1887

Abstract

Blood culture is the cornerstone of an established aetiological diagnosis of septicaemia. The automated blood culture systems used for this purpose have changed little in the last decade, and the clinical value of results depends on a variety of factors, including pre- and post-analytical variables. Growing scepticism over the value of blood culture results and pressure for the introduction of molecular detection systems have prompted a critical path analysis of pre-, peri- and post-analytical stages in the generation of positive blood culture results. The impact of a positive blood culture was studied in a teaching hospital for 12 months before and 12 months after the introduction of a microbiologist's blood culture round. Active culture reporting via a blood culture ward round was supported by a personal data assistant database of contemporaneous laboratory and clinical data. Hospital occupancy and death register records were subsequently obtained through the State Government data linkage project. There was no evidence that faster laboratory generation of positive blood culture results, faster reporting of results or direct clinical interaction with the patient's primary medical team reduced the risk of death in hospital. However, there was a threefold increase in the rate of death in hospital following a 1 day delay in collection of blood cultures after hospital admission (=0.0010). The overall duration of hospital stay for patients with a positive blood culture fell by 2.5 days compared with the previous 12 month period (=0.0003). The interval between the initial positive culture result and patient discharge fell by 2 days (=0.0010). This difference was attributed to shorter overall admissions and shorter intervals between positive cultures containing Gram-positive cocci and subsequent patient discharge (=0.0018). An increased mortality rate from community-acquired bacteraemic infections was associated with delayed culture collection, but not with a prolonged laboratory processing interval. Thus, the speed of conventional blood culture analysis and the form of clinical reporting have little direct effect on the clinical outcome of bacteraemia, but may contribute to a reduction in the length of hospital admission. Introduction of molecular identification tests, such as multiplex PCR methods, at the Gram-stain stage of blood culture is unlikely to affect the rate of death in hospital, but may reduce the length of hospital admission.

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2008-01-01
2019-10-15
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References

  1. Corkill, J. E. ( 1985; ). Effects of media, working practice, and automation on the rapid detection of bacteraemia. J Clin Pathol 38, 336–340.[CrossRef]
    [Google Scholar]
  2. Cunney, R. J., McNamara, E. B., Alansari, N., Loo, B. & Smyth, E. G. ( 1997; ). The impact of blood culture reporting and clinical liaison on the empiric treatment of bacteraemia. J Clin Pathol 50, 1010–1012.[CrossRef]
    [Google Scholar]
  3. Endimiani, A., Tamborini, A., Luzzaro, F., Lombardi, G. & Toniolo, A. ( 2002; ). Epidemiology of bloodstream infections and time to detection of positive blood cultures: an evaluation of the automated BacT/Alert and BACTEC 9240 systems. New Microbiol 25, 9–16.
    [Google Scholar]
  4. Francois, P., Charbonnier, Y., Jacquet, J., Utinger, D., Bento, M., Lew, D., Kresbach, G. M., Ehrat, M., Schlegel, W. & Schrenzel, J. ( 2006; ). Rapid bacterial identification using evanescent-waveguide oligonucleotide microarray classification. J Microbiol Methods 65, 390–403.[CrossRef]
    [Google Scholar]
  5. Fujita, S., Senda, Y., Iwagami, T. & Hashimoto, T. ( 2005; ). Rapid identification of staphylococcal strains from positive testing blood culture bottles by internal transcribed spacer PCR followed by microchip gel electrophoresis. J Clin Microbiol 43, 1149–1157.[CrossRef]
    [Google Scholar]
  6. Hall, K. K. & Lyman, J. A. ( 2006; ). Updated review of blood culture contamination. Clin Microbiol Rev 19, 788–802.[CrossRef]
    [Google Scholar]
  7. Holman, C. D., Bass, A. J., Rouse, I. L. & Hobbs, M. S. ( 1999; ). Population-based linkage of health records in Western Australia: development of a health services linked database. Aust N Z J Public Health 23, 453–459.[CrossRef]
    [Google Scholar]
  8. Kelly, A. M. ( 1998; ). Rationalising the ordering of blood cultures. Aust Health Rev 21, 245–250.[CrossRef]
    [Google Scholar]
  9. Kennedy, M., Bates, D. W., Wright, S. B., Ruiz, R., Wolfe, R. E. & Shapiro, N. I. ( 2005; ). Do emergency department blood cultures change practice in patients with pneumonia? Ann Emerg Med 46, 393–400.[CrossRef]
    [Google Scholar]
  10. Khatib, R., Saeed, S., Sharma, M., Riederer, K., Fakih, M. G. & Johnson, L. B. ( 2006; ). Impact of initial antibiotic choice and delayed appropriate treatment on the outcome of Staphylococcus aureus bacteremia. Eur J Clin Microbiol Infect Dis 25, 181–185.[CrossRef]
    [Google Scholar]
  11. Lindholm, L. & Sarkkinen, H. ( 2004; ). Direct identification of Gram-positive cocci from routine blood cultures by using AccuProbe tests. J Clin Microbiol 42, 5609–5613.[CrossRef]
    [Google Scholar]
  12. Mirrett, S., Reller, L. B., Petti, C. A., Woods, C. W., Vazirani, B., Sivadas, R. & Weinstein, M. P. ( 2003; ). Controlled clinical comparison of BacT/ALERT standard aerobic medium with BACTEC standard aerobic medium for culturing blood. J Clin Microbiol 41, 2391–2394.[CrossRef]
    [Google Scholar]
  13. Mitchell, D. H. & Howden, B. P. ( 2005; ). Diagnosis and management of Staphylococcus aureus bacteraemia. Intern Med J 35 (Suppl. 2), S17–S24.[CrossRef]
    [Google Scholar]
  14. Mountain, D., Bailey, P. M., O'Brien, D. & Jelinek, G. A. ( 2006; ). Blood cultures ordered in the adult emergency department are rarely useful. Eur J Emerg Med 13, 76–79.[CrossRef]
    [Google Scholar]
  15. Peters, R. P., Savelkoul, P. H., Simoons-Smit, A. M., Danner, S. A., Vandenbroucke-Grauls, C. M. & van Agtmael, M. A. ( 2006; ). Faster identification of pathogens in positive blood cultures by fluorescence in situ hybridization in routine practice. J Clin Microbiol 44, 119–123.[CrossRef]
    [Google Scholar]
  16. Wellinghausen, N., Wirths, B., Franz, A. R., Karolyi, L., Marre, R. & Reischl, U. ( 2004; ). Algorithm for the identification of bacterial pathogens in positive blood cultures by real-time LightCycler polymerase chain reaction (PCR) with sequence-specific probes. Diagn Microbiol Infect Dis 48, 229–241.[CrossRef]
    [Google Scholar]
  17. Wilson, M. L., Weinstein, M. P. & Reller, L. B. ( 1994; ). Automated blood culture systems. Clin Lab Med 14, 149–169.
    [Google Scholar]
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