Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018




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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Lucknow
On Sep 2018




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Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : February | Volume : 16 | Issue : 2 | Page : DC20 - DC24 Full Version

Early Identification and Antimicrobial Susceptibility Testing of Short versus Standard Incubated Blood Cultures from a Tertiary Care Centre in Southern India


Published: February 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/52679.16004
Kanne Padmaja, Sukanya Sudhaharan, Lakshmi Vemu, Vijay Dharma Teja

1. Associate Professor, Department of Microbiology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India. 2. Associate Professor, Department of Microbiology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India. 3. Professor, Department of Microbiology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India. 4. Professor and Head, Department of Microbiology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India.

Correspondence Address :
Dr. Sukanya Sudhaharan,
Associate Professor, Department of Microbiology, Nizam’s Institute of Medical Sciences,
Hyderabad-500082, Telangana, India.
E-mail: sukanyavimala@gmail.com

Abstract

Introduction: Blood cultures play an important role in the early diagnosis of sepsis and its management. Early detection of pathogens in Blood Stream Infections (BSI) and their Antimicrobial Susceptibility Testing (AST) pattern, plays a vital role in the diagnosis of sepsis and is important for guidance of appropriate therapy.

Aim: To evaluate the accuracy of shortly incubated blood cultures in comparison with standard method for an early Identification (ID) and AST.

Materials and Methods: This was a prospective observational study undertaken from July 2015 to June 2016 at Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India. The blood cultures were loaded in the BacT/Alert system. A total of 92 patients with two sets of blood cultures that flagged positive within 24 hours of collection were included in the study. Grams stain and subcultures of the broths were done. The culture plates were examined after four hours and then at hourly intervals for the presence of growth. Once the growth was sufficient it was processed immediately for ID and AST by Vitek 2C. Incubation of the plates was continued for the rest of the 24 hours at 37oC and was processed again. The mean time for detection were compared between short and standard cultures.

Results: Gram negative pathogens were the predominant organisms isolated in 82/92 (89.1%) followed by gram positive in 10/92 (10.9%). The short and standard cultures had comparable results with respect to ID of the isolates. But, the AST results were comparable only in 88/92 (95.6%) patients. Of the remaining four patients, the AST showed Very Major Error (VME) in 3 (3.3%) patients and Major Error (ME) in 1 (1.08%) patient.

Conclusion: Short incubation of cultures enabled earliest ID and AST of the isolates from blood cultures than standard incubation.

Keywords

Blood stream infections, Concordance, Very major error

Globally, sepsis is one of the important causes of mortality (1). Bacterial infections are the major cause of sepsis in a hospitalised patient (2). Early detection of pathogens in BSI and their AST pattern plays a vital role in the diagnosis of sepsis and is important for guidance of appropriate therapy though the rate of positivity is low with blood cultures (3). Immediate administration of antibiotics in sepsis is essential, so as to reduce the morbidity and mortality rate in the hospitals (4). Early and appropriate antibiotic treatment improves the clinical outcome of patients with septicaemia; hence, there is a need to reduce the Turn Around Time (TAT) for ID and AST test results (5).

Though, automated systems like Continuous Monitoring Blood culture Systems (CMBS) has reduced TAT, but the reporting of blood cultures takes 48-72 hours after flagging positive in a CMBS (2). All these routine microbiological methods are time consuming, thereby delaying appropriate treatment henceforth implementation of short-term incubation method could provide ID results on the same day of blood culture positivity detection and one day earlier than the conventional AST method as this is a simple, rapid and novel method that could facilitate rapid ID and AST results on the same day and can be included into the routine workflow of clinical microbiology laboratory which could improve patient outcomes (3).

Hence, authors decided to reduce the TAT after a blood culture is flagged positive in the automated system by introducing this novel methodology in present laboratory. Present study was done to evaluate the accuracy of ID and susceptibility of the organism grown from blood cultures incubated for short time in comparison with standard method of incubation for 24 hours.

Material and Methods

This was a prospective observational study undertaken at Nizam’s Institute of Medical Sciences Hyderabad, Telangana, India, from July 2015 to June 2016. A total of 112 patient’s blood cultures were received to the Department of Microbiology during the study period. A total of 92 patients with two sets of blood cultures that flagged positive with single organism in gram stain and culture within 24 hours of collection were included in the study. The study was an internal audit and patient identity was not revealed. However, all ethical procedures were followed.

Inclusion criteria: All the samples from patients with two sets of blood cultures (one set includes each one bottle of BacT/Alert SN and FAN) were included in the study.

Exclusion criteria: The patients with one blood culture/one bottle in a set or patients with more than one type of organism on gram stain and culture were excluded from the study. Twenty patients were excluded based on the exclusion criteria.

Study Procedure

The blood culture bottles received were loaded in the BacT/Alert system (bioMérieux, Marcy l’Etoile, France). Grams stain and subcultures of the positively flagged broths were done. The culture plates (5% sheep blood and chromogenic agar (bioMérieux, Marcy l’Etoile, France) were incubated at 37oC were examined for growth.

Short cultures: The cultures were examined after four hours and then at hourly intervals for the presence of growth (Table/Fig 1).

