BD BACTEC Standard/10 Aerobic/F Culture Vials Soybean-Casein Digest Broth in a Plastic Vial

{0} 1 # 510(k) SUBSTANTIAL EQUIVALENCE DETERMINATION DECISION SUMMARY ASSAY ONLY TEMPLATE A. 510(k) Number: K161810 B. Purpose for Submission: To obtain a substantial equivalence determination for a premarket notification for the BD BACTEC™ Standard/10 Aerobic/F Culture Vials Soybean-Casein Digest Broth in a Plastic Vial C. Measurand: Aerobic microorganisms (bacteria and yeast) from blood D. Type of Test: Liquid culture medium for recovery of microorganisms from blood using fluorescent technology to detect the increased CO₂ produced by the growth of microorganisms E. Applicant: Becton, Dickinson and Company F. Proprietary and Established Names: BD BACTEC™ Standard/10 Aerobic/F Culture Vials Soybean-Casein Digest Broth in a Plastic Vial G. Regulatory Information: 1. Regulation section: 21 CFR 866.2560 Microbial Growth Monitor 2. Classification: Class I 3. Product code: MDB System, Blood Culturing {1} 4. Panel: 83 Microbiology H. Intended Use: 1. Intended use(s): BD BACTEC Standard/10 Aerobic/F culture vials (enriched Soybean-Casein Digest broth with CO₂) are for aerobic blood cultures. Principal use is with the BD BACTEC fluorescent series instruments for the qualitative culture and recovery of aerobic microorganisms (bacteria and yeast) from blood. 2. Indication(s) for use: Same as Intended Use 3. Special conditions for use statement(s): Prescription use Limitations: Recovery of SPS Sensitive Organisms from Blood Samples Because blood can neutralize the toxicity of SPS toward organisms sensitive to SPS, the recommendation of maximum volumes of blood (8–10 mL) can help to optimize recovery of these organisms. Some fastidious organisms, such as certain Haemophilus species, require growth factors, such as NAD, or factor V, which are provided by the blood specimen. If the blood specimen volume is 3.0 mL or less, an appropriate supplement may be required for recovery of these organisms. BD BACTEC FOS™, Fastidious Organism Supplement, may be used as a nutritional supplement. Recovery of Haemophilus parainfluenzae is strain dependent. General Considerations The default 5-day (120 hours) protocol was utilized for all analytical testing with the BD BACTEC Standard/10 Aerobic/F culture media and protocol lengths of >5 days have not been evaluated. 4. Special instrument requirements: BACTEC fluorescent series instruments BACTEC 9050, BACTEC 9240, BACTEC FX, and BACTEC FX40 using software versions listed below: 2 {2} | Instrument | Software Version | | --- | --- | | BACTEC 9050 | V2.01 | | BACTEC 9240 | V4.95 | | BACTEC FX | V5.20 | | BACTEC FX 40 | V2.51B | # I. Device Description: The blood sample to be tested is inoculated into one or more vials which are inserted into the BACTEC fluorescent series instrument for incubation and periodic reading. Each vial contains a chemical sensor which can detect increases in $\mathrm{CO}_{2}$ produced by the growth of microorganisms. The sensor is monitored by the instrument every ten minutes for an increase in its fluorescence, which is proportional to the amount of $\mathrm{CO}_{2}$ present. A positive reading indicates the presumptive presence of viable microorganisms in the vial. Detection is limited to microorganisms that will grow in a particular type of medium. # J. Substantial Equivalence Information: 1. Predicate device name(s): BD BACTEC Standard/10 Aerobic/F Culture Vials Soybean-Casein Digest Broth (glass) 2. Predicate $510(\mathrm{k})$ number(s): K954921 3. Comparison with predicate: Table 1: Comparison with Predicate Device | Item | Device BD BACTEC Standard/10 Aerobic/F (Plastic) | Predicate BD BACTEC Standard/10 Aerobic/F (Glass) K954921 | | --- | --- | --- | | Similarities | | | | Intended Use | Qualitative culture and recovery of aerobic microorganisms (bacteria and yeast) from blood with the BD BACTEC fluorescent series instrument | Same (from Name and Intended Use sections) | | Sample Type | Human blood | Same | | Instrument | BD BACTEC