Adequate or Inadequate? The Volume of Blood Submitted for Blood Culture at a Tertiary Children’s Hospital

Harewood, Freya C; Curtis, Nigel; Daley, Andrew J; Bryant, Penelope A; Gwee, Amanda; Connell, Tom

doi:10.1177/0009922818778042

Cited by 24 publications

(23 citation statements)

References 25 publications

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“…Definitely, it is recommended to collect a weight-or age-dependent blood volume and inoculate this sample into one paediatric or adult aerobic BC bottle if the total volume sampled does not exceed 4e5 mL or 10 mL, respectively [27e29, 39,45]. For quality management reasons it is strongly recommended that monitoring be performed frequently and that all personnel involved in drawing blood be trained regarding sampling volume and processing [39,40,43]. Besides BC, molecular-based diagnostics may be an interesting alternative in future, with the advantage of requiring a small blood volume.…”

Section: Discussionmentioning

confidence: 99%

“…Despite proper aseptic handling, the BC contamination rate is 1e3%, resulting in inconclusive diagnosis, unnecessary antimicrobial treatment [1], increased mortality of patients with suspected sepsis, and a burden on the health system [39]. In addition to aseptic BC procedure and methodology, inadequate blood volume inoculation into culture bottles is associated with a disproportionate risk of culturing contaminants [43]. A recent study conducted at Batson Children's Hospital in Jackson, Mississippi (USA), demonstrated a decrease in contamination rates from 2.85% to 1.54% as a result of introducing a standardized blood sampling method with optimized (weight-based) volume (Table 1) and personnel training [39].…”

Section: Blood Volume and Contaminationmentioning

confidence: 99%

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The correct blood volume for paediatric blood cultures: a conundrum?

Huber

Hetzer

Crazzolara

et al. 2020

Clinical Microbiology and Infection

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Background: Bloodstream infections (BSIs) are a major cause of morbidity and mortality in paediatric patients. For fast and accurate diagnosis, blood culture (BC) is the reference standard. However, the procedure for blood sampling in paediatric patients, particularly the optimal blood volume, is the subject of controversy stemming from a lack of knowledge of the bacterial load and because of several obstacles such as low intravascular volume and the risk of causing anaemia. Aims: The aim of this narrative review is to summarize current knowledge on blood sampling in paediatric patients for BC purposes, in particular blood volume and number and type of BC bottles needed for reasonable future guidelines/recommendations. Sources: A comprehensive literature search of PubMed, including all publications in English, was performed in June 2019 using the search terms 'blood culture', 'blood volume', 'bloodstream infection', 'diagnostic', 'paediatric' and/or 'sepsis'. Content: The amount of inoculated blood determines the sensitivity, specificity and time to positivity of a BC, and low-level bacteraemia (10 cfu/mL) in paediatric patients is presumed to be more common than reported. Current approaches for 'adequate' blood volume for paediatric BC are mainly weight-or agedependent. Of these recommendations, the scheme devised by Gaur and colleagues seems most appropriate and calls for a sample of 1e1.5 mL for children weighing <11 kg and 7.5 mL for a patient weight of 11e17 kg to be drawn into one BC bottle. Inclusion of a more detailed grading in the weight range 4e14 kg, as published by Gonsalves and colleagues, might be useful. Implications: This review could be important for future guidelines on paediatric BC collection and thus could contribute to improving patient management and lowering the economic and global health burden associated with BSI. Furthermore, upcoming molecular-based approaches with low sample volumes might be an interesting alternative.

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Section: Discussionmentioning

confidence: 99%

Section: Blood Volume and Contaminationmentioning

confidence: 99%

The correct blood volume for paediatric blood cultures: a conundrum?

