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Simulated positive blood cultures with 84 known stock strains of streptococci were used to comparatively evaluate the direct identification of these organisms by fluorescein-tagged antibody staining (immunofluorescence [IF]) and latex agglutination (LA). IF was not evaluated for Lancefield group D strains (a total of 81 strains tested) and had 89% sensitivity and 91% specificity. IF was least sensitive for the identification of Lancefield group F, in which three of seven strains showed no fluorescence with the group F reagent. Since LA was more convenient and revealed comparable sensitivities and specificities on 84 simulated cultures, we tested this procedure using an additional 29 fresh positive clinical blood cultures, for a total of 113 cultures tested by this technique. Of 11 Streptococcus pneumoniae strains, 9 reacted with the LA group C reagent, a problem not observed with IF. However, all these strains were identified by a rapid modified bile solubility test. Of the 12 Streptococcus faecalis strains, 4 were falsely negative with the group D reagent, but all were correctly identified by a rapid litmus milk reduction test. Of 12 group A strains, 1 was not detected. Of all 113 strains tested by LA, eliminating S. faecalis and S. pneumoniae, the sensitivity and specificity were 97 and 98%, respectively. LA was simple and reliable in the rapid identification of streptococci from blood cultures and appeared to be preferable to IF. When LA is used, the group D reagent should not be used, and all samples reacting with the group C reagent should be tested by a modified rapid bile solubility test to exclude S. pneumoniae.

Comparison of latex agglutination and immunofluorescence for direct Lancefield grouping of streptococci from blood cultures