COMPARATIVE STUDY OF MONITORING RESULTS OBTAINED THROUGH TWO HEMOCULTURE SYSTEMS, IN A GROUP OF PATIENTS WITH HEPATIC TRANSPLANT

Introduction. Blood borne infections have a decisive role in the evolution of the liver transplant patient. Detecting these infections remains an absolute priority. Objectives. To compare the ability of two automated microbiological screening systems (VersaTREK versus BACTEC 9050) in detecting the bacterial and fungal etiology of hemocultures in the curable-phases of infection in liver transplant patients, in order to apply the timely and guided antibiotic and antifungal treatment. Material and method. The microbiological study was performed on 60 liver transplant patients (38 men and 22 women) at the "Dan Setlacec" General Surgery and Liver Transplantation Centre from Fundeni Clinical Institute. This study was performed from February to November 2013, in patients with at least 2-3 episodes of transient bacteremia and / or in postoperative sepsis, with 1 to 30 CFU / ml blood the limit of detection. 480 blood cultures from both systems were collected, 240 aerobic and 240 anaerobic. VersaTREK bottles (Redox 1/40 ml, Redox 2/40 ml) were compared with aerobic and anaerobic standard BACTEC/F. By comparing these systems, we detected isolated bacteria and fungi from positive blood cultures. Results. The time to growth detection from the moment of incubation was 18 hours for all organisms on the VersaTREK system, with detection sensitivity of fewer than 20 CFU / ml, as compared to the BACTEC system where growth was detected at 24 hours. We isolated a percent of 30% Gram- negative bacilli (non-fermenters and fermenters), 21.6% MRSA and 6.6% Candida albicans. False positive results were detected - 16.6% for VersaTREK and 25% on BACTEC. Contaminations were particularly present when blood was drawn from an indwelling catheter and less often when a percutaneous venipuncture was performed. For the VersaTREK system, an inoculum of 0.1 ml yielded detection and isolation of germs after only 3 hours after incubation. Conclusions. Both systems were effective in detection of bacteria and fungi in liver transplant patients, but in the case of the VersaTREK system germs were detected and isolated from 0.1 ml inoculum at >3 hours from incubation. Cuvinte cheie: screening bacteriologic, hemocultură, transplant hepatic Rezumat: Introducere: Infecțiile transmise pe cale sanguină au o importan ță decisivă in evoluția pacientului cu transplant hepatic. Diagnosticarea acestor infecții r ămâne o prioritate absolută. Obiectiv: Depistarea in faze curabile a etiologiei bacteriene si fungice urmărită comparativ cu ajutorul a dou ă sisteme automate de screening microbiologic (VersaTREK versus BACTEC 9050) la pacientul transplantat hepatic, in scopul aplicării tratamentului antibiotic si antifungic adecvat cât mai rapid. Material si metod ă: Studiul microbiologic s-a efectuat pe un lot de 60 de pacien ţi (38 b ărbaţi si 22 femei) transplantaţi hepatic in Centrul de Chirurgie Generală si Transplant Hepatic "Dan Setlacec" din Institutul Clinic Fundeni. Acesta s-a efectuat in perioada februarie-noiembrie 2013 la pacienţi care au prezentat cel puţin 2-3 episoade de bacteriemii tranzitorii in cadrul sepsisului postoperator cu o limită de detec ţie de 1-30 UFC / ml sânge. S-au recoltat 480 prelevate - hemoculturi din ambele sisteme, aerobe (240) si anaerobe (240). Flacoanele VersaTREK (Redox 1/40ml, Redox 2/40 ml) au fost comparate cu standardul aerob si anaerob BACTEC/F. S-au identificat bacteriile si fungii izolaţi din hemoculturi pozitive. Rezultate: Timpul de cre stere-pozitivare din momentul incubării la sistemul VersaTREK a detectat o cre stere la 24 ore. S-a evidenţiat un procent de 30% bacili Gram negativi nefermentativi si fermentativi, 21,6% MRSA si 6,6% Candida albicans. S-au obţinut rezultate fals pozitive - contaminări evidenţiate in special in cazurile in care nu s-a folosit metoda percutanată de venopuncţie periferică, recoltarea fiind practicată pe cateter intr-un procent de 16,6% la sistemul VersaTREK si 25% la sistemul BACTEC. Concluzii: Ambele sisteme au fost eficiente in detecţia bacteriilor si fungilor la pacientul transplantat hepatic, dar in cazul sistemului VersaTREK din inoculul de 0,1 ml s-au detectat si izolat germeni la >3 ore de la incubare.