fluorescent series | Same | | Detection Technology | Continuous monitoring; measurement of CO2 increase; rocking agitation parameters | Same | | Incubation | 35°C (± 1.5°C) up to 120 hours | Same | {3} | Item | Device BD BACTEC Standard/10 Aerobic/F (Plastic) | Predicate BD BACTEC Standard/10 Aerobic/F (Glass) | | --- | --- | --- | | Differences | | | | Vial Material | Plastic | Glass | | Vial Weight | Lighter than glass | -- | | Vial Height | 5.0 inches | 5.6 inches | | Sensor Adhesion Promoter | Yes | N/A | | Vial Sensor | 2.6 gram per vial, specific for the plastic vial geometry | 1.75 gram per vial | | Sensor Components | BCP (indicator) - 6.5 mg/gram of sensor Red dye- 4.0 mg/gram of sensor | BCP (indicator)- 1.8 mg/gram of sensor Red dye- 1.9 mg/gram of sensor | # K. Standard/Guidance Document Referenced (if applicable): Not Applicable # L. Test Principle: The BD BACTEC Standard/10 Aerobic/F medium is an enriched soybean- casein digest broth, with each vial containing $40~\mathrm{mL}$ of broth. The formulation is specifically designed to enhance the recovery of aerobic microorganisms from blood. Yeast extract is added to the soy casein digest base to supplement the B-vitamin concentrations. Menadione and hemin are added to fortify the medium; sucrose is added to the broth to enhance recovery of fastidious fermentative bacteria (Streptococci), Staphylocci and yeast. Sodium polyanetholesulfonate (SPS) is added to the medium as an anticoagulant and compliment fixation inhibitor. Each BD BACTEC Standard/10 Aerobic/F blood culture medium vial contains a chemical sensor in a silicon rubber base that can detect increases in $\mathrm{CO}_{2}$ produced by the growth of microorganisms. Three to seven mL of blood is inoculated into the BD BACTEC Standard/10 Aerobic/F blood culture medium vial, which is inserted into the BD BACTEC Fluorescent Series instrument for incubation, agitation and periodic measurement. When microorganisms are present in the blood sample, they metabolize nutrients in the culture medium, releasing $\mathrm{CO}_{2}$ into the medium. A dye in the sensor reacts with the $\mathrm{CO}_{2}$ , modulating the amount of light that is absorbed by the fluorescent material in the sensor. The instrument's photo detectors monitor the sensor every 10 minutes and measure the level of fluorescence, which is proportional to the amount of $\mathrm{CO}_{2}$ present in the vial. Positivity of a vial is determined by algorithms resident in the instrument rack's microprocessor. The algorithms use the rate of $\mathrm{CO}_{2}$ production as well as the absolute increase in $\mathrm{CO}_{2}$ to interpret the data. Culture vials flagged as presumptively positive are removed from the instrument for subculture and Gram stain in order to identify the microorganisms for further evaluation and proposed patient treatment. Culture vials that are not flagged as positive remain in the {4} instrument until the test protocol has been completed and negative bottles are discarded at the end of protocol (120 hours). ## M. Performance Characteristics (if/when applicable): ### 1. Analytical performance: #### a. Precision/Reproducibility: The BACTEC Standard/10 Aerobic/F (plastic) vial was evaluated across three lots in the Time To Detection (TTD) and the Percent Recovery (Detection) studies. Different lots of key raw materials were used to manufacture each lot of culture media. The actual inoculum level of 0-1, 2-10, and >10 CFU were used in the analysis. The actual inoculum level was determined on the basis of growth observed on non-selective agar plate. The time to detection results are presented in Table 2. Table 2: Precision/Reproducibility: Lot to Lot Difference | Lot | Bld Vol (mL) | MedianTime to Detection in Hours (95% CI) | | | | --- | --- | --- | --- | --- | | | | 0*-1 CFU | 2 -10 CFU | >10 CFU | | 1 | 3 | 33.34 (24.536, 49.901) | 20.4 (17.086, 25.350) | 18.14 (16.800, 20.126) | | | 10 | 27.12 (17.559, 35.246) | 19.91 (16.836, 25.574) | 18.34 (16.717, 20.324) | | 2 | 3 | 28.91 (19.058, 