Assessment of the FAN anaerobic bottle for culture of continuous ambulatory peritoneal dialysis fluid using the BacT/Alert system

The purpose of this study was to determine if the newly available FAN anaer obic bottle (FANAN) alone would be comparable to the combination of the FAN aerobic (FANAE) plus the standard BacT/Alert anaerobic (REGAN) bottles for culture of continuous ambulatory peritoneal dialysis (CAPD) fluid from pat ients with CAPD peritonitis. CAPD fluid (10 mt) was injected into each bott le, which was then monitored by the BacT/Alert instrument by using a 7-day protocol. Aerobic and anaerobic terminal subculture were performed on all b ottles before they were classified as being culture negative. There were 181 effluents received that were suitable for analysis. Growth w as detected in 76 (42%) eftluents by at least one method. FANAE was the sin gle best medium detecting 84/96 (88%) of all organisms whereas the FANAN an d REGAN each detected 69/96 (72%). The combination of FANAE and REGAN bottl es detected 92/96 (96%) isolates, which was significantly better than the F ANAN or FANAE alone for isolate recovery (p < 0.001). The isolates that wer e missed by the FANAN but that were recovered by either FANAE or REGAN were all facultative anaerobes commonly detected in CAPD fluids. Terminal subcu lture revealed otherwise undetected pathogens in 3.9% of positive effluents , usually Pseudomonas aeruginosa. Based on our data, FANAE was the single best bottle for detection of CAPD p eritonitis and, in combination with an anaerobic bottle, detected growth fr om the most effluents. FANAN alone could not substitute for the FANAE/REGAN combination. Although terminal subculture remains controversial, we recomm end routine aerobic subculture to ensure that no P. aeruginosa isolates are missed. (C) 2000 Elsevier Science Inc. All rights reserved.