Rapid identification of Streptococcus pneumoniae in blood cultures by using the ImmuLex, Slidex and Wellcogen latex agglutination tests and the BinaxNOW antigen test
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Rapid identification of Streptococcus pneumoniae in blood culture (BC) bottles is important for early directed antimicrobial therapy in pneumococcal bacteraemia. We evaluated a new latex agglutination (LA) test on BC bottles, the ImmuLex™ S. pneumoniae Omni (Statens Serum Institut, Denmark), and compared the performance with the Slidex® pneumo-Kit (bioMérieux, France) and the Wellcogen™ S. pneumoniae (Remel, UK) LA tests, as well as the BinaxNOW® S. pneumoniae (Alere, USA) antigen test. The four tests were directly applied on 358 positive BC bottles with Gram-positive cocci in pairs or chains and on 15 negative bottles. Valid test results were recorded in all cases for ImmuLex and BinaxNOW and in 88.5 % (330/373) and 94.1 % (351/373) of cases for Slidex and Wellcogen, respectively. Based on bottles positive for S. pneumoniae by conventional methods, the sensitivity of ImmuLex was 99.6 %, similar to the other tests (range, 99.6–100 %). Based on bottles positive for non-pneumococcal pathogens, the specificity of ImmuLex was 82.6 %, in comparison to 97.6 % for Slidex (p < 0.01) and 85.4 % for Wellcogen (p = ns). The BinaxNOW test had a lower specificity (64.1 %) than any LA test (p < 0.01). On BC bottles positive for α-haemolytic streptococci, ImmuLex was positive in 12/67 (17.9 %) cases, Slidex in 2/59 (3.4 %) cases, Wellcogen in 11/64 (17.2 %) cases and BinaxNOW in 25/67 (37.3 %) cases. In conclusion, the ImmuLex test provides a valid and sensitive technique for the rapid detection of S. pneumoniae in BC bottles, similar to the other compared methods. However, the specificity was sub-optimal, since the test may cross-react with other Gram-positive bacteria.
KeywordsBlood Culture Bottle Latex Agglutination Test Enterococcus Species Test Circle Blood Culture System
We thank SSI Diagnostica, bioMérieux, Remel and Alere for providing the tests evaluated in this study. We gratefully acknowledge the support from Camilla Borg and the other staff members at the clinical microbiology laboratory at Karolinska University Hospital Huddinge, Stockholm, Sweden. Data from the manuscript were presented at the 55th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), San Diego, California, USA, September 17–21 2015.
Compliance with ethical standards
This study was performed in accordance with the Declaration of Helsinki and with the ethical standards of the research committee in Stockholm, Sweden.
Conflict of interest
The authors declare no conflicts of interest.
- 3.Arbique JC, Poyart C, Trieu-Cuot P, Quesne G, Carvalho Mda G, Steigerwalt AG, Morey RE, Jackson D, Davidson RJ, Facklam RR (2004) Accuracy of phenotypic and genotypic testing for identification of Streptococcus pneumoniae and description of Streptococcus pseudopneumoniae sp. nov. J Clin Microbiol 42(10):4686–4696. doi: 10.1128/jcm.42.10.4686-4696.2004 CrossRefPubMedPubMedCentralGoogle Scholar
- 4.Altun O, Almuhayawi M, Ullberg M, Ozenci V (2013) Clinical evaluation of the FilmArray blood culture identification panel in identification of bacteria and yeasts from positive blood culture bottles. J Clin Microbiol 51(12):4130–4136. doi: 10.1128/jcm.01835-13 CrossRefPubMedPubMedCentralGoogle Scholar
