TY - JOUR
T1 - Evaluation of blood culture epidemiology and efficiency in a large European teaching hospital
AU - Nannan Panday, R. S.
AU - Wang, S.
AU - van de Ven, P. M.
AU - Hekker, T. A. M.
AU - Alam, N.
AU - Nanayakkara, P. W. B.
N1 - Publisher Copyright: © 2019 Nannan Panday et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2019
Y1 - 2019
N2 - Background 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. Methods We 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. Results In 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. Conclusion This 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.
AB - Background 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. Methods We 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. Results In 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. Conclusion This 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.
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Anti-Bacterial Agents/administration & dosage
KW - Bacteremia/diagnosis
KW - Bacteriological Techniques
KW - Blood Culture/methods
KW - Emergency Service, Hospital
KW - Female
KW - Hospitals, Teaching
KW - Humans
KW - Male
KW - Middle Aged
KW - Netherlands/epidemiology
KW - Patients' Rooms
KW - Predictive Value of Tests
KW - Retrospective Studies
KW - Specimen Handling
KW - Time Factors
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85063349593&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/30897186
U2 - https://doi.org/10.1371/journal.pone.0214052
DO - https://doi.org/10.1371/journal.pone.0214052
M3 - Article
C2 - 30897186
SN - 1932-6203
VL - 14
JO - PLOS ONE
JF - PLOS ONE
IS - 3
M1 - e0214052
ER -