49.107) | 20.16 (17.491, 25.077) | 18.63 (16.895, 20.465) | | | 10 | 27.60 (19.342, 49.534) | 19.72 (17.049, 26.088) | 18.57 (16.873, 20.470) | | 3 | 3 | 24.54 (18.221, 40.566) | 20.40 (17.200, 26.172) | 18.05 (16.791, 20.043) | | | 10 | 32.95 (22.702, 53.436) | 20.84 (17.224, 28.034) | 18.10 (16.667, 20.078) | * No growth observed on non-selective media for inoculum verification due to sampling imprecision at low target inoculum level of 1 CFU/vial. The percent recovery results stratified by lot (combining blood volumes, inoculum levels, organisms, and instruments) are shown in Table 3. Table 3: Percent of Positive Results by Lot | Lot | Total | Positive | Percent Recovery (95% CI) | | --- | --- | --- | --- | | 1 | 448 | 408 | 91.07% (87.94%, 93.47%) | | 2 | 448 | 407 | 90.85% (87.69%, 93.28%) | | 3 | 448 | 397 | 88.62% (85.22%, 91.33%) | Similar performance was observed among the lots and there were no statistically significant differences across all three lots in the precision study. #### b. Linearity/assay reportable range: Not Applicable #### c. Traceability, Stability, Expected values (controls, calibrators, or methods): ##### Quality Control An internal validation study across three lots with inoculum at 10-100 CFU per vial {5} was conducted using the organisms listed below: Alcaligenes faecalis ATCC 8750 Candida albicans ATCC 18804 Escherichia coli ATCC 25922 Haemophilus influenzae ATCC 19418 Neisseria meningitidis ATCC 13090 Pseudomonas aeruginosa ATCC 27853 Staphylococcus aureus ATCC 25923 Streptococcus pneumoniae* ATCC 6305 Streptococcus pyogenes ATCC 19615 *Specified in CLSI Standard, Quality Control for Commercially Prepared Microbiological Culture Media There were a total of 150 replicates of these nine QC organisms for the study. Each organism was tested for either 15 (5 replicates x 3 lots) or 18 (6 replicates x 3 lots) replicates. All organisms were detected ≤72 hours, with mean ranges from 9.7 hours (E. coli) to 26.1 hours (Neisseria meningitidis). d. Detection limit: ## Microbial Detection Limit (MDL, target inoculum level 0-1, 1-10 CFU/vial) The microbial detection limit study was conducted to assess the capability of the culture media to detect low numbers of organisms (expected target level of 0-1 and 1-10 CFU/vial) when present in blood. The study included 15 organisms tested at two blood volumes (3 and 10 mL), each with two inoculum levels of 0-1 and 1-10 CFU/vial and across three lots by two instruments (BACTEC FX and BACTEC 9240): 15 org x 3 lots x 2 blood vol x 2 inoculum levels x 2 instruments= 360 Results for target inoculum levels of 0-1 and 1-10 CFU/vial are provided in Tables 4.1 and 4.2 respectively. The percent recovery, difference between predicate and the new plastic bottles (henceforth referred to as Modified) was calculated with 95% two-sided bootstrap confidence intervals and stratified by organism for each target inoculum level. The combined performance of 0-1 and 1-10 is provided in Table 4.3. 6 {6} Table 4.1: MDL Difference by Organism at Target Inoculum of 0-1 CFU/Vial | Organism Name | Number of Samples | Percent recovery for Modified | Percent recovery for Predicate | Difference between percent recovery of Modified and Predicate | 95% CI (low) | 95% CI (high) | | --- | --- | --- | --- | --- | --- | --- | | Candida albicans | 12 | 41.67 | 66.67 | -25 | -71.91 | 21.91 | | Candida glabrata | 12 | 75 | 75 | 0 | -46.2 | 46.2 | | Cryptococcus neoformans | 12 | 66.67 | 33.33 | 33.33 | -1.95 | 68.62 | | Enterococcus faecalis | 12 | 66.67 | 25 | 41.67 | -12.3 | 95.63 | | Escherichia coli | 12 | 0 | 33.33 | -33.33 | -68.62 | 1.95 | | Haemophilus influenzae | 12 | 58.33 | 83.33 | -25 | -71.91 | 21.91 | | Haemophilus parainfluenzae biotype I (ATCC 33392) | 12 | 0 | 0 | 0 | -23.1 | 23.1 | | Micrococcus luteus | 12 | 16.67 | 25 | -8.33 | -44.55 | 27.88 | | Neisseria gonorrhoeae | 12 | 58.33 | 33.33 | 25 | -15.83 | 65.83 | | Neisseria meningitidis | 12 | 100 | 91.67 | 8.33 | -19.56 | 36.23 | | Pseudomonas aeruginosa | 12 | 50 | 33.33 | 16.67 | -34.12 | 67.45 | | Staphylococcus aureus | 12 | 75 | 66.67 | 8.33 | -27.88 | 44.55 | | Staphylococcus epidermidis | 12 | 58.33 | 25 | 33.33 | -1.95 | 68.62 | | Streptococcus pneumoniae | 12 | 41.67 | 25 | 16.67 | -28.56 | 61.89 | | Streptococcus sanguinis | 12 | 41.67 | 75 | -33.33 | -81.42 | 14.75 | | Total | 180 | 50.00 | 46.11 | 3.89 | -5.77 | 13.55 | {7} Table 4.2: MDL Difference by Organism at Target Inoculum of 1-10 CFU/Vial | Organism Name | Number of Samples | Percent recovery for Modified | Percent recovery for Predicate | Difference between percent recovery of Modified and Predicate | 95% CI (low) | 95% CI (high) | | --- | --- | --- | --- | --- | --- | --- | | Candida albicans | 12 | 100 | 100 | 0 | -23.1 | 23.1 | | Candida glabrata | 12 | 100 | 100 | 0 | -23.1 | 23.1 | | Cryptococcus neoformans | 12 | 100 | 91.67 | 8.33 | -19.56 | 36.23 | | Enterococcus faecalis | 12 | 100 | 100 | 0 | -23.1 | 23.1 | | Escherichia coli | 12 | 91.67 | 100 | -8.33 | -36.23 | 19.56 | | Haemophilus influenzae | 12 | 100 | 100 | 0 | -23.1 | 23.1 | | Haemophilus parainfluenzae biotype I (ATCC 33392) | 12 | 0 | 0 | 0 | -23.1 | 23.1 | | Micrococcus luteus | 12 | 83.33 | 91.67 | -8.33 | -36.23 | 19.56 | | Neisseria gonorrhoeae | 12 | 100 | 83.33 | 16.67 | -14.61 | 47.94 | | Neisseria meningitidis | 12 | 100 | 100 | 0 | -23.1 | 23.1 | | Pseudomonas aeruginosa | 12 | 100 | 100 | 0 | -23.1 | 23.1 | | Staphylococcus aureus | 12 | 100 | 91.67 | 8.33 | -19.56 | 36.23 | | Staphylococcus epidermidis | 12 | 100 | 100 | 0 | -23.1 | 23.1 | | Streptococcus pneumoniae | 12 | 100 | 83.33 | 16.67 | -14.61 | 47.94 | | Streptococcus sanguinis | 12 | 100 | 100 | 0 | -23.1 | 23.1 | | Total | 180 | 91.67 | 89.44 | 2.22 | -1.21 | 5.65 | The MDL study demonstrated that the modified plastic device performed equivalently when compared to the predicate glass device at low target inoculum levels. However, none of the 24 paired sets of Haemophilus parainfluenzae ATCC 33392 were detected in the modified plastic or the predicate glass vials. The culture medium of BD BACTEC Standard/10 Aerobic/F does not support the growth of H. parainfluenzae at low target inoculum of 0-1 or 1-10 CFU/vial. Information about this organism was noted as a limitation in labeling. {8} 9 Table 4.3: MDL Difference at Target Inocula of 0-1, 1-10 CFU/Vial, and Combined | Target CFU | Number of Samples | Percent recovery for Modified | Percent recovery for Predicate | Difference between percent recovery of Modified and Predicate | 95% CI (low) | 95% CI (high) | | --- | --- | --- | --- | --- | --- | --- | | 0-1 | 180 | 50.00 | 46.11 | 3.89 | -5.77 | 13.55 | | 1-10 | 180 | 91.67 | 89.44 | 2.22 | -1.21 | 5.65 | | 0-1, 1-10 | 360 | 70.83 | 67.78 | 3.06 | -2.01 | 8.12 | In summary, the data sets demonstrated that the modified plastic device performed equivalently when compared to the predicate glass device. e. Analytical specificity: Not applicable f. Assay cut-off: Not applicable 2. Comparison studies: Performance of the BD BACTEC Standard/10 Aerobic/F (plastic) blood culture vials was evaluated in seeded internal analytical studies to demonstrate comparable performance to the predicate device, the BD BACTEC Standard/10 Aerobic/F (glass) blood culture vials. Comparison results were acceptable. The comparisons were made using the following parameters: time to detection, percent recovery, false negative rate, and false positive. For statistical analysis, 95% two-sided bootstrap confidence intervals for differences between the modified and the predicate devices were used. a. Method comparison with predicate device: Instrument Time to Detection (TTD) study The TTD (in hours) was recorded as part of the combined Percent recovery and the Microbial Detection Limit studies using the BD BACTEC FX and 9240 instruments at three inoculum levels, across two blood volumes (3 mL and 10 mL) over three media lots. The Percent Recovery study represented by the standard inoculum of 10 to 100 CFU per vial and the Microbial Detection Limit study represented by the