Evaluation of blood culture epidemiology and efficiency in a large European teaching hospital

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 adm...

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Published in:PloS one 2019-03, Vol.14 (3), p.e0214052-e0214052
Main Authors: Nannan Panday, R S, Wang, S, van de Ven, P M, Hekker, T A M, Alam, N, Nanayakkara, P W B
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Analysis
Anti-Bacterial Agents - administration & dosage
Antibiotics
Bacteremia
Bacteremia - diagnosis
Bacteremia - drug therapy
Bacteremia - epidemiology
Bacteriological Techniques
Biology and Life Sciences
Blood
Blood culture
Blood Culture - methods
Blood Culture - standards
Blood Culture - statistics & numerical data
Blood tests
Collection
Comparative analysis
Contamination
Culture
Diagnostic software
Diagnostic systems
Efficiency
Emergencies
Emergency medical services
Emergency Service, Hospital
Engineering and Technology
Epidemiology
Female
Future predictions
Hospitals
Hospitals, Teaching
Humans
Infections
Internal medicine
Laboratories
Male
Medicine
Medicine and Health Sciences
Microbiology
Microorganisms
Middle Aged
Netherlands - epidemiology
Pathogens
Patients
Patients' Rooms
Predictive Value of Tests
Retrospective Studies
Sepsis
Specimen Handling
Teachers
Technology
Time Factors
Yield
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van de Ven, P M
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description 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. 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. 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
doi_str_mv 10.1371/journal.pone.0214052
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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. 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 (&gt; 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. 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&lt;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&lt;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. 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. 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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. 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 (&gt; 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. 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&lt;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&lt;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. 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. 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source Publicly Available Content Database (Proquest) (PQ_SDU_P3); PubMed Central
subjects Adult
Aged
Aged, 80 and over
Analysis
Anti-Bacterial Agents - administration & dosage
Antibiotics
Bacteremia
Bacteremia - diagnosis
Bacteremia - drug therapy
Bacteremia - epidemiology
Bacteriological Techniques
Biology and Life Sciences
Blood
Blood culture
Blood Culture - methods
Blood Culture - standards
Blood Culture - statistics & numerical data
Blood tests
Collection
Comparative analysis
Contamination
Culture
Diagnostic software
Diagnostic systems
Efficiency
Emergencies
Emergency medical services
Emergency Service, Hospital
Engineering and Technology
Epidemiology
Female
Future predictions
Hospitals
Hospitals, Teaching
Humans
Infections
Internal medicine
Laboratories
Male
Medicine
Medicine and Health Sciences
Microbiology
Microorganisms
Middle Aged
Netherlands - epidemiology
Pathogens
Patients
Patients' Rooms
Predictive Value of Tests
Retrospective Studies
Sepsis
Specimen Handling
Teachers
Technology
Time Factors
Yield
title Evaluation of blood culture epidemiology and efficiency in a large European teaching hospital
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