Verification of blood volume for blood culture and detection rate in pediatrics

Ohnishi, Takuma; Kamimaki, Isamu; Kobayashi, Ryōji; Nakatogawa, Kohei; Amemiya, Atsuko; Mishima, Yoshinori; Asato, Shinya; Shikoro, Nobuaki; Nakazawa, M.

doi:10.1016/j.jiac.2019.12.008

Cited by 7 publications

(4 citation statements)

References 15 publications

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“…Following our analysis of these volumes, we will target the hospital services for which the BC volumes are insufficient and inform the nurses. In addition, it has also been shown that monitoring the BC volume for paediatric bottles could improve diagnostic ability [11,12].…”

Section: Discussionmentioning

confidence: 99%

Quality indicators for blood culture: 1 year of monitoring with BacT/Alert Virtuo at a French hospital

Emeraud

Yılmaz

Fortineau

et al. 2021

Journal of Medical Microbiology

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Introduction. Blood culture (BC) remains the gold standard for the diagnosis of bloodstream infection. Clinical microbiology laboratories must ensure the quality of their BC process from receipt to definitive results. Aim. In this study, we followed the evolution of different quality indicators for BCs over the first year of implementation of the BacT/Alert Virtuo system in a French hospital. Methodology. In our laboratory, we instituted regular monitoring of several quality indicators to track (i) delays in sample registration, (ii) delays in loading BC bottles in our incubating system (BacT/Alert Virtuo) after registration, (iii) the volume of blood in bottles and (iv) the contamination rates. Results. For 53 892 BC bottles loaded in the BacT/Alert Virtuo from 23 January to 31 December 2019, the delays in sample registration, loading and unloading were respectively 3.5 h±0.016, 44 min±0.209 and 5.8 h±0.0727. Intriguingly, the automated process performed by the BacT/Alert Virtuo system to check the blood volume in bottles was only performed for 60 % of the loaded bottles. Among these, 30 % contained the recommended volume of blood (between 7 and 13 ml). Finally, the contamination rate was found to be 27.2 % for samples at our institution. Conclusions. The delays in sample registration, loading and unloading were found to be acceptable, even though they could be improved by ensuring a continuous service during the night duty period. Furthermore, the percentage of volumes measured is insufficient and must be improved and the majority of bottles do not contain the recommended blood volume.

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Section: Discussionmentioning

confidence: 99%

Quality indicators for blood culture: 1 year of monitoring with BacT/Alert Virtuo at a French hospital

Emeraud

Yılmaz

Fortineau

et al. 2021

Journal of Medical Microbiology

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“…Amongst pediatric interventional studies, our study shows the greatest increase in median blood volume (88% vs. 21–46%) [ 26 , 32 ], which may be due to the active nature of our intervention with ongoing feedback and education, and lower baseline volumes. Interestingly, most studies have also found the lowest rates of adequate filling in older children [ 26 , 31 ].…”

Section: Discussionmentioning

confidence: 83%

Pediatric blood cultures—turning up the volume: a before and after intervention study

Whelan,

Mulrooney,

Moriarty

et al. 2024

Eur J Pediatr

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The major determinant of blood culture (BC) diagnostic performance is blood volume, and pediatric sample volumes are frequently low. We aimed to assess BC volumes in our institution, design an intervention to increase volumes, and assess its impact. All pediatric BCs submitted over a 7-month period to the microbiology laboratory in a university hospital (including emergency department, pediatric ward, and neonatal unit) were included. A pre-intervention period assessed current practice. A multi-faceted intervention (education, guideline introduction, active feedback strategies) was collaboratively designed by all stakeholders. Impact was assessed in a post-intervention period. The main outcome measures included the percentage of samples adequately filled using three measures of sample adequacy (1) manufacturer-recommended minimum validated volume—> 0.5 ml, (2) manufacturer-recommended optimal minimum volume—> 1.0 ml, (3) newly introduced age-specific recommendations. Three hundred ninety-eight pre-intervention and 388 post-intervention samples were included. Initial volumes were low but increased significantly post-intervention (median 0.77 ml vs. 1.52 ml), with multivariable regression analysis estimating volumes increased 89% post-intervention. There were significant increases in all measures of volume adequacy, including an increase in age-appropriate filling (20.4–53.1%), with less improvement in those aged > 3 years. Overall, 68.4% of pathogens were from adequately filled cultures, while 76% of contaminants were from inadequately filled cultures. A pathogen was detected in a higher proportion of adequately filled than inadequately filled cultures (9.4% vs. 2.2%, p < 0.001). Conclusion: Blood volume impacts BC sensitivity, with lower volumes yielding fewer pathogens and more contaminants. Focused intervention can significantly improve volumes to improve diagnostic performance. What is Known:• Blood volume is the major determinant of blood culture positivity, and yet pediatric blood culture volumes are frequently low, resulting in missed pathogens and increased contamination. What is New:• Adequately filled (for age) blood cultures have a pathogen detection rate three times higher than inadequately filled blood cultures.• This interventional study shows that collaboratively designed multi-modal interventions including focus on accurate volume measurement can lead to significant increases in blood volumes and improve blood culture diagnostic performance.

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“…Furthermore, increasing the volume of blood does not increase sensitivity. Ohnishi et al showed that the positive detection rate of blood cultures did not improve even when the collected blood volume was increased from a median blood volume of 1.64 mL to 2.41 mL [ 67 ]. Following this observation, the authors concluded that one millilitre of blood may be adequate for infants and children [ 65 , 66 , 67 ].…”

Section: Umbilical Cord Perspectivementioning

confidence: 99%

Group B Streptococcus Early-Onset Disease: New Preventive and Diagnostic Tools to Decrease the Burden of Antibiotic Use

et al. 2023

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The difficulty in recognizing early-onset neonatal sepsis (EONS) in a timely manner due to non-specific symptoms and the limitations of diagnostic tests, combined with the risk of serious consequences if EONS is not treated in a timely manner, has resulted in a low threshold for starting empirical antibiotic treatment. New guideline strategies, such as the neonatal sepsis calculator, have been proven to reduce the antibiotic burden related to EONS, but lack sensitivity for detecting EONS. In this review, the potential of novel, targeted preventive and diagnostic methods for EONS is discussed from three different perspectives: maternal, umbilical cord and newborn perspectives. Promising strategies from the maternal perspective include Group B Streptococcus (GBS) prevention, exploring the virulence factors of GBS, maternal immunization and antepartum biomarkers. The diagnostic methods obtained from the umbilical cord are preliminary but promising. Finally, promising fields from the newborn perspective include biomarkers, new microbiological techniques and clinical prediction and monitoring strategies. Consensus on the definition of EONS and the standardization of research on novel diagnostic biomarkers are crucial for future implementation and to reduce current antibiotic overexposure in newborns.

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Verification of blood volume for blood culture and detection rate in pediatrics

Cited by 7 publications

References 15 publications

Quality indicators for blood culture: 1 year of monitoring with BacT/Alert Virtuo at a French hospital

Quality indicators for blood culture: 1 year of monitoring with BacT/Alert Virtuo at a French hospital

Pediatric blood cultures—turning up the volume: a before and after intervention study

Group B Streptococcus Early-Onset Disease: New Preventive and Diagnostic Tools to Decrease the Burden of Antibiotic Use

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