Comparative evaluation of agar dilution and broth microdilution by commercial and in-house plates for Bacteroides fragilis group: An economical and expeditious approach for resource-limited settings.

OBJECTIVE: To compare the performance of agar dilution and broth microdilution by commercial and in-house prepared plates for the Bacteroides fragilis group. The cost analysis was performed to demonstrate that in-house prepared BMD plates were a suitable alternative to agar dilution given the high cost and low feasibility of incorporating commercial BMD plates in routine, particularly in the tertiary care institutes of many low- and middle-income countries. METHODS: Thirty B. fragilis group isolates were tested against six antibiotics, frequently used as empirical therapy for anaerobic infections including metronidazole, clindamycin, imipenem, piperacillin-tazobactam, cefoxitin, and chloramphenicol. The running consumable expenditure for all methodologies was calculated. RESULTS: The results demonstrated essential and categorical agreement of >90% for all antibiotics except cefoxitin, which showed <90% categorical agreement. No major or very major errors were observed. We observed a high agreement and strong concordance for MIC values between both methods and inter-rate reliability of >0.9 by Cohen's kappa analysis, indicating almost perfect agreement between both methods using either of the plates. In contrast to agar dilution, a 20.5 fold cost reduction was seen in BMD using in-house plates and a 5.8 fold reduction using commercial plates to test a single isolate. However, when testing 30 isolates concurrently the cost significantly increased for commercial BMD plates by 8.4 folds, and only 1.03 fold cost reduction was seen with in-house BMD plates. CONCLUSION: BMD gives comparable results to agar dilution and can be considered a method of choice to test a small number of samples. The technique is an economical option when plates are standardized in-house and could be employed for susceptibility testing of the B. fragilis group.

Comparison of four agar media for the enumeration of the Mycobacterium abscessus complex.

Background: Traditional culture of nontuberculous mycobacteria (NTMs) has involved egg-based formulations (Lowenstein-Jensen medium) or defined media (Middlebrook formulations), which have disadvantages of composition complexity, availability, and cost. This study quantitatively compared three non-selective, non-blood based basal agars with Columbia blood agar (CBA), to enumerate Mycobacterium abscessus complex organisms in pure culture. Methods: M. abscessus subsp. massiliense, M. abscessus subsp. bolletii, and M. abscessus subsp. abscessus were employed. Inocula of each of these were counted on three basal agar media, including (i) standard plate count agar (SPCA), (ii) tryptone soya agar (TSA), and (iii) Mueller-Hinton agar (MHA) and compared to counts on CBA. Results: All NTM isolates of all subspecies grew successfully on all four media examined. The growth was most profuse on SPCA, with a mean colony diameter of 3 mm, whereas the mean colony diameter on all other media was 1 mm. Statistically, there was no significant difference in counts when comparing CBA with SPCA or MHA (P > 0.05), whereas there was a statistically significant difference between CBA and TSA (P = 0.01). There was no statistically significant difference between SPCA and MHA (P = 0.53). Conclusion: This study indicates that SPCA and MHA are equally effective as CBA, when enumerating of M. abscessus complex organisms. Employment of TSA gave significantly lower counts than CBA (P = 0.01) and therefore should not be employed when enumerating these organisms. SPCA yielded the most profuse growth of all media examined. In addition to these advantages, given that SPCA does (i) not require blood as a medium constituent, (ii) is simple to reconstitute, (iii) is relatively cheap, and (iv) is widely available commercially, this study endorses employment of SPCA for the nonselective culture of M. abscessus complex organisms, including enumeration.

Performance of Low-Cost Agar from Gracilaria salicornia on Tissue Culture of Pleurotus HK-37.

Currently, the demand of Pleurotus HK-37 (oyster mushroom) in Tanzania is growing rapidly due to the increasing of awareness on its nutrition, health, and economic benefits. Despite the increasing demand, the availability of strains of Pleurotus HK-37 species is still a challenge due to high cost of tissue culture technology. The high cost of importing agar seems to be among the factors for this failure. This study aimed at investigating the performance of low-cost agar from local Gracilaria salicornia on tissue culture of Pleurotus HK-37. Local extracted agars with different gel strengths ranging between 100, 200, 300, 400, and 500 g/cm2 were used to make PDA media. The average mycelia growth rate (mm/day) ranged between 9.87 ± 1.44 and 14.9 ± 0.85 mm/day. Low-cost agar shows quite similar performance as that of standard agar on active growth of Pleurotus HK-37 mycelia. All PDA plates appeared white and feathery and showed to grow in a circular mode (radial extension). Mycelia growth on standard agar PDA took 5 days while on extracted local agar PDA took 5 to 7 days to fully colonize the plate at 27 ± 2°C. The present study shows that the production cost can be reduced by ∼35-78% by using local agar.

