Is it time for a culture change? Blood culture collection in the emergency department

Denny, Kerina J.; Sweeny, Amy; Crilly, Julia; Maloney, Samuel; Keijzers, Gerben

doi:10.1111/1742-6723.13122

Cited by 10 publications

(15 citation statements)

References 5 publications

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“…2 Around 11%-15% of collected BCs are positive and studies show that up to half of those are false positives through contamination. [4][5][6] These…”

Section: Introductionmentioning

confidence: 99%

Using machine learning to predict blood culture outcomes in the emergency department: a single-centre, retrospective, observational study

Boerman

Schinkel

Meijerink³

et al. 2022

BMJ Open

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ObjectivesTo develop predictive models for blood culture (BC) outcomes in an emergency department (ED) setting.DesignRetrospective observational study.SettingED of a large teaching hospital in the Netherlands between 1 September 2018 and 24 June 2020.ParticipantsAdult patients from whom BCs were collected in the ED. Data of demographic information, vital signs, administered medications in the ED and laboratory and radiology results were extracted from the electronic health record, if available at the end of the ED visits.Main outcome measuresThe primary outcome was the performance of two models (logistic regression and gradient boosted trees) to predict bacteraemia in ED patients, defined as at least one true positive BC collected at the ED.ResultsIn 4885 out of 51 399 ED visits (9.5%), BCs were collected. In 598/4885 (12.2%) visits, at least one of the BCs was true positive. Both a gradient boosted tree model and a logistic regression model showed good performance in predicting BC results with area under curve of the receiver operating characteristics of 0.77 (95% CI 0.73 to 0.82) and 0.78 (95% CI 0.73 to 0.82) in the test sets, respectively. In the gradient boosted tree model, the optimal threshold would predict 69% of BCs in the test set to be negative, with a negative predictive value of over 94%.ConclusionsBoth models can accurately identify patients with low risk of bacteraemia at the ED in this single-centre setting and may be useful to reduce unnecessary BCs and associated healthcare costs. Further studies are necessary for validation and to investigate the potential clinical benefits and possible risks after implementation.

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“…2 Around 11%-15% of collected BCs are positive and studies show that up to half of those are false positives through contamination. [4][5][6] These…”

Section: Introductionmentioning

confidence: 99%

Using machine learning to predict blood culture outcomes in the emergency department: a single-centre, retrospective, observational study

Boerman

Schinkel

Meijerink³

et al. 2022

BMJ Open

View full text Add to dashboard Cite

show abstract

“…Moreover, real-life use of MS procedures often result in a low number of BC collection. A single BC set (i.e., culture of only 2 bottles also named solitary BC) is obtained in up to 41% to 94% of patients when MS procedure is used [ 1 , 13 , 14 ]. Another concern with the MS procedure is the rapid and significant loss of pathogen detection after initiation of antibiotic therapy [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of a strategy based on unique blood culture sampling on contamination rate and detection of bloodstream infections in critically ill patients

Mahieu

Lemarié

Douillet

et al. 2023

Ann. Intensive Care

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Background Unique blood culture (UBC) has been proposed to limit the number of venipuncture and to decrease the risk of BC contaminations (BCC) without affecting their yield. We hypothesized that a multi-faceted program based on UBC in the ICU may reduce the rate of contaminants with a similar performance for bloodstream infections (BSI) identification. Methods In a before and after design, we compared the proportion of BSI and BCC. A first 3-year period with multi-sampling (MS) strategy followed by a 4-month washout period, where staff received education and training for using UBC, and a 32-month period, where UBC was routinely used, while education and feedback were maintained. During the UBC period, a large volume of blood (40 mL) was sampled through a unique venipuncture with additional BC collections discouraged for 48 h. Results Of the 4,491 patients included (35% female patients, mean age 62 years) 17,466 BC were collected. The mean volume of blood per bottle collected increased from 2.8 ± 1.8 mL to 8.2 ± 3.9 mL between the MS and UBC periods, P < 0.01. A 59.6% reduction (95% CI 56.7–62.3; P < 0.001) of BC bottles collected per week was observed between the MS and UBC periods. The rate of BCC per patient decreased between the two periods from 11.2% to 3.8% (73.4% reduction; P < 0.001) for the MS and UBC periods, P < 0.001. Meanwhile, the rate of BSI per patient remained stable at 13.2% and 13.2% for the MS and UBC periods, P = 0.98. Conclusions In ICU patients, a strategy based on UBC reduces the contamination rate of cultures without affecting their yield. Graphical Abstract

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“… 3 The percentage of true-positive blood cultures, disregarding contamination, ranges from 1.4% to 12.2% in ED populations worldwide. 4 , 5 , 6 , 7 , 8 , 9 , 10 Due to these low yields, blood culture outcomes affect treatment decisions in only 0.18–2.8% of patients presenting to the ED with suspected infection. 4 , 5 …”

Section: Introductionmentioning

confidence: 99%

“…A substantial 40–55% of positive cultures can be contaminated. 5 , 6 , 8 , 9 , 12 Three decades of research on this topic has consistently shown that contamination is associated with additional resource use (laboratory and microbiological testing), increased use of antibiotics, prolonged hospital stay, and even increased in-hospital mortality. 9 , 12 , 13 , 14 …”

Section: Introductionmentioning

confidence: 99%

Diagnostic stewardship for blood cultures in the emergency department: A multicenter validation and prospective evaluation of a machine learning prediction tool

et al. 2022

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Is it time for a culture change? Blood culture collection in the emergency department

Abstract: BCs are a common investigation in the ED with a high false-positive rate. Strategies are required to reduce false positives, including reducing inappropriate collection and improving collection techniques.

Cited by 10 publications

References 5 publications

Using machine learning to predict blood culture outcomes in the emergency department: a single-centre, retrospective, observational study

Using machine learning to predict blood culture outcomes in the emergency department: a single-centre, retrospective, observational study

Impact of a strategy based on unique blood culture sampling on contamination rate and detection of bloodstream infections in critically ill patients

Diagnostic stewardship for blood cultures in the emergency department: A multicenter validation and prospective evaluation of a machine learning prediction tool

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