Impact of Introduction of the BD Kiestra InoqulA on Urine Culture Results in a Hospital Clinical Microbiology Laboratory Sharon Strauss, a Paul P. Bourbeau b Reading Hospital, Reading, Pennsylvania, USA a ; BD Diagnostics, Sparks, Maryland, USA b This study compared results from plating urine specimens with the BD InoqulA instrument using a 10-l inoculum with results from cultures plated manually with a 1-l loop for comparable 2-month periods. The positivity rates, turnaround times for posi- tive cultures, and BD Phoenix identification and antimicrobial susceptibility test results were comparable for both time periods. We experienced no problems with culture interpretation as the result of moving to the 10-l inoculum. I n contrast to the 1-l urine specimen routinely plated in U.S. and Canadian laboratories, many European labs (1, 2, 3), as well as lab- oratories in other parts of the world, historically have plated 10-l urine specimens. The BD Kiestra InoqulA (BD Kiestra B.V., Drachten, The Netherlands) utilizes a pipetting device with a dispos- able pipette that dispenses a minimum volume of 10 l. As a result, routine urine specimens plated with the BD InoqulA generally utilize a 10-l inoculum volume, although volumes up to 100 l can be dispensed if needed for a specific laboratory protocol/application. Urine cultures represent a significant percentage of routine bacteri- ology cultures in most clinical microbiology laboratories, and conse- quently, any changes to urine culture protocols merit significant at- tention. For a laboratory that is transitioning from plating 1 l of urine with a manual loop to 10 l with the BD InoqulA, it would be important to assess any impact(s) that this change might have on culture metrics, including positivity rates, ability to obtain isolated colonies, and time(s) to results. This study, designed to compare urine culture results obtained for a fixed time period prior to the installation of a BD InoqulA when plating for specified urine speci- men types, was performed manually using a 1-l loop with a time period post-BD InoqulA installation comparable to that when plat- ing was performed with the BD InoqulA using a 10-l inoculum volume. On the basis of the repeated experiences of European labo- ratories (1, 2, 3), we hypothesized that we would obtain sufficient isolated colonies with the BD InoqulA 10-l inoculum so as to not adversely affect time to completion of cultures or positivity rates compared to results obtained with a 1-l inoculum volume. All urine specimens for the pre-BD InoqulA installation and post-BD InoqulA installation time periods were plated on Mac- Conkey agar and Trypticase soy agar with 5% sheep blood with in- cubation of all plates at 35°C to 37°C in 5 to 7% CO 2 . Only clean- catch urine specimens or urine collected from indwelling catheters was included in this study. All cultures were examined the day follow- ing inoculation, and cultures with no growth on day 1 were reincu- bated for one additional day. Cultures were worked up similarly dur- ing the preinstallation and postinstallation time periods using standard Reading Hospital microbiology laboratory protocols, with workup performed by the microbiology technologist(s) routinely as- signed to the urine bench. As appropriate, for positive results, organ- ism identification and antimicrobial susceptibility testing were per- formed with the BD Phoenix instrument (BD Diagnostics, Sparks, MD). Nearly all specimens for which a BD Phoenix antimicrobial susceptibility test was set up also had a BD Phoenix identification panel set up. The only rapid/spot tests routinely performed in this laboratory are for identification of Aerococcus spp. and for serotyp- ing of beta-hemolytic streptococci. Any required supplemental organism identifications (e.g., spot indole test) and/or antimicro- bial susceptibility testing (Etests) were performed per routine lab- oratory protocols. Retrospective urine culture results were reviewed for a 2-month period prior to installation of the BD InoqulA instrument (1 l of urine plated manually with a calibrated loop) and for a 2-month period 3 months post-BD InoqulA installation (10 l of urine plated with the BD InoqulA instrument). Culture result metrics extracted from Cerner Classic LIS 015 using Discern Explorer included speci- men source, time and date of receipt, organism(s) identification and quantity, completion time and date, BD Phoenix instrument com- pletion time and date, and received-to-completion time for culture and for each BD Phoenix instrument result. The “start time” for the culture was defined as the time when the specimen was accessioned and the test was ordered (not plated) in the microbiology laboratory; there was no change in this process between the two phases of the study. The actual inoculation time was not recorded or captured. The BD Phoenix result was defined as the time that the BD Phoenix instrument finalized the result. For most speci- mens, this BD Phoenix result included the biochemical identification and antimicrobial susceptibility test result. When both biochemical identification and an antimicrobial susceptibility test were performed on an isolate, the BD Phoenix instrument was programmed to not release the identification until the susceptibility testing was com- pleted. The culture completion time was the time when a technologist electronically finalized the culture result. Since culture work-up is performed on only one shift in this laboratory, there was always a difference between the time of reporting of the BD Phoenix result and the time of the final culture report. For example, a BD Phoenix result may have been finalized at 3:00 a.m., whereas the culture was not Received 12 February 2015 Accepted 19 February 2015 Accepted manuscript posted online 4 March 2015 Citation Strauss S, Bourbeau PP. 2015. Impact of introduction of the BD Kiestra InoqulA on urine culture results in a hospital clinical microbiology laboratory. J Clin Microbiol 53:1736 –1740. doi:10.1128/JCM.00417-15. Editor: B. A. Forbes Address correspondence to Sharon Strauss, sharon.strauss@readinghealth.org. Copyright © 2015, American Society for Microbiology. All Rights Reserved. doi:10.1128/JCM.00417-15 1736 jcm.asm.org May 2015 Volume 53 Number 5 Journal of Clinical Microbiology