28 Blood culture collection practices in NICU; A national survey

Abstract

Abstract Background Blood cultures are the gold standard in the investigation of neonatal sepsis, which is associated with significant morbidity and mortality. However, there are currently no consensus guidelines for blood collection for culture in newborns. In addition, it can be challenging to obtain sufficient blood volume in infants, which can affect the validity of culture results. Objectives To examine current practices in blood collection for culture in the investigation of neonatal sepsis in NICUs across Canada. Design/Methods A 9-item electronic survey (Appendix A) was sent to each of the 29 level 3 NICUs in Canada, which are equipped to provide highly specialized care for newborns. Results Responses were received from 26 (90%) of the 29 level 3 NICUs. Fifty-six percent of NICUs have blood collection guidelines for the investigation of neonatal sepsis. Forty-eight percent of NICUs routinely collect 1.0 mL of blood per culture bottle. By contrast, 32% of NICUs determine adequate blood volume using body weight and 8% using gestational age. In late-onset neonatal sepsis (LONS), 58% of centres process one aerobic culture bottle. Four NICUs (15%) routinely add anaerobic culture bottles. Few centres draw blood for culture from an indwelling catheter when present as a first-line option in LONS. Specifically, one NICU routinely draws blood from a central venous line and four NICUs (17%) routinely draw from a peripheral arterial line. In early-onset neonatal sepsis (EONS), 73% of NICUs draw blood for culture from umbilical lines, while 72% use peripheral venepuncture. Two centres routinely collect cord blood from the placenta for culture in EONS. Only one NICU applies the concept of differential time-to-positivity (DTP) in suspected central-line associated bloodstream infection (CLABSI) to determine whether a colonized catheter is the true source of infection. Conclusion There is significant practice variation in blood collection for culture in level 3 NICUs across Canada. Standardization of blood collection practices will improve antimicrobial stewardship and appropriate resource utilization, as well as provide reliable estimates of the true incidence of neonatal sepsis in Canada.