Evaluation of Phadebact and Streptex Kits for rapid grouping of streptococci directly from blood cultures

Abstract

The Phadebact Streptococcus Test and the Streptex Test kits were evaluated for grouping streptococci directly from blood cultures. Pellets of bacteria obtained from centrifuged samples of positive blood cultures were inoculated into Todd-Hewitt broth for 2- and 4-h Phadebact tests and into pronase for Streptex tests. Hemolysis was determined after pipetting a portion of each pellet into cuts made in blood agar plates incubated anaerobically for 2 to 6 h. Serological groups were also determined from colonies of the 137 strains of streptococci used in the study by the Lancefield precipitin method. Of the 126 strains tested by the 4-h Phadebact method, 120 (95.2%) agreed with Lancefield groupings, and 133 (97.1%) of the 137 strains tested by Streptex were in agreement. In contrast, only 31 of 55 strains (56.4%) were correctly identified by the 2-h Phadebact method. Misidentifications were related to multiple agglutinations and weak agglutinations in homologous antisera. Group A isolates were most frequently misidentified by all of the test methods. Hemolysis was determined within 4 h for 92.7% of the isolates and within 6 h for the remaining strains. Although the 4-h Phadebact procedure and the Streptex procedure were comparable in overall accuracy, cost, and technologist time, Streptex was the method of choice for direct groups. Results were available within 75 min for the Streptex procedure compared with 4 h for the Phadebact method. Because few cross-reactions occurred, agglutination responses were clearer and easier to interpret. Results from 2-h Phadebact tests were not satisfactory, and this method is not recommended.