By Syed Wahab, Manager, Clinical Microbiology, Forum Health

Forum Health is the largest hospital system in the Youngstown area, with approximately 5,000 staff members. It includes two general hospitals, one children’s hospital, three ambulatory treatment facilities, and a number of outpatient physical, occupational and mental treatment facilities. Forum Health’s outreach services encompass Northeast Ohio into at least three counties.

Our Laboratory performs over a million tests in total a year and prides itself in providing many services not commonly available in a community hospital setting such as Electron Microscopy, Cytogenetics, and Virology. In microbiology alone we do over 100,000 tests per year. Annually we run about 18,000 blood cultures with a positivity rate of 10-12%.

We have made many improvements in our Microbiology Department since 1993, but none as important as our decision to update our blood culture system. Our biggest improvement was moving from a manual to an automated blood culture system.

We acquired our first automated system in 1993, the Bactec 9240 (Becton Dickinson), which we had for about five years. We used the aerobic resin bottle, a non-resin anaerobic bottle, and a pediatric resin bottle with this system. In 1999 we changed over to the BacT/Alert (bioMerieux). Finally in 2003, we converted to the VersaTREK® Automated Microbial Detection System from TREK Diagnostic Systems.

The decision to move from the Bactec 9240 to the BacT/Alert was driven purely by economics. By switching from Bactec to BacT/ Alert our lab was able to save a considerable amount of money on media. I was aware of the “ inconveniences” my technologists would be facing with the BacT/Alert, such as difficulty with gram stain reading and the easy breakage of the BacT/ Alert bottles; however I have a wonderful team of technologists and knew they would work through those challenges. I tried to utilize the BacT/Alert standard media, but during our internal correlation and validation study I noticed I was not recovering as many organisms as I thought I should have with the bioMerieux’s standard media. I felt I was forced to switch over from bioMerieux’s standard to their premium (higher cost) FAN media in order to feel comfortable that the media would sustain the recovery of wider variety organisms we normally encounter in our laboratory.

Switching from BacT/Alert to the VersaTREK system was an easy decision that was based on several factors. First and foremost I always believed in the technology of the ESP® Culture System II and VersaTREK Automated Microbial Detection System. With its comprehensive detection technology (CDT), fastidious organisms that may not necessarily signal on the other systems, due to low CO2 production, will signal on the VersaTREK system. I thought that we may have been missing some fastidious organisms with the other systems due to low CO2 production. The VersaTREK system detects pressure changes within the headspace of the bottle regardless of what type of gas is produced or consumed (O2, CO2, N2, or H2). Secondly, I am confident in TREK’s media. Having been in use for several years in the ESP format, I believe it has proven itself to be of excellent quality when it comes to overall recovery. At Forum we currently utilize the 40 ml EZ Draw® Direct Draw blood culture bottles. Because there is no charcoal or resin in the bottles, gram stains are much easier to interpret.

Prior to the evolution of the VersaTREK system, I had looked at the ESP® Culture System II. As mentioned above, I had always believed in TREK’s comprehensive detection technology and thought that detecting the production and consumption of all microbial gases was superior than detecting just CO2. However, I did have several reservations regarding the ESP instrument. Those reservations included the connector that must be placed onto each blood culture bottle prior to placement into the instrument, the DOS computer seemed complicated, and placement of the bottle into the instrument appeared to be cumbersome. I told TREK Diagnostic Systems about my concerns. I was very impressed at the 2002 ASM when I first saw the VersaTREK instrument and realized that my hardware concerns were all addressed within this instrument. The connector only takes a second to place onto the bottle (my technologists don’t see this as a negative when you consider the superior organism recovery abilities of the system), the instrument and new windows-based software are intuitive and user-friendly, and the new bottle placement guides located in the instrument help tremendously with bottle insertion. I must say that TREK does listen to what the marketplace has to say about their products!

During the transition from manual to automated, and from one instrument to another, we have always followed very rigorous correlation and validation procedures to ensure the instrument was performing to our standards. During the VersaTREK correlation study, we ran over 100 patients and included fastidious organisms such as Haemophilus influenzae, Neisseria gonorrhoeae, Bacteroides fragilis, and Bacteroides thetaiotaomicron. In addition, protocol organism groups with and without antibiotics were simultaneously run on both instruments. FAN aerobic bottles were used on the BacT/ Alert and REDOX 1® media was used with the VersaTREK instrument. This small but very precise protocol began by inoculating 0.1 ml of organism suspension into each blood culture bottle. Then 0.01 ml of an antibiotic concoction was added to the bottles. This was similar to the protocol we had followed during our transition from Bactec 9240 to the BacT/Alert when we acquired them years ago. As you can see from the table on the cover page, the VersaTREK instrument was able to recover the organisms listed faster than BacT/Alert even though the ersaTREK system does not require the costly specialty media! I must confess that the VersaTREK system performed better than I had anticipated and we are very happy with the instrument!

Not only was I impressed with the VersaTREK instrument, but also with the comprehensive level of training we received when the system was installed. This installation process ran very smoothly and the structured training program was great. To this day some of my technologists still comment on how great TREK Diagnostic Systems was in the training process. They had tremendous patience and had the answers to just about every question we came up with. In addition, TREK Diagnostic Systems is very good in responding to questions or concerns we may have with the instrument. Their quick response time is greatly appreciated in our busy laboratory setting.

Since the introduction of the VersaTREK system into our lab, we have noticed an increase in the number of fastidious organisms and a faster time-todetection for those organisms compared to our previous systems. In addition, we are recovering more Streptomycetes and AFB organisms than ever before.

I can confidently say that I am pleased with my decision to move to the VersaTREK Automated Microbial Detection System. My staff is a wonderful group of people and if they are happy with the instrumentation they are using, then I am happy too!