Abstract
BackgroundThe collection of blood cultures is an extremely important method in the management of patients with suspected infection. Microbiology laboratories should monitor blood culture collection.MethodsOver an 8-month period we developed a prospective, observational study in an adult Intensive Care Unit (ICU). We correlated the mass contained in the blood vials with blood culture positivity and we also verified the relationship between the mass of blood and blood volume collected for the diagnosis of bloodstream infection (BSI), as well as we explored factors predicting positive blood cultures.ResultsWe evaluated 345 patients with sepsis, severe sepsis or septic shock for whom blood culture bottles were collected for the diagnosis of BSI. Of the 55 patients with BSI, 40.0 % had peripheral blood culture collection only. BSIs were classified as nosocomial in 34.5 %. In the multivariate model, the blood culture mass (in grams) remained a significant predictor of positivity, with an odds ratio 1.01 (i.e., for each additional 1 mL of blood collected there was a 1 % increase in positivity; 95 % CI 1.01–1.02, p = 0.001; Nagelkerke R Square [R2] = 0.192). For blood volume collected, the adjusted odds ratio was estimated at 1.02 (95 % CI: 1.01–1.03, p < 0.001; R2 = 0.199). For each set of collected blood cultures beyond one set, the adjusted odds ratio was estimated to be 1.27 (95 % CI: 1.14–1.41, p < 0.001; R2 = 0.221).ConclusionsOur study was a quality improvement project that showed that microbiology laboratories can use the weight of blood culture bottles to determine if appropriate volume has been collected to improve the diagnosis of BSI.
Highlights
The collection of blood cultures is an extremely important method in the management of patients with suspected infection
We evaluated 345 patients with sepsis, severe sepsis or septic shock for whom blood culture bottles were collected for the diagnosis of bloodstream infection
It was necessary to weigh prior to blood culture collection because we observed that the blood culture bottles had different weights. We proved that this variable can be used as a quality indicator for the microbiology laboratory because it is easier to measure than the exact volume collected in each bottle
Summary
The collection of blood cultures is an extremely important method in the management of patients with suspected infection. The collection of blood cultures is crucial in the management of patients with suspected infection. It is the key piece of information in the etiologic diagnosis of septic shock, and for the choice of appropriate antimicrobial therapy [1, 2]. The American Society for Microbiology (ASM) and the College of American Pathologists (CAP) recommends a collection volume of 30–40 mL for the diagnosis of bloodstream infection. This recommendation is based on observations made over 30 years ago, before the existence of automated blood culture systems [5, 6].
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