challenge inoculum levels of 0 to 1 and 1 to 10 CFU per vial. The TTD data was also analyzed by target inoculum level, blood volume or lot numbers. The results are shown in Tables 5.1- 5.4. The results for all data combined are shown in Table 5.5 {9} Table 5.1: Summary of TTD Study Results by Target Inoculum Levels and Blood Volumes ${}^{a}$ | Target CFU | # of Org. | Bld. Vol. | Median of TTD for Modified (95% CI) | Median of TTD for Predicate (95% CI) | Median of TTD differenceb (95% CI) | | --- | --- | --- | --- | --- | --- | | 0 to 1 | 15 | 3 | 26.17 (21.798, 43.939) | 25.57 (21.519, 32.781) | -1.04 (-6.530, 2.166) | | | | 10 | 21.27 (18.405, 36.353) | 25.05 (19.553, 32.271) | -3.25 (-8.668, 0.665) | | 1 to 10 | 15 | 3 | 21.49 (19.231, 24.814) | 23.97 (20.853, 29.144) | -2.42 (-4.167, -1.500) | | | | 10 | 22.68 (19.604, 27.832) | 26.12 (21.422, 30.900) | -2.25 (-3.751, -1.000) | | 10 to 100 | 41 | 3 | 18.10 (17.232, 19.313) | 20.31 (19.015, 21.435) | -1.25 (-1.501, -1.001) | | | | 10 | 18.30 (17.297, 19.418) | 20.17 (18.986, 21.262) | -0.75 (-0.917, -0.584) | a All lots combined b Median of the difference between Modified and Predicate devices Table 5.2: Summary of TTD Study Results by Target Inoculum Levels ${}^{\mathrm{c}}$ | Target CFU | Median of TTD for Modified (95% CI) | Median of TTD for Predicate (95% CI) | Median of TTD difference (95% CI) | | --- | --- | --- | --- | | 0 to 1 | 23.52 (21.001, 30.806) | 25.32 (22.341, 29.872) | -2.00 (-5.613, 0.332) | | 1 to 10 | 21.97 (20.008, 24.617) | 24.93 (22.047, 28.770) | -2.34 (-3.418, -1.501) | | 10 to 100 | 18.21 (17.509, 19.043) | 20.24 (19.362, 21.031) | -0.92 (-1.085, -0.834) | c All lots and blood volumes combined Table 5.3: Summary of TTD Results by Blood Volumes ${}^{d}$ | Blood Volume (mL) | Median of TTD for Modified (95% CI) | Median of TTD for Predicate (95% CI) | Median of TTD difference (95% CI) | | --- | --- | --- | --- | | 3 | 19.10 (18.141, 20.018) | 21.00 (20.011, 22.015) | -1.34 (-1.668, -1.085) | | 10 | 19.06 (18.103, 20.015) | 21.00 (19.926, 21.917) | -0.83 (-1.083, -0.669) | d All lots and target inoculum levels combined Table 5.4: Summary of TTD Results by Lots ${}^{\mathrm{e}}$ | Lot # | Median of TTD for Modified (95% CI) | Median of TTD for Predicate (95% CI) | Median of TTD difference (95% CI) | | --- | --- | --- | --- | | Lot 1 | 19.00 (17.852, 20.094) | 19.00 (17.852, 20.094) | -0.92 (-1.168, -0.750) | | Lot 2 | 19.26 (18.110, 20.374) | 21.06 (19.818, 22.305) | -1.17 (-1.584, -0.917) | | Lot 3 | 19.00 (17.823, 20.174) | 21.06 (19.842, 22.308) | -1.17 (-1.584, -0.917) | e All blood volumes and target inoculum levels combined Table 5.5: TTD Median Difference for All Data Combined | Median of TTD for Modified (95% CI) | Median of TTD for Predicate (95% CI) | Median of TTD difference (95% CI) | | --- | --- | --- | | 19.08 (18.405, 19.749) | 20.98 (20.266, 21.667) | -1.08 (-1.251, -0.918) | The TTD study demonstrated that the modified plastic device performed equivalently when compared to the predicate glass device when stratified by target inoculum level, blood volume or lot numbers. It was observed that the median TTD for the modified plastic vial and the predicate glass {10} vial was 19.08 hours and 20.98 hours respectively. The median TTD difference was -1.08 hours (95% CI, -1.25, -0.92), favoring the modified plastic vial. ## Percent Recovery (Detection) Study The percent recovery (detection) was evaluated in a study of 984 paired sets at the standard inoculum level of 10 to 100 CFU/vial on four instruments across three lots using a diverse set of microorganisms frequently isolated in blood. 