[Thin layer agar represents a cost-effective alternative for the rapid diagnosis of multi-drug resistant tuberculosis]. / Agar de capa delgada: Una opción costo-efectiva para el diagnóstico rápido de tuberculosis multirresistente.

OBJECTIVE: Using cost-benefit analysis for comparing the thin-layer agar culture method to the standard multiple proportion method used in diagnosing multidrug-resistant tuberculosis (MDR TB). METHODS: A cost-benefit evaluation of two diagnostic tests was made at the Corporación para Investigaciones Biológicas (CIB) in Medellín, Colombia. RESULTS: 100 patients were evaluated; 10.8% rifampicin resistance and 14.3% isoniazid resistance were found. A computer-based decision tree model was used for cost-effectiveness analysis (Treeage Pro); the thin-layer agar culture method was most cost-effective, having 100% sensitivity, specificity and predictive values for detecting rifampicin and isoniazid resistance. The multiple proportion method value was calculated as being US$ 71 having an average 49 day report time compared to US$ 18 and 14 days for the thin-layer agar culture method. DISCUSSION: New technologies have been developed for diagnosing tuberculosis which are apparently faster and more effective; their operating characteristics must be evaluated as must their effectiveness in terms of cost-benefit. The present study established that using thin-layer agar culture was cheaper, equally effective and could provide results more quickly than the traditional method. This implies that a patient could receive MDR TB treatment more quickly.

Agar de capa delgada: Una opción costo-efectiva para el diagnóstico rápido de tuberculosis multirresistente / Thin layer agar represents a cost-effective alternative for the rapid diagnosis of multi-drug resistant tuberculosis

Objetivo Realizar un análisis de costo efectividad comparando el método de cultivo en agar de capa delgada y el método estándar de proporciones múltiples, utilizados en el diagnóstico de Tuberculosis Multi-drogorresistente (TB MDR). Métodos Estudio de evaluación económica en el cual se evalúan los costos y la efectividad de dos pruebas diagnósticas, ejecutado en la Corporación para Investigaciones Biológicas-CIB en Medellín, Colombia. Resultados Se evaluaron 100 pacientes, encontrando una prevalencia de resistencia a la Rifampicina de 10,8 % y resistencia a Isoniazida de 14,3 %. Se presenta un análisis en términos de costo-efectividad mediante el diseño de un árbol de decisiones (Treeage Pro ®), resultando ser la prueba basada en cultivo en agar de capa delgada más costo-efectiva; con valores de sensibilidad, especificidad y predictivos del 100 % para detectar resistencia a Rifampicina e Isoniazida. El valor del método de las proporciones múltiples fue calculado en US$ 71, con una media de tiempo para ser reportado de 49 días versus US$ 18 y 14 días respectivamente para el cultivo en agar de capa delgada. Discusión Se han desarrollado nuevas tecnologías para el diagnóstico de Tuberculosis, aparentemente más rápidas y efectivas, que deben ser evaluadas no solo en sus características operativas, sino también en términos de costo-efectividad. El presente estudio establece que el empleo de la capa delgada es menos costoso, igualmente efectivo, y puede aportar resultados más rápidamente; cuando se compara con el método tradicional. Esto implica, entre otros aspectos, que el paciente pueda recibir más oportunamente el tratamiento dirigido para TB MDR.

Objective Using cost-benefit analysis for comparing the thin-layer agar culture method to the standard multiple proportion method used in diagnosing multidrug-resistant tuberculosis (MDR TB). Methods A cost-benefit evaluation of two diagnostic tests was made at the Corporación para Investigaciones Biológicas (CIB) in Medellín, Colombia. Results 100 patients were evaluated; 10.8 % rifampicin resistance and 14.3 % isoniazid resistance were found. A computer-based decision tree model was used for cost-effectiveness analysis (Treeage Pro); the thin-layer agar culture method was most cost-effective, having 100 % sensitivity, specificity and predictive values for detecting rifampicin and isoniazid resistance. The multiple proportion method value was calculated as being US$ 71 having an average 49 day report time compared to US$ 18 and 14 days for the thin-layer agar culture method. Discussion New technologies have been developed for diagnosing tuberculosis which are apparently faster and more effective; their operating characteristics must be evaluated as must their effectiveness in terms of cost-benefit. The present study established that using thin-layer agar culture was cheaper, equally effective and could provide results more quickly than the traditional method. This implies that a patient could receive MDR TB treatment more quickly.

