Abstract
BackgroundBlood cultures remain the gold standard for detecting bacteremia despite their limitations. The current practice of blood culture collection is still inefficient with low yields. Limited focus has been given to the association between timing of specimen collection at different time points during admission and their yield.MethodsWe carried out a retrospective observational study by analyzing all 3,890 sets of cultures collected from the 1,962 admitted patients over the seven-month period of this study. We compared the blood culture yield between the early group (≤24 hours after admission) and the late group (> 24 hours of admission). We also investigated the effect of prehospital oral antibiotics and pre-analytical time on the first cultures in the emergency department. Epidemiology and efficiency of blood cultures were studied for each medical specialty.ResultsIn total, 3,349(86.1%) blood cultures were negative and 541(13.9%) were positive for one or more microorganisms. After correcting for contamination, the overall yield was 290 (7.5%). The early group (n = 1,490) yielded significantly more true-positive cultures (10.1% versus 5.8%, P<0.001) than the late group (n = 2,400). The emergency department had a significantly higher yield than general wards, 11.2% versus 5.7% (p<0.001). Prehospital oral antibiotic use and pre-analytical time did not affect the yield of first cultures at the emergency department (p = 0.735 and 0.816 respectively). The number of tests needed to obtain one true-positive culture varied between departments, ranging from 7 to 45.ConclusionThis study showed that blood cultures are inefficient in detecting bacteremia. Cultures collected during 24 hours after admission yielded more positive results than those collected later. Significant variations in blood culture epidemiology and efficiency per specialty suggest that guidelines should be reevaluated. Future studies should aim at improving blood culture yield, implementing educational programs to reduce contamination and cost-effective application of modern molecular diagnostic technologies.
Highlights
Blood cultures (BCs) are one of the most frequently performed microbiological tests in hospitals worldwide and still remain the gold standard for detecting bacteremia [1, 2].Currently, sepsis/septic shock and associated bloodstream infections (BSI) are among the most prevalent causes of morbidity and mortality in many European and North American countries with an estimated 157,000 deaths annually in Europe and as much as 94,000 in North America [3]
Prehospital oral antibiotic use and pre-analytical time did not affect the yield of first cultures at the emergency department (p = 0.735 and 0.816 respectively)
This study showed that blood cultures are inefficient in detecting bacteremia
Summary
Blood cultures (BCs) are one of the most frequently performed microbiological tests in hospitals worldwide and still remain the gold standard for detecting bacteremia [1, 2].Currently, sepsis/septic shock and associated bloodstream infections (BSI) are among the most prevalent causes of morbidity and mortality in many European and North American countries with an estimated 157,000 deaths annually in Europe and as much as 94,000 in North America [3]. Blood cultures (BCs) are one of the most frequently performed microbiological tests in hospitals worldwide and still remain the gold standard for detecting bacteremia [1, 2]. Hospital protocols and guidelines advice that BCs should be collected in the event of a temperature spike in order to optimize BC yield. Blood cultures remain the gold standard for detecting bacteremia despite their limitations. The current practice of blood culture collection is still inefficient with low yields. Limited focus has been given to the association between timing of specimen collection at different time points during admission and their yield
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