41 org x 3 lots x 2 blood vol x 4 instruments= 984 paired sets The performance of each organism at inculum of 10 to 100 CFU per vial is shown in Table 6.1. Table 6.1: Percent Recovery (10-100 CFU/Vial) Summary by Organism | Organism Name | # of Samples | Percent Recovery for Modified | Percent Recovery for Predicate | Difference between percent recovery of Modified and Predicate | 95% CI (low) | 95% CI (high) | | --- | --- | --- | --- | --- | --- | --- | | Abiotrophia defectiva | 24 | 100 | 100 | 0 | -11.55 | 11.55 | | Acinetobacter lwoffii | 24 | 100 | 100 | 0 | -11.55 | 11.55 | | Aerococcus viridans | 24 | 100 | 100 | 0 | -11.55 | 11.55 | | Aggregatibacter actinomycetemcomitans | 24 | 100 | 100 | 0 | -11.55 | 11.55 | | Alcaligenes faecalis | 24 | 100 | 100 | 0 | -11.55 | 11.55 | | Bacillus subtilis | 24 | 100 | 100 | 0 | -11.55 | 11.55 | | Candida albicans | 24 | 100 | 100 | 0 | -11.55 | 11.55 | | Candida glabrata | 24 | 95.83 | 100 | -4.17 | -18.21 | 9.88 | | Cardiobacterium hominis | 24 | 100 | 100 | 0 | -11.55 | 11.55 | | Corynebacterium jeikeium | 24 | 100 | 100 | 0 | -11.55 | 11.55 | | Cryptococcus neoformans | 24 | 100 | 95.83 | 4.17 | -9.88 | 18.21 | | Eikenella corrodens | 24 | 100 | 100 | 0 | -11.55 | 11.55 | | Enterobacter cloacae | 24 | 100 | 100 | 0 | -11.55 | 11.55 | | Enterococcus faecalis | 24 | 100 | 100 | 0 | -11.55 | 11.55 | | Escherichia coli | 24 | 100 | 100 | 0 | -11.55 | 11.55 | | Granulicatella adiacens | 24 | 100 | 100 | 0 | -11.55 | 11.55 | | Haemophilus influenzae | 24 | 95.83 | 100 | -4.17 | -18.21 | 9.88 | | Haemophilus influenzae biotype I | 48 | 100 | 97.92 | 2.08 | -4.96 | 9.13 | | Haemophilus parainfluenzae biotype I (ATCC 33392) | 24 | 0 | 4.17 | -4.17 | -18.21 | 9.88 | | Kingella kingae | 24 | 100 | 100 | 0 | -11.55 | 11.55 | | Klebsiella pneumoniae | 24 | 100 | 100 | 0 | -11.55 | 11.55 | | Leuconostoc citreum | 24 | 100 | 100 | 0 | -11.55 | 11.55 | {11} | Organism Name | # of Samples | Percent Recovery for Modified | Percent Recovery for Predicate | Difference between percent recovery of Modified and Predicate | 95% CI (low) | 95% CI (high) | | --- | --- | --- | --- | --- | --- | --- | | Micrococcus luteus | 24 | 100 | 100 | 0 | -11.55 | 11.55 | | Neisseria gonorrhoeae | 24 | 100 | 87.5 | 12.5 | -5.06 | 30.06 | | Neisseria meningitidis | 24 | 100 | 100 | 0 | -11.55 | 11.55 | | Pediococcus acidilactici | 24 | 95.83 | 83.33 | 12.5 | -8.52 | 33.52 | | Proteus mirabilis | 24 | 100 | 100 | 0 | -11.55 | 11.55 | | Providencia stuartii | 24 | 100 | 100 | 0 | -11.55 | 11.55 | | Pseudomonas aeruginosa | 24 | 100 | 100 | 0 | -11.55 | 11.55 | | Rothia mucilaginosa | 24 | 100 | 100 | 0 | -11.55 | 11.55 | | Staphylococcus aureus | 24 | 100 | 100 | 0 | -11.55 | 11.55 | | Staphylococcus epidermidis | 24 | 100 | 100 | 0 | -11.55 | 11.55 | | Stenotrophomonas maltophilia | 24 | 100 | 100 | 0 | -11.55 | 11.55 | | Streptococcus agalactiae (Strep. group B) | 24 | 100 | 100 | 0 | -11.55 | 11.55 | | Streptococcus pneumoniae | 96 | 100 | 100 | 0 | -2.89 | 2.89 | | Streptococcus pyogenes (Strep. group A) | 24 | 100 | 100 | 0 | -11.55 | 11.55 | | Streptococcus sanguinis | 24 | 100 | 100 | 0 | -11.55 | 11.55 | | TOTAL | 984 | 97.26 | 96.75 | 0.51 | -0.26 | 1.28 | The results from 984 paired sets are shown in Table 6.2: Table 6.2: Percent Recovery (10- 100 CFU/Vial) Summary | | Predicate | | | | | --- | --- | --- | --- | --- | | | | Positive | | Negative | | Modified | Positive | 948 | 9 | 957 | | | Negative | 4 | 23 | 27 | | | | 952 | 32 | 984 | Of the 984 paired sets, 948 sets recovered organisms in both the modified plastic vial and the predicate glass vial and 23 sets were negative by both vials. The 23 paired sets were Haemophilus parainfluenzae not detected at actual inoculum level of 82 CFU. In addition, the modified plastic vial had four detection failures for the following organisms: one detection failure for Candida glabrata, Pediococcus acidilactici, Haemophilus influenzae type b, and Haemophilus parainfluenzae at 66, 26, 64, and 82 CFU respectively. The culture medium of BD BACTEC Standard/10 Aerobic/F does not support the growth of $H$ parainfluenzae at target inoculum of 10-100 CFU/vial. {12} # Additional Testing a) Candida spp. A study was conducted to evaluate TTD of Candida species other than C. albicans. The study included two strains each for Candida tropicalis, C. parapsilosis and one strain each for C. glabrata, Cryptococcus neoformans at target