Back to the kitchen: food-grade agar is a low-cost alternative to bacteriological agar.

Food-grade agar can be used as a low-cost substitute for bacteriological agar in the preparation of solid microbial media. No difference was observed in the colony morphology, growth rate, or viability of bacteria grown on solid media prepared using food-grade agar as compared with using bacteriological-grade agar. This simple tip can reduce the cost of the most common solid media by 80% or more.

Microcolony culture techniques for tuberculosis diagnosis: a systematic review.

BACKGROUND: There is considerable demand for quicker and more affordable yet accurate diagnostic tools for tuberculosis (TB). The microscopic observation drug susceptibility (MODS) assay and the thin-layer agar (TLA) assay are inexpensive, rapid microcolony-based culture methods. METHODS: A systematic review and meta-analysis was performed to assess the accuracy and other test characteristics of MODS and TLA compared to a reference standard of traditional solid or liquid culture. Pooled estimates of sensitivity and specificity and their 95% confidence intervals were estimated with an exact binomial likelihood random effects meta-analysis. RESULTS: A total of 21 eligible studies were identified, 12 that evaluated MODS, seven that evaluated TLA and two that evaluated both. The overall pooled sensitivity and specificity of MODS were respectively 92% (95%CI 87-97) and 96% (90-100), and for TLA they were respectively 87% (95%CI 79-94) and 98% (95%CI 94-100), although there was considerable heterogeneity of results. When the studies were restricted to those assessing accuracy of MODS in sputum samples only, the sensitivity was 96% (95%CI 94-98) and the specificity 96% (95%CI 89-100). The mean intervals from reception of specimens to results were 9.2 days with MODS and 11.5 days with TLA; contamination rates averaged 6.6% with MODS and 12.3% with TLA; materials and supplies costs averaged US$1.48 for MODS and US$2.42 for TLA. CONCLUSIONS: MODS and TLA appear to be accurate and rapid yet inexpensive diagnostic tools for active TB. However, this review did not find sufficient evidence on the feasibility and costs of implementation of these tests, nor on the impact of these tests on patient outcomes.

[Evaluation of chromogenic medium Uriselect4 in urine culture]. / Évaluation du milieu chromogène Uriselect4 au cours des urocultures.

We evaluated the performance and the cost of chromogenic medium Uriselect4 agar with regard to the standard medium for the detection and identification of urinary tract pathogens. A total of 503 clinical urine specimens containing leucocytes greater or equal to 104/mL were analysed prospectively, in parallel by two different persons on blood agar (GS) and Uriselect4 according to the manufacturers' instructions. Of the 503 urine specimens tested, 210 gave a positive culture on Uriselect4 versus 181 on GS. The majority of bacterial species grew on both media; enterobacteria grew on Uriselect4 better than GS. The identification of Escherichia coli (E. coli), Proteus mirabilis (P. mirabilis), KES group and Enterococcus faecalis (E. faecalis) did not require the use of galleries Api and has a gain of 24  h. Positive pure cultures on Uriselect4 corresponding to negative cultures of GS were noted in 17 ases. Conversely, in seven cases a positive pure culture on GS was noted while the corresponding Uriselect4 cultures were negative. The cost of identification on GS (including the cost of galleries Api), was about two times higher than Uriselect4. Uriselect4 medium isolates the most frequent urinary tract pathogens and identify them so almost immediately, with a lower cost.

Cost-effectiveness of blood agar for isolation of mycobacteria.

