Estimation of missed bloodstream infections without the third blood culture set: a retrospective observational single-centre study

Collazos-Blanco, A.; Pérez-García, Felipe; Sánchez‐Carrillo, Carlos; Egea, Viviana de; Muñóz, Patricia; Bouza, Emilio

doi:10.1016/j.cmi.2018.06.024

Cited by 16 publications

(9 citation statements)

References 22 publications

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“…In this study, three blood cultures of 20 ml detected 98.2% of BSI and only with four blood cultures, >99% of BSI episodes were detected. Another recent study confirmed the need for at least three blood cultures (or 60 ml) to be sampled, as they found that 7.5% of BSI episodes would have been missed without a third blood culture (157).…”

Section: Methods and Techniques For Processing Manual Blood Culturesmentioning

confidence: 87%

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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Section: Methods and Techniques For Processing Manual Blood Culturesmentioning

confidence: 87%

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

et al. 2019

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“…This critical factor drove one fundamental change in automated blood culture systems: the need for capacity to accommodate three or more sets of bottles from a blood cultures series and enable the management of a larger number of bottles to conform to guidelines [7,34,35]. At the same time, in order to accommodate more bottles per instrument, the time required to test each bottle needed to drop substantially.…”

Section: Number Of Blood Culturesmentioning

confidence: 99%

Development of new methods for detecting bloodstream pathogens

Wilson

2020

Clinical Microbiology and Infection

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Background: Current blood culture systems were developed and evolved, in part, based on our knowledge of the critical factors in the recovery of pathogenic microorganisms from blood, changes in the spectrum of pathogens causing bloodstream infections, changes in technology and changes in expectations for blood culture system performance. Aims: The aim was to review historical data about development of blood culture systems and how that knowledge will continue to influence newer generations of technology for detecting and identifying bloodstream pathogens. Sources: Sources were literature review of published papers, previous select reviews, and updated guidelines. Content: This review focuses on how blood culture systems evolved in response to changes in our knowledge about the critical factors for recovering bloodstream pathogens, the spectrum of pathogens that cause bacteraemia and fungaemia, changes in technology, and changes in expectation of performance. Implications: As we move into an era characterized by molecular identification of bloodstream pathogens, and eventually direct detection of pathogens in blood, the historical knowledge that drove the development and subsequent evolution of contemporary blood culture systems also will drive development and incremental improvements in molecular methods. Our knowledge of bloodstream infections is not static; these systems reflect changes in that knowledge.

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“…-Recommendations for complete BC sampling suggest at least two sets, corresponding to 30-40 mL in total [24], subdivided into four BC bottles, two for aerobic and two for anaerobic organisms; the aerobic bottle should be filled first. BC should take priority in the case of several specimens from the same venipuncture [26,28,[34][35][36][37][38][39][40]. -Recently, a retrospective study of 4000 BSI episodes demonstrated that without a third BC set, 7.9% of BSIs would have been missed, although in 33.9% of the missed episodes, the same organism recovered in the third BC was isolated in other clinical specimens (i.e.…”

Section: Blood Volumementioning

confidence: 99%

“…-Recently, a retrospective study of 4000 BSI episodes demonstrated that without a third BC set, 7.9% of BSIs would have been missed, although in 33.9% of the missed episodes, the same organism recovered in the third BC was isolated in other clinical specimens (i.e. urine) for an actual rate of approximately 5% [39]. -The practice of a "solitary BC" (only two bottles or one set), although still common, is not acceptable and should be actively discouraged [8,28,35].…”

Section: Blood Volumementioning

confidence: 99%

Collection, transport and storage procedures for blood culture specimens in adult patients: recommendations from a board of Italian experts

Plato¹,

Fontana

Gherardi

et al. 2019

Clinical Chemistry and Laboratory Medicine (CCLM)

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Bloodstream infections (BSIs) remain a potentially life-threatening condition. The gold standard for the diagnosis of BSI is still blood cultures (BCs), and the diagnostic yield depends on clinical and technical factors that have an impact on collection and transportation. Hence, monitoring of the entire pre-analytical process from blood collection to transportation to the microbiology laboratory is critical. To optimize the clinical impact of the diagnostic and therapeutic procedures, a multidisciplinary approach and univocal protocols are mandatory. A board of specialists discussed the available evidence on the pre-analytical process and produced the present document to guide physicians and nurses on the ideal execution of BC: (1) timing and preparation for blood collection; (2) skin antisepsis; (3) blood volume; (4) sampling method and safety; (5) medium to be used; (6) time to BC transportation; and (7) quality assurance and quality management.

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Estimation of missed bloodstream infections without the third blood culture set: a retrospective observational single-centre study

Abstract: Our data suggest that performing a third BCS is useful, as not doing this could result in an unacceptable number of BSIs going undetected.

Cited by 16 publications

References 22 publications

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

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

Development of new methods for detecting bloodstream pathogens

Collection, transport and storage procedures for blood culture specimens in adult patients: recommendations from a board of Italian experts

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