United States National Hospital Survey of anaerobic culture and susceptibility methods, II

To assess the status of clinical anaerobic bacteriology in the United States, we surveyed (by means of a questionnaire) 120 hospitals selected at random with bed capacities of 200-1000, and we received responses from 78 (65%), all of which performed some degree of clinical anaerobic microbiology. Separate anaerobic blood culture bottles were used by 73 labs (94%) (median, 450 specimens/mo): 56% used Bactec 7, 27 or 37; 15% used 'BacT-Alert'; 11% used Columbia broth; 5% used thioglycolate and 'lytic'; 3% each used, Dupont Isolator, Supplemented peptone or other media. Selective media was used for primary anaerobe isolation by 89% labs which included: LKV, 76%; PEA, 53%; BBE, 31%; CNA, 28%; 'CDC', 12%. Sixty labs (78%) stored anaerobes after isolation (median 7 days), most using blood agar plates (31%), chopped meat (26%) or thioglycolate broth (27%) either for further identification (30 out of 78) or susceptibility testing (33 out of 78), if clinically indicated. Only 23% performed routine anaerobic susceptibility testing of clinical isolates. Of the 77% that do not perform susceptibility studies, 59% would not even perform them upon physician request; 30% relied on published surveys; 68% did not publish results of anaerobic susceptibility in annual summaries. When susceptibility testing was performed, the test agents selected were related to availability on a commercial system (21), NCCLS recommendation (20), hospital formulary (15) or hospital committee input (20). Nine of 78 labs (12%) had discussed stopping or decreasing the performance of both anaerobic bacteriology and susceptibility testing. Despite educational and published guidelines, clinical anaerobic bacteriology is not uniformly practiced and could be improved. In addition, an educational effort must be made in order to stress the relevance and increase performance of anaerobic bacteriology.