Huber

Hetzer

Crazzolara

et al. 2020

Clinical Microbiology and Infection

View full text Add to dashboard Cite

show abstract

“…Many articles however recommend an age-based sampling strategy illustrated in Table 5 (166, 170, 171). This age-based sampling is convenient and safe, as the volumes are noticeably smaller than with weight-based guidelines (see Figure 7 for an example in LMICs).…”

Section: Methods and Techniques For Processing Manual Blood Culturesmentioning

confidence: 99%

Best Practices of Blood Cultures in Low- and Middle-Income Countries

et al. 2019

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Bloodstream infections (BSI) have a substantial impact on morbidity and mortality worldwide. Despite scarcity of data from many low- and middle-income countries (LMICs), there is increasing awareness of the importance of BSI in these countries. For example, it is estimated that the global mortality of non-typhoidal Salmonella bloodstream infection in children under 5 already exceeds that of malaria. Reliable and accurate diagnosis of these infections is therefore of utmost importance. Blood cultures are the reference method for diagnosis of BSI. LMICs face many challenges when implementing blood cultures, due to financial, logistical, and infrastructure-related constraints. This review aims to provide an overview of the state-of-the-art of sampling and processing of blood cultures, with emphasis on its use in LMICs. Laboratory processing of blood cultures is relatively straightforward and can be done without the need for expensive and complicated equipment. Automates for incubation and growth monitoring have become the standard in high-income countries (HICs), but they are still too expensive and not sufficiently robust for imminent implementation in most LMICs. Therefore, this review focuses on “manual” methods of blood culture, not involving automated equipment. In manual blood cultures, a bottle consisting of a broth medium supporting bacterial growth is incubated in a normal incubator and inspected daily for signs of growth. The collection of blood for blood culture is a crucial step in the process, as the sensitivity of blood cultures depends on the volume sampled; furthermore, contamination of the blood culture (accidental inoculation of environmental and skin bacteria) can be avoided by appropriate antisepsis. In this review, we give recommendations regarding appropriate blood culture sampling and processing in LMICs. We present feasible methods to detect and speed up growth and discuss some challenges in implementing blood cultures in LMICs, such as the biosafety aspects, supply chain and waste management.

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“…Different biomarkers are currently used for the diagnosis of neonatal sepsis, such as white blood count and absolute neutrophil count, procalcitonin, C-reactive protein, and cytokines, but they have a very low positive predictive value due to the low specificity [5][6][7][8][9]. Blood culture is considered the gold standard for the diagnosis of neonatal sepsis, but its positivity rate is affected by volume of blood submitted for culture, level of bacteremia, or prenatal antibiotic use, which can delay the growth of bacteria and the time to positivity with a negative impact on the sensitivity of the test [10,11].…”

Section: Introductionmentioning

confidence: 99%

Clinical Utility of the FilmArray® Blood Culture Identification (BCID) Panel for the Diagnosis of Neonatal Sepsis

Caunedo-Jiménez¹,

Fernández-Colomer²,

Fernández-Suarez³

et al. 2023

Preprint

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This prospective single-center study was designed to assess the clinical utility of the FilmArray® blood culture identification (BCID) panel for improving the diagnostic accuracy in neonatal sepsis. Results obtained using the FilmArray® BCID panel were correlated with results of blood culture in all consecutive neonates with suspicion of early-onset (EOS) and late-onset sepsis (LOS) attended in our service over a 2-year period. A total of 102 blood cultures from 92 neonates were included, 69 (67.5%) in cases of EOS and 33 (32.3%) in LOS. The FilmArray® BCID panel was performed in negative culture bottles at a median of 10 hours of blood culture incubation (range 7.5-20 hours), without differences by the type of sepsis. The FilmArray® BCID panel showed a 66.7% sensitivity, 100% specificity, 100% positive predictive value, and 95.7% negative predictive value. There were four false-negative cases, three of which of Streptococcus epidermidis in neonates with LOS and one case of Granulicatella adiacens in one neonate with EOS. We conclude that the use of the FilmArray® BCID panel in negative blood cultures from neonates with clinical suspicion of sepsis is useful in decision-making of starting or early withdrawal of empirical antimicrobials because of the high specificity and negative predictive values of this assay.

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Adequate or Inadequate? The Volume of Blood Submitted for Blood Culture at a Tertiary Children’s Hospital

Cited by 24 publications

References 25 publications

The correct blood volume for paediatric blood cultures: a conundrum?

The correct blood volume for paediatric blood cultures: a conundrum?

Best Practices of Blood Cultures in Low- and Middle-Income Countries

Clinical Utility of the FilmArray® Blood Culture Identification (BCID) Panel for the Diagnosis of Neonatal Sepsis

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