Analysis and comparison of the difference between two major blood culture system in the laboratory and neonatal intensive care unit

Background: Neonatal sepsis is a critical health concern that demands accurate and timely diagnosis. Blood culture, the gold standard, is challenging in extremely low birth weight (ELBW) infants because of the limited blood volume and potential aerobic culture limitations. The VersaTREK (Thermo Fisher Scientific, Waltham, MA, USA) blood culture system, which requires less blood and offers both aerobic and anaerobic cultures, presents a potential solution. This study aimed to compare the diagnostic performance with the widely used BD (Becton Dickinson, Franklin Lakes, NJ, USA) blood culture systems for neonatal sepsis patients. Methods: We conducted a three-step study, including in vitro testing of common pathogens, prospective observational cohort data from a neonatal intensive care unit (NICU), and a head-to-head comparison. VersaTREK's blood culture bottles include aerobic and anaerobic media, whereas BD uses a specialized bottle for aerobic cultures. Results: In phase 1 of this in vitro comparison study, VersaTREK outperformed BD, particularly at low bacterial loads. In phase 2, a prospective observational cohort analysis revealed a significantly greater yield with VersaTREK, especially for gram-positive cocci and gram-negative bacteria. In phase 3, a head-to-head comparison demonstrated comparable performance between the two systems, with potential advantages for VersaTREK in scenarios involving minimal blood volumes, as little as 0.1 mL. Conclusions: The VersaTREK and BD blood culture systems demonstrated similar diagnostic performance, with VersaTREK capable of detecting as little as 0.1 mL of blood. While this is promising in scenarios with minimal blood volume, further investigations with larger sample sizes are needed.