Raupach-Rosin Heike, Duddeck Arne, Gehrlich Maike, Helmke Charlotte, Huebner Johannes, Pletz Mathias W, Mikolajczyk Rafael, Karch André
ESME - Epidemiological and Statistical Methods Research Group, Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124, Brunswick, Germany.
Division of Pediatric Infectious Diseases, Dr. Von Hauner Children's Hospital, Ludwig Maximilian University Munich, Munich, Germany.
Infection. 2017 Aug;45(4):433-441. doi: 10.1007/s15010-017-0990-7. Epub 2017 Feb 15.
Blood culture (BC) sampling rates in Germany are considerably lower than recommended. Aim of our study was to assess knowledge, attitudes, and practice of physicians in Germany regarding BC diagnostics.
We conducted a cross-sectional mixed-methods study among physicians working in inpatient care in Germany. Based on the results of qualitative focus groups, a questionnaire-based quantitative study was conducted in 2015-2016. In total, 706 medical doctors and final-year medical students from 11 out of 16 federal states in Germany participated.
BC sampling was considered an important diagnostic tool by 95% of the participants. However, only 23% of them would collect BCs in three scenarios for which BC ordering is recommended by present guidelines in Germany; almost one out of ten physicians would not have taken blood cultures in any of the three scenarios. The majority of participants (74%) reported not to adhere to the guideline recommendation that blood culture sampling should include at least two blood culture sets from two different injection sites. High routine in blood culture sampling, perceived importance of blood culture diagnostics, the availability of an in-house microbiological lab, and the department the physician worked in were identified as predictors for good blood culture practice.
Our study suggests that there are substantial deficits in BC ordering and the application of guidelines for good BC practice in Germany. Based on these findings, multimodal interventions appear necessary for improving BC diagnostics.
德国的血培养（BC）采样率远低于推荐水平。我们研究的目的是评估德国医生在BC诊断方面的知识、态度和实践情况。
我们对在德国从事住院护理工作的医生开展了一项横断面混合方法研究。基于定性焦点小组的结果，在2015 - 2016年进行了一项基于问卷的定量研究。德国16个联邦州中的11个州的706名医生和医学专业最后一年的学生参与了研究。
95%的参与者认为BC采样是一种重要的诊断工具。然而，对于德国现行指南推荐进行BC检测的三种情况，只有23%的参与者会采集血培养样本；近十分之一的医生在这三种情况中的任何一种都不会采集血培养样本。大多数参与者（74%）报告未遵循血培养采样应至少包括来自两个不同注射部位的两套血培养样本的指南建议。血培养采样的高常规性、血培养诊断的感知重要性、内部微生物实验室的可用性以及医生所在的科室被确定为良好血培养实践的预测因素。
我们的研究表明，德国在BC检测医嘱开具以及良好BC实践指南的应用方面存在重大缺陷。基于这些发现，多模式干预对于改善BC诊断似乎是必要的。
