title: Optimal use of Myco/F lytic and standard BACTEC blood culture bottles for detection of yeast and mycobacteria.
abstract: BACKGROUND
  The optimal use of dedicated fungal and mycobacterial blood culture bottles, such as the BACTEC Myco/F Lytic bottle, has not been well defined in clinical practice.
  
  
  OBJECTIVE
  To compare the performance of Myco/F Lytic and standard blood culture in clinical practice in an urban tertiary care hospital setting and to implement a strategy for optimal use of Myco/F Lytic culture.
  
  
  METHODS
  Retrospective review of laboratory records.
  
  
  RESULTS
  Myco/F Lytic culture did not increase detection of yeasts. Nor did it decrease time to detection except for Candida glabrata, where mean time to positivity dropped from 2.6 +/- 1.1 days in standard to 1.8 +/- 0.8 days in Myco/F Lytic culture. Therefore, an algorithm was developed in which Myco/F Lytic culture was reserved primarily for detection of mycobacteria in patients with severely depressed CD4 counts. Implementation of this algorithm led to a sustained 3-fold reduction in Myco/F Lytic blood culture usage.
  
  
  CONCLUSIONS
  Retrospective analysis suggests substantial clinical equivalence of standard blood and Myco/F Lytic culture for detection of yeast. A multifaceted educational approach based on this data led to a sustained change in physician ordering practices and more cost-effective use of resources.
authors.affiliation: Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. jekirby@bidmc.harvard.edu
authors.forename: James E
authors.initials: JE
authors.lastname: Kirby
authors.forename: Meghan
authors.initials: M
authors.lastname: Delaney
authors.forename: Qinfang
authors.initials: Q
authors.lastname: Qian
authors.forename: Howard S
authors.initials: HS
authors.lastname: Gold
mesh_terms: D000465:Algorithms; D001431:Bacteriological Techniques / Q000295:instrumentation* / Q000379:methods; D001769:Blood / Q000382:microbiology*; D002175:Candida / Q000254:growth & development / Q000302:isolation & purification*; D002177:Candidiasis / Q000175:diagnosis / Q000382:microbiology; D006786:Hospitals, Urban; D009161:Mycobacterium / Q000254:growth & development / Q000302:isolation & purification*; D009164:Mycobacterium Infections / Q000175:diagnosis / Q000382:microbiology; D012189:Retrospective Studies