Once the growth was sufficient, it was processed immediately for ID and susceptibility (0.5 Mc Farland density) testing by Vitek 2C ((bioMérieux, Marcy l’Etoile, France). The ID GN and AST N281 (bioMérieux) panels were used for detection of gram negative pathogens and ID GP and P628 panels for gram positive pathogens (3),(6).

Standard cultures: Incubation of the plates was continued for the rest of the 24 hours at 37oC. The 24 hours cultures were again processed in the Vitek 2C for ID and AST.

Calculation of parameters: Mean time to flagging was calculated by dividing the sum of time taken by the blood culture bottles to flag positive by the total number of bottles flagged positive.

Mean time for appearance of growth on plates was calculated by dividing the sum of time taken for appearance of growth in positive cultures plates by the number of positive cultures.

Mean time taken for ID and AST was calculated by dividing the sum of time taken for ID and AST for each culture by the total number of positive cultures.

Total mean time to detection was calculated by adding the mean time to flagging, average time for appearance of growth on plates and average time taken for ID and AST from time of incubation.

Very Major Error (VME): False susceptible-If the reference result was resistant (R) and the test method result was susceptible (S).

Major Error (ME): False resistant-If reference result was sensitive (S) and the test method was resistant (R).

Minor Error (mE): If reference result was R or S and the test method result was intermediate (I) or vice versa (7),(8),(9).

statistical analysis

In the present study, descriptive analysis was done and data was presented as percentages.

Results

Among 92 patients, 57 patients were male 35 were female. The M:F ratio is 1.6:1. Most of the patients were in the age group of 41-50 years (45.7%) (Table/Fig 2). The clinical diagnosis of the patients is shown in (Table/Fig 3).

Gram negative pathogens were the predominant organisms isolated in 82/92 (89.1%) followed by gram positive in 10/92 (10.9%). Of the gram negative pathogens Escherichia coli in 40/82 (48.7%) followed by K. pneumoniae 24/82 (29.2%) (Table/Fig 4). A 38/40 (95%) of E. coli were Extended Spectrum Beta Lactamase Producers (ESBL) and 2/40 (5%) were Multidrug Resistant (MDR) by standard culture method. A 23/24 (95.8%) of K. pneumoniae were ESBL producers and 1/24 (4.2%) was MDR. Of the gram positive pathogens Staphylococcus aureus 6/10 (60%) was the predominant pathogen isolated (Table/Fig 5).

The short and standard cultures had comparable results with respect to ID of the isolates (Table/Fig 6). But, the AST results were comparable only in 88 (95.6%) patients. Of the remaining four patients, the AST showed VME in 3 (3.3%) patients and ME in 1 (1.08%) patient. The standard method identified three ESBL producers of K. pneumoniae which were identified as MDR by short cultures and one MDR of E. coli which was identified as ESBL by short cultures (Table/Fig 6).

The mean time for sufficient growth to appear for processing was 6.6 hours and seven hours for gram negative bacilli and gram positive cocci respectively. The difference in the total mean time to detect between short and standard cultures was about 23-24 hours (Table/Fig 7).

Discussion

Timely ID and providing appropriate therapy plays a crucial role in preventing the mortality associated with bacteremia (10). Rapid ID of the organisms along with its AST results would help to improve the clinical outcome of patients (11). Delay in reporting of AST results leads to empiric therapy with broad spectrum antibiotics and antimicrobial resistance (8). Early report of microscopy led to the start of empiric therapy in 14.8% which was changed in 4% of patients after rapid species ID. Similarly in patients who were on empiric therapy before sending blood cultures, there was change in 6.6% after microscopy and 19.7% after species reporting the therapy changes was rational in 72.2% of the patients (6).

Several studies were done to reduce the TAT for reporting of blood cultures (3),(6),(8),(11). Molecular studies helps in direct detection of organisms and resistance genes from blood culture broths, but it does not provide the Minimum Inhibitory Concentration (MIC) of each of antibiotic and also is not cost effective and identifies the organisms in 81% of cases (7),(12),(13).

Identification and susceptibility testing was done directly from the positive flagged bottles or from after the growth of the organisms by short/standard incubation (3),(8),(11),(14). In present study, ID and AST were done after growth of cultures. Matrix-Assisted Laser Desorption/Ionization-Time Of Flight (MALDI-TOF) helps in the rapid ID of the organisms but sensitivity of the organism has to be done separately by using other methods like Vitek 2C (15). Several methods like lysis filtration, protein extraction were studied for the direct ID of the pathogens which provided 60-99% ID of the pathogens (3),(11).

In present study, the initial steps of extraction were not done and the positively flagged bottles were inoculated on chromogenic and blood agar plates and were checked hourly for sufficient growth for testing. By this method, authors tried to standardise the shortest time of incubation in comparison to the standard time of 24 hours for doing ID and AST of the pathogens. For gram negative pathogens it was around 6.6 hours and for gram positive cocci it was 7 hours.