inoculum level of 10-100 CFU with two blood volumes (3 and $10~\mathrm{mL}$ ) tested on four instruments (9050, 9240, FX, and FX40). The TTD results for all data combined are shown in Table 6.3. Table 6.3: TTD Median Difference at 10-100 CFU for All Data Combined | Median of TTD for Modified (95% CI) | Median of TTD for Predicate (95% CI) | Median of TTD difference (95% CI) | | --- | --- | --- | | 28.71 (27.560, 30.045) | 30.67 (28.680, 51.510) | -1.33 (-2.490, -1.000) | The study demonstrated that the modified plastic device performed equivalently when compared to the predicate glass device. b) Haemophilus parainfluenzae Five well-characterized $H.$ parainfluenzae strains were tested to evaluate recovery in both the predicate glass and the modified plastic device. The isolates were tested in triplicates with three blood volumes (3, 5, and $10~\mathrm{mL}$ ), two instruments (9240, FX) at 10-100 CFU/vial, resulting in 90 paired sets. The result is provided in Table 6.4. 5 strains x 3 bld vol. x triplicates x 2 instruments= 90 paired sets Table 6.4: Haemophilus parainfluenzae Percent Recovery with Well-Characterized Strains at Target Inoculum 10-100 CFU | Strain ID | Modified Plastic | Predicate Glass | | --- | --- | --- | | ATCC 9796 | 94% (17/18) | 100% (18/18) | | ATCC 33392 | 38.9% (7/18) | 33.3% (7/18) | | Strain #3 | 0% (0/18) | 6% (1/18) | | Strain #4 | 0% (0/18) | 6% (1/18) | | Strain #5 | 0% (0/18) | 6% (1/18) | The recovery of $H.$ parainfluenzae varied from $0\%$ to $94\%$ and $6\%$ to $100\%$ for modified plastic and predicate glass respectively. The modified plastic device performed equivalently when compared to the predicate glass device. The text below was added to the existing limitation for Haemophilus species in the Recovery of SPS Sensitive Organisms from Blood Samples section of the package insert: "Recovery of Haemophilus parainfluenzae is strain dependent." Further, the study result was also described in the Performance Characteristics section of the package insert: {13} "In an additional seeded study with five Haemophilus parainfluenzae strains tested with blood volumes 3, 5, and 10 mL at target inoculum 10–100 CFU, recovery rate was strain dependent and varies from 0% to 94% for plastic vial and from 6% to 100% for glass vial." ## False Positive Rates (Instrument-positive, subculture-negative) False positive was defined as instrument positive but subculture negative in the evaluation. False positivity was assessed with vials inoculated with fresh human blood of 2, 4, 6, 8, and 10 mL, but no organisms were added to the vials. There were a total of 240 pair sets across three lots using BACTEC FX and BACTEC 9240 and completed at the default 5-day protocol. 40 vials x 3 lots x 2 instruments = 240 paired sets There was no positive observed in the predicate glass vial; one positive (instrument positive and subculture positive) was observed in the modified plastic vial on BACTEC FX at 16.98 hours. The organism was viridans group streptococcus (Streptococcus salivarius) which likely was a contaminant introduced during the inoculation process. The performance is shown in Table 7. Table 7: Summary of False Positive Study | # of paired sets | Percent Recovery for Modified | Percent Recovery for Predicate | Deference between Percent Recovery of Modified and Predicate | 95% CI (low) | 95% CI (high) | | --- | --- | --- | --- | --- | --- | | 240 | 0 | 0.42 | -0.42 | -1.83 | 1.00 | The modified device performed equivalently when compared to the predicate device in the false positive study. ## False Negative Rates (Instrument-negative, subculture-positive) All inoculated paired sets (984 from the Recovery study + 360 from the Microbial Detection Limit study = 1344) that were instrument negative at the end of default protocol (120 hours) were subcultured onto appropriate culture media plates. This combined data set was evaluated for the false negative rates. A false negative is a vial that was instrument-negative at the end of protocol yet contains viable organisms