Four-day incubation for detection of bacteremia using the BACTEC 9240

Records of 29,356 blood cultures performed between April 1994 and April 1997, using the BACTEC 9240 continuous monitoring blood culture system, were reviewed retrospectively. From these, 3,127 blood culture vials became positive. Of 95 blood culture isolates detected after three days of incubation, 63 were recovered on day four and 32 on day five. Twenty-six contaminants were recovered on day four, and 21 on day five. Chart review was performed for all day four and five isolates that did not meet our definition of a contaminant. Of the 40 isolates that were clinically insignificant, 31 were recovered on day four, and nine on day five. Of eight clinically significant isolates, six were recovered on day four, and two on day five. Our data support a four-day incubation protocol for the recovery of all clinically significant bacteria with overall sensitivity reduced by only 0.06% when compared with a five-day protocol.