BACKGROUND: Mycobacterium species are grown using specific media that increase laboratory cost, thus hampering their diffusion in resource-limited countries. Preliminary data suggested that versatile blood agar may be also used for mycobacterial culture. METHODOLOGY: We examined the growth of 41 different Mycobacterium species on 5% blood agar. Over a 24-month period we analysed isolation of mycobacteria after parallel inoculation of clinical specimens into both a reference automated system (BACTEC 9000 MB broth) and 5% blood agar slant tubes, after NaOH decontamination, and compared the cost of performing 1,000 analyses using these two techniques. CONCLUSIONS: Mycobacterium reference species cultured on blood agar, with the exception of Mycobacterium ulcerans. Inoculation of 1,634 specimens yielded 95 Mycobacterium isolates. Blood agar performed significantly more efficiently than BACTEC 9000 MB broth (94 vs 88 isolates, P = 0.03). Decontamination of Candida albicans in 5 specimens by addition of amphotericin B in blood agar yielded one more M. tuberculosis isolate that could not be isolated in BACTEC broth. Uneven distribution of time to culture positivity for M. tuberculosis had a median (range) of 19+/-5 days using blood agar and 26+/-6 days using BACTEC 9000 MB broth. Cost for 1,000 analyses in France was estimated to be of 1,913 euros using the blood agar method and 8,990 euros using the BACTEC 9000 MB method. Blood agar should be regarded as a first-line medium for culturing Mycobacterium species. It saves time, is cost-effective, is more sensitive than, and at least as rapid as the automated method. This is of particular importance for resource-limited countries in which the prevalence of tuberculosis is high.

Xanthan gum: an economical substitute for agar in plant tissue culture media.

Xanthan gum, a microbial desiccation-resistant polysaccharide prepared commercially by aerobic submerged fermentation from Xanthomonas campestris, has been successfully used as a solidifying agent for plant tissue culture media. Its suitability as a substitute to agar was demonstrated for in vitro seed germination, caulogenesis and rhizogenesis of Albizzia lebbeck, androgenesis in anther cultures of Datura innoxia, and somatic embryogenesis in callus cultures of Calliandra tweedii. Culture media used for eliciting these morphogenic responses were gelled with either 1% xanthan gum or 0.9% agar. Xanthan gum, like agar, supported all these responses.

'Spiking' as a rapid method for differentiation of Candida albicans from other yeast species.

This paper describes a simple and rapid method for the differentiation of Candida albicans from other yeast species in primary cultures based on colonial morphology following incubation in carbon dioxide. The technique has superior sensitivity to the traditional germ-tube method and requires no additional laboratory tests. In a busy laboratory, this can result in significant savings in cost and time, as well as improvements in patient care.

[Gel-producing properties of exopolysaccharide acrylamide in composition with agar-agar]. / Zheliruiushchie svoistva ékzopolisakharidakriamida v kompozitsii s agar-agarom.

A possibility to use a new polymer--exopolysaccharide acrylamide (EPAA)--for partial substitution of agar-agar in solid nutrient media in microbiology has been studied. It has been established than the EPAA in concentration 6.0-12.0 g/l with agar in concentration 10.0 g/l produce gel which is so strong as agar in concentration 15.0-20.0 g/l. Quality of gels produced depends an the method of EPAA mixing with agar. It has been shown that usage of EPAA in nutrient media does not affect growth, colony and cell morphology and biochemical properties of microorganisms. The use of EPAA to prepare nutrient media permits us to reduce expenditures for agar.

Seasonal variation in the biomass and agar yield from Gracilaria cervicornis and Hydropuntia cornea from Brazil.

Seasonality of biomass and agar yield from two agarophytes (G. cervicornis and H. cornea) was determined. The biomass from G. cervicornis was higher (390 g m-2) during the dry season and lower during the rainy season (129 g m-2). The data analysis for G. cervicornis revealed a significant seasonal variation (P < 0.05). H. cornea did not show a clear seasonal variation and was present only from March to August. The peak in biomass for this species was recorded in April (383 g m-2) and was significantly different from the other months (P < 0.05). The agar yield for G. cervicornis varied from 11% to 20%, with generally higher values recorded during the dry season. The agar yield showed a highly significant variation (P < 0.001). Agar yield from H. cornea ranged from 29% to 41%, with a peak recorded in June. The results above indicate that H. cornea can be considered a good candidate for commercial use.

Cost-effectiveness and efficacy of CHROMagar Candida medium in clinical specimens.

CHROMagar Candida is a new medium for the differential isolation and identification of certain clinically important Candida species. This study evaluated the cost-effectiveness of this medium compared with conventional methods. Thirty reference strains, 158 clinical specimens and 105 stock cultures were investigated. Specimens were cultured on CHROMagar Candida medium and on Sabouraud chloramphenicol agar. Identification was by conventional methods on Sabouraud agar and appearance of colonies on CHROMagar Candida medium. CHROMagar Candida correctly identified isolates of C. albicans, C. tropicalis and C. krusei. It was superior in detecting mixed cultures. A comparison of time and cost was carried out. CHROMagar Candida provides a simple, accurate and cost-effective method for identifying some clinically important Candida species.