upon subculturing onto appropriate culture media. There were a total of 91 paired sets where both the modified and the predicate devices were negative at 120 hours; there were 41 sets where the predicate device only detected (i.e., 41 modified plastic vials subcultured) and 57 vials where the new device detected (i.e., 57 predicate glass vials subcultured). There were 34 false negatives; 18 (12 at 10 to 100 CFU) that were observed in the predicate glass vials and 16 (9 at 10-100 CFU) in the modified plastic vial. The 16 false negatives included one each for Candida glabrata, Haemophilus influenzae, and Pediococcus acidilactici, two Cryptococcus neoformans and 11 Haemophilus parainfluenzae. The modified device performed equivalently when compared to the predicate device in the false negative study. {14} The false negatives of the modified plastic vial is noted in the Performance Characteristics section of the package insert: "Sixteen false negatives across all inoculum levels were identified within the BD BACTEC Standard/10 Aerobic/F medium contained in a plastic vial: Candida glabrata (1) Cryptococcus neoformans (2), Haemophilus influenzae (1), Haemophilus parainfluenzae biotype I (11), and Pediococcus acidilactici (1). Of the eleven Haemophilus parainfluenzae biotype I, six inoculated at 82 CFU and five inoculated at 2 CFU." ## BD BACTEC Instrument Compatibility Study The BACTEC instrument compatibility study was evaluated from the Percent Recovery study (i.e., 984 paired sets) dataset across four fluorescent- series instruments: BD BACTEC FX, FX40, 9240, and 9050. The study included 3 and 10 mL of blood at inoculum level of 10-100 CFU per vial. The BACTEC instrument compatibility study is shown in Table 8. Table 8: Summary of Instrument Compatibility Study | Instrument | Blood Volume (mL) | Median Time to Detection (TTD) in Hours (95% CI) | | | | --- | --- | --- | --- | --- | | | | TTD Median for Modified | TTD Median for Predicate | Median of TTD difference | | FX | 3 | 18.08 (16.532, 20.101) | 20.11 (17.812, 22.149) | -1.17 (-1.668, -0.752) | | | 10 | 18.40 (16.618, 20.817) | 20.30 (18.049, 22.302) | -0.67 (-1.002, -0.501) | | FX40 | 3 | 18.60 (16.962, 20.656) | 21.11 (18.750, 23.580) | -1.34 (-2.250, -0.752) | | | 10 | 18.59 (16.726, 20.653) | 20.42 (18.334, 22.510) | -0.75 (-1.167, -0.501) | | 9240 | 3 | 17.51 (16.102, 19.903) | 19.44 (17.096, 21.524) | -1.33 (-1.834, -1.000) | | | 10 | 17.66 (16.033, 20.044) | 19.30 (17.157, 21.658) | -0.75 (-1.167, -0.500) | | 9050 | 3 | 18.25 (16.584, 20.917) | 20.58 (18.250, 23.167) | -1.08 (-1.916, -0.750) | | | 10 | 18.42 (16.667, 20.584) | 20.58 (18.167, 22.834) | -0.75 (-1.167, -0.500) | The study demonstrated that the four instruments performed equivalently and they are compatible with BD BACTEC Standard/10 Aerobic/F culture medium in plastic vials. ## b. Matrix comparison: In seeded analytical studies, the performance of BD BACTEC Standard/10 Aerobic/F culture medium in plastic vial was compared to that in glass vial, with two human blood volumes, 38 common blood bloodstream bacteria and five yeasts across four fluorescent series instruments: BACTEC FX, FX40, BACTEC 9240, and BACTEC 9050. ## 3. Clinical studies: Not applicable; seeded analytical studies to compare the new plastic blood culture vials to the glass blood culture vials (predicate). ## a. Clinical Sensitivity: Not applicable {15} b. Clinical specificity: Not applicable c. Other clinical supportive data (when a. and b. are not applicable): Not applicable 4. Clinical cut-off: Not applicable 5. Expected values/Reference range: Seeded analytical studies demonstrated equivalent performance of the BD BACTEC Standard/10 Aerobic/F (plastic) blood culture medium when compared to the BD BACTEC /10 Aerobic/F (glass) blood culture medium. N. Proposed Labeling: The labeling is sufficient and it satisfies the requirements of 21 CFR Part 809.10. O. Conclusion: The submitted information in this premarket notification is complete and supports a substantial equivalence decision. 16