- 5.Sullivan KV, Turner NN, Roundtree SS, Young S, Brock-Haag CA, Lacey D, Abuzaid S, Blecker-Shelly DL, Doern CD (2013) Rapid detection of Gram-positive organisms by use of the Verigene Gram-positive blood culture nucleic acid test and the BacT/Alert Pediatric FAN system in a multicenter pediatric evaluation. J Clin Microbiol 51(11):3579–3584. doi: 10.1128/jcm.01224-13 CrossRefPubMedPubMedCentralGoogle Scholar
- 6.Abdeldaim GM, Strålin K, Olcén P, Blomberg J, Herrmann B (2008) Toward a quantitative DNA-based definition of pneumococcal pneumonia: a comparison of Streptococcus pneumoniae target genes, with special reference to the Spn9802 fragment. Diagn Microbiol Infect Dis 60(2):143–150. doi: 10.1016/j.diagmicrobio.2007.08.010 CrossRefPubMedGoogle Scholar
- 9.Wüppenhorst N, Consoir C, Lörch D, Schneider C (2012) Direct identification of bacteria from charcoal-containing blood culture bottles using matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry. Eur J Clin Microbiol Infect Dis 31(10):2843–2850. doi: 10.1007/s10096-012-1638-2 CrossRefPubMedGoogle Scholar
- 11.Fothergill A, Kasinathan V, Hyman J, Walsh J, Drake T, Wang YF (2013) Rapid identification of bacteria and yeasts from positive-blood-culture bottles by using a lysis-filtration method and matrix-assisted laser desorption ionization-time of flight mass spectrum analysis with the SARAMIS database. J Clin Microbiol 51(3):805–809. doi: 10.1128/jcm.02326-12 CrossRefPubMedPubMedCentralGoogle Scholar
- 12.Baggett HC, Rhodes J, Dejsirilert S, Salika P, Wansom T, Jorakate P, Kaewpan A, Olsen SJ, Maloney SA, Peruski LF (2012) Pneumococcal antigen testing of blood culture broth to enhance the detection of Streptococcus pneumoniae bacteremia. Eur J Clin Microbiol Infect Dis 31(5):753–756. doi: 10.1007/s10096-011-1370-3 CrossRefPubMedGoogle Scholar
- 16.Otte S, Skovsted IC, Kerrn MB, Elverdal PL (2014) Rapid detection of Streptococcus pneumoniae in spiked sheep blood culture. Paper presented at the 9th International Symposium on Pneumococci and Pneumococcal Diseases (ISPPD-9), Hyderabad, India, March 9–13, 2014Google Scholar
- 17.Mellmann A, Cloud J, Maier T, Keckevoet U, Ramminger I, Iwen P, Dunn J, Hall G, Wilson D, Lasala P, Kostrzewa M, Harmsen D (2008) Evaluation of matrix-assisted laser desorption ionization-time-of-flight mass spectrometry in comparison to 16S rRNA gene sequencing for species identification of nonfermenting bacteria. J Clin Microbiol 46(6):1946–1954. doi: 10.1128/jcm.00157-08 CrossRefPubMedPubMedCentralGoogle Scholar
- 18.Otte S, Haugan MS, Eriksen HB, Kerrn MB, Elverdal PL (2014) ImmuLex™ S. pneumoniae Omni - a new latex agglutination test for rapid detection of S. pneumoniae in blood cultures and plate cultures. Paper presented at the 9th International Symposium on Pneumococci and Pneumococcal Diseases (ISPPD-9), Hyderabad, India, March 9–13, 2014Google Scholar
- 24.Murdoch DR, Laing RT, Mills GD, Karalus NC, Town GI, Mirrett S, Reller LB (2001) Evaluation of a rapid immunochromatographic test for detection of Streptococcus pneumoniae antigen in urine samples from adults with community-acquired pneumonia. J Clin Microbiol 39(10):3495–3498. doi: 10.1128/JCM.39.10.3495-3498.2001 CrossRefPubMedPubMedCentralGoogle Scholar
- 27.Saha SK, Darmstadt GL, Baqui AH, Hossain B, Islam M, Foster D, Al-Emran H, Naheed A, Arifeen SE, Luby SP, Santosham M, Crook D (2008) Identification of serotype in culture negative pneumococcal meningitis using sequential multiplex PCR: implication for surveillance and vaccine design. PLoS One 3(10):e3576. doi: 10.1371/journal.pone.0003576 CrossRefPubMedPubMedCentralGoogle Scholar