems. In E. coli resin-containing bottles, recovery was observed in 10/24 (42%), 17/24 (71%), and 18/24 (75%) (P = 0.034) of those exposed to peak, midpoint, and trough concentrations, respectively. In K. pneumoniae resin-containing bottles, recovery was observed in 8/16 (50%), 10/16 (63%), and 10/16 (63%) (P = 0.710), respectively. No growth was detected in bottles containing cefepime regardless of concentration, while recovery was observed in the presence of all concentrations of cefazolin and piperacillin-tazobactam. Recovery in bottles with meropenem and imipenem was more frequently observed in BacT/Alert FN Plus bottles compared with Bactec Plus bottles. Resin-free bottles demonstrated significantly lower recovery than bottles containing binding resin. Clinical concentrations of certain antibiotics can adversely affect detection of E. coli and K. pneumoniae in anaerobic blood culture bottles. Obtaining blood cultures immediately before a dose and utilizing resin-containing anaerobic bottles will maximize the likelihood of recovery.

[1]  D. Nicolau,et al.  Recovery of Gram-Negative Bacteria from Aerobic Blood Culture Bottles Containing Antibiotic Binding Resins after Exposure to β-Lactam and Fluoroquinolone Concentrations , 2019, Journal of Clinical Microbiology.

[2]  B. Posteraro,et al.  Efficient Inactivation of Clinically Relevant Antimicrobial Drug Concentrations by BacT/Alert or Bactec Resin-Containing Media in Simulated Adult Blood Cultures , 2019, Antimicrobial Agents and Chemotherapy.

[3]  D. Nicolau,et al.  Effects of Clinically Meaningful Concentrations of Antipseudomonal β-Lactams on Time to Detection and Organism Growth in Blood Culture Bottles , 2017, Journal of Clinical Microbiology.

[4]  Alan E. Jones,et al.  Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016 , 2017, Intensive Care Medicine.

[5]  W. Dunne,et al.  Antimicrobial binding and growth kinetics in BacT/ALERT® FA Plus and BACTEC® Aerobic/F Plus blood culture media , 2016, European Journal of Clinical Microbiology & Infectious Diseases.

[6]  Y. Geffen,et al.  Predominance of Gram-negative bacilli among patients with catheter-related bloodstream infections. , 2014, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[7]  M. Neely,et al.  Individualization of Piperacillin Dosing for Critically Ill Patients: Dosing Software To Optimize Antimicrobial Therapy , 2014, Antimicrobial Agents and Chemotherapy.

[8]  M. D. Kraker,et al.  The changing epidemiology of bacteraemias in Europe: trends from the European Antimicrobial Resistance Surveillance System. , 2013, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[9]  M. Al-Hasan,et al.  Overall burden of bloodstream infection and nosocomial bloodstream infection in North America and Europe. , 2013, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[10]  David N. Williams,et al.  Comparison of 2 blood culture media shows significant differences in bacterial recovery for patients on antimicrobial therapy. , 2013, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[11]  Á. Soriano,et al.  Changing epidemiology of central venous catheter-related bloodstream infections: increasing prevalence of Gram-negative pathogens. , 2011, The Journal of antimicrobial chemotherapy.

[12]  R. Ariano,et al.  Optimization of meropenem dosage in the critically ill population based on renal function , 2011, Intensive Care Medicine.

[13]  R. Ariano,et al.  Population Pharmacokinetics of High-Dose, Prolonged-Infusion Cefepime in Adult Critically Ill Patients with Ventilator-Associated Pneumonia , 2009, Antimicrobial Agents and Chemotherapy.

[14]  G. Drusano,et al.  Population Pharmacokinetics and Pharmacodynamics of Continuous versus Short-Term Infusion of Imipenem-Cilastatin in Critically Ill Patients in a Randomized, Controlled Trial , 2007, Antimicrobial Agents and Chemotherapy.

[15]  J. Mainardi,et al.  Relevance of Routine Use of the Anaerobic Blood Culture Bottle , 2007, Journal of Clinical Microbiology.

[16]  K. Carroll,et al.  Comparison of BACTEC PLUS Blood Culture Media to BacT/Alert FA Blood Culture Media for Detection of Bacterial Pathogens in Samples Containing Therapeutic Levels of Antibiotics , 2006, Journal of Clinical Microbiology.

[17]  G. Drusano,et al.  Relationship between fluoroquinolone area under the curve: minimum inhibitory concentration ratio and the probability of eradication of the infecting pathogen, in patients with nosocomial pneumonia. , 2004, The Journal of infectious diseases.

[18]  F. Luzzaro,et al.  Prevalence and Drug Susceptibility of Pathogens Causing Bloodstream Infections in Northern Italy: A Two-Year Study in 16 Hospitals , 2002, European Journal of Clinical Microbiology and Infectious Diseases.

[19]  R. Eng,et al.  In vitro evaluation of the BACTEC resin-containing blood culture bottle , 1983, Journal of clinical microbiology.

[20]  M. Pfeffer,et al.  Clinical Pharmacokinetics and Safety of High Doses of Ceforanide (BL-S786R) and Cefazolin , 1979, Antimicrobial Agents and Chemotherapy.