Direct inoculation from positive blood culture bottles into Vitek 2C, 93-95% were correctly identified, but in a study from Spain 62% showed complete agreement with the standard method for species ID, while none of the gram positive cocci were correctly identified by the direct method (14),(16),(17). In a study from Ireland, ID of the organisms after six hours was done by MALDI-TOF and correlation was seen in all gram positive cocci but only in 96% of gram negative bacilli (18). Prolongation of incubation condition to six hours gives more valid results compared to shorter periods. In a study from Korea, after short term incubation for six hours they compared three methods-MicroFlex LT, Vitek-MS, and Vitek 2 Systems for ID and found that the concordance of the species level ID results obtained using MicroFlex LT and Vitek-MS with Vitek 2 system was 82.3% and 78.3% respectively (3). In various studies they found that after three to four hours of incubation, the concordance of ID was 70-80% (19),(20). In another study 94% of the isolates were identified on the same day after standard incubation by Vitek 2 MS (11). Overall, present study was different from most studies as they identified the pathogens by different instruments like Vitek, MALDI-TOF etc., after short incubation of 4-6 hours/standard incubation and same day ID. In present study, authors used Vitek 2C for ID and compared results between short and standard time incubated cultures and there was complete agreement in ID of the pathogens between six hours and 24 hours of incubation. This method gave better results than direct ID, but still has to be studied for larger number of samples.

Susceptibility testing of positive blood cultures done using the Accelerate Pheno™ system and direct Vitek® 2 card inoculation workflows gave faster and reliable results (8). In present study, AST was done by Vitek 2C, available in present lab. The time of incubation was shorten to six hours and compared with standard time of 24 hours. In present study, there were errors in the AST in gram negative pathogens and not in gram positive pathogens. Very major error is the false susceptible result of rapid AST, ME is the false resistant result of rapid AST, and mE is the false categorisation involving intermediate result standard method and resistant or susceptible by test method (7),(8). Data showed that, for gram negative rods, there were 50% categorical agreements between the direct and standard methods for all drugs tested and 38% for gram positive cocci from direct AST from broths (17). Comparison between direct AST from positive broths and standard AST showed VME of 3.6%, ME 2.2%, and mE 3.8% in a study from Italy (21), 0.8% VME and 0.02% ME rates from Netherlands (14), and 0.6% VME, 0.1% ME and 2.1% mE from Spain (16). In short and standard methods of incubation, in a study from Ireland, there was 6.7% showed mE, 0.6% ME and 0.4% VME (18). Similarly, in various other studies, VME was 0.5-1%, ME 0.7-1%, mE 1-3% (3),(11). In present study the VME was 1.08% and ME was 3.3%. VME was in one isolate of E. coli which was susceptible to carbapenems in short cultures and was resistant in the standard cultures. Major error in three isolates of K. pneumoniae which was resistant to carbapenems in short cultures and was and sensitive in the standard cultures. There was agreement between other antibiotics in short and standard cultures. To our knowledge and literature search, this was the first study from Southern India. Comparison of different studies from all over the world is shown in (Table/Fig 8) (3),(7),(9),(11),(16),(17).

The US Food and Drug Administration (FDA) has set the limits for major and VME as <3% and <1.5%, respectively, and its within limits in present study (19),(22). The errors in AST could be due to the technical error while doing AST where the appropriate McFarland was not taken or due to insufficient growth of that pathogen.

In a study from United States, the average time to ID and AST from sample collection was 41.4 hours vs. 84.8 hours (11). Another study from Spain, the mean time for ID of gram negative rods was 78.2 minutes in Brain Heart Infusion (BHI) broth for gram positive cocci was 128.5 minutes in BHI (23). In present study, the average time to detect gram negative bacilli and gram positive cocci by short incubation was 27 hours and 33 hours respectively, in comparison to standard time which was 51 hours and 56 hours respectively. The average time difference between standard and short incubation was 23 hours and 24 hours for gram negative bacilli and gram positive cocci, respectively. Hence, there was a difference of one day between short and standard cultures, which is a very crucial period in a patient with sepsis, for initiation of antimicrobial therapy.

Limitation(s)

The limitation of this study was that sample size was low, not evaluated for yeast isolates and is not useful in case of polymicrobial growth.

Conclusion

Blood cultures remain the gold standard for diagnosis of bacteremia in patients with sepsis. The time taken for reporting of blood cultures plays an important role in the management of the patients. In this study, it was observed that mean time for detection of gram negative bacteremia was lower than gram positive isolates. This simple and rapid method would facilitate the implementation of rapid ID and AST into the routine workflow of clinical microbiology laboratories, which could improve patient outcomes. With the resources available at our institute, authors observed that short incubation of cultures helped not only in early diagnosis but also provided appropriate and prompt therapy to the patients which would prevent the mortality, length of hospital stay, cost to the patients and reduce TAT in detection of bacteremia.

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DOI and Others

DOI: 10.7860/JCDR/2022/52679.16004

Date of Submission: Oct 01, 2021
Date of Peer Review: Nov 15, 2021
Date of Acceptance: Dec 23, 2021
Date of Publishing: Feb 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? No
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Oct 07, 2021
• Manual Googling: Dec 20, 2021
• iThenticate Software: Dec 22, 2021 (20%)

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