Abstract
BackgroundOptimal sampling is critical for the performance of blood cultures (BCs). Most guidelines recommend collecting 40 ml of blood, divided between two venipuncture sites, i.e., multi-sampling strategy (MSS). Sampling through a single venipuncture site, i.e., single-sampling strategy (SSS) is easier; however, the diagnostic performance of SSS compared to MSS remains unknown. Thus, we aimed to study if SSS is non-inferior to MSS for detection of pathogenic microorganisms.MethodsA prospective, paired, non-inferiority design was used. Patients with clinically suspected sepsis admitted to an Emergency Department were included. Six BC bottles were simultaneously collected, consisting of four BC bottles from the first arm and two from the other arm. SSS consisted of BC bottles 1, 2, 3, and 4, and MSS consisted of BC bottles 1, 2, 5, and 6. Samples were incubated in a BacT/ALERT BC system.ResultsThe final analysis included 549 episodes. Pathogenic microorganisms were detected in 162 cases (29.5%) with MSS and 160 cases (29.1%) with SSS, yielding an absolute difference of 0.36%, with a 95% confidence interval of -1.33 to 2.06%, which did not exceed the predefined non-inferiority margin of 5%. MSS tended to produce more contaminant growth (7.3% of cases) than SSS (5.3% of cases; p = 0.072).ConclusionThe study showed that SSS was non-inferior to MSS in detecting pathogenic microorganisms and supports the use of SSS as a routine method.
Highlights
Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection (Singer et al, 2016; Seymour et al, 2017)
The study showed that single-sampling strategy (SSS) was non-inferior to multi-sampling strategy (MSS) in detecting pathogenic microorganisms and supports the use of SSS as a routine method
Optimal blood culture (BC) sampling followed by initiation of antibiotic therapy is a cornerstone of sepsis management (Rello et al, 2017; Levy et al, 2018), and BC is widely accepted as the gold standard for microbiological diagnostics in sepsis (Lamy et al, 2016; Rello et al, 2017)
Summary
Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection (Singer et al, 2016; Seymour et al, 2017). Sampling Strategies for Blood Cultures in Sepsis. The goal of BC sampling should be to collect a sufficient volume of blood to optimize the chance to detect pathogenic microorganisms and minimize sample contamination risk. Recommendations are scarce regarding the optimal number of bottles and venipunctures referred to as sampling strategy. This includes recent international guidelines for sepsis, which do not specify a recommended sampling strategy (Rhodes et al, 2017). Most guidelines recommend collecting 40 ml of blood, divided between two venipuncture sites, i.e., multi-sampling strategy (MSS). Sampling through a single venipuncture site, i.e., single-sampling strategy (SSS) is easier; the diagnostic performance of SSS compared to MSS remains unknown. We aimed to study if SSS is non-inferior to MSS for detection of pathogenic microorganisms
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