Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands.
Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Crit Care Med. 2021 Jan 1;49(1):60-69. doi: 10.1097/CCM.0000000000004717.
Although the Surviving Sepsis Campaign bundle recommends obtaining blood cultures within 1 hour of sepsis recognition, adherence is suboptimal in many settings. We, therefore, implemented routine blood culture collection for all nonelective ICU admissions (regardless of infection suspicion) and evaluated its diagnostic yield.
A before-after analysis.
A mixed-ICU of a tertiary care hospital in the Netherlands.
Patients acutely admitted to the ICU between January 2015 and December 2018.
Automatic orders for collecting a single set of blood cultures immediately upon ICU admission were implemented on January 1, 2017. Blood culture results and the impact of contaminated blood cultures were compared for 2015-2016 (before period) and 2017-2018 (after period). Positive blood cultures were categorized as bloodstream infection or contamination. Blood cultures were obtained in 573 of 1,775 patients (32.3%) and in 1,582 of 1,871 patients (84.5%) in the before and after periods, respectively (p < 0.0001), and bloodstream infection was diagnosed in 95 patients (5.4%) and 154 patients (8.2%) in both study periods (relative risk 1.5; 95% CI 1.2-2.0; p = 0.0006). The estimated number needed to culture for one additional patient with bloodstream infection was 17. Blood culture contamination occurred in 40 patients (2.3%) and 180 patients (9.6%) in the before period and after period, respectively (relative risk 4.3; 95% CI 3.0-6.0; p < 0.0001). Rate of vancomycin use or presumed episodes of catheter-related bloodstream infections treated with antibiotics did not differ between both study periods.
Implementation of routine blood cultures was associated with a 1.5-fold increase of detected bloodstream infection. The 4.3-fold increase in contaminated blood cultures was not associated with an increase in vancomycin use in the ICU.
虽然《拯救脓毒症运动》（Surviving Sepsis Campaign）指南建议在脓毒症识别后 1 小时内采集血培养，但在许多情况下，其依从性并不理想。因此，我们对所有非选择性 ICU 入院患者（无论是否怀疑感染）常规采集血培养，并评估其诊断效果。
前后对照分析。
荷兰一家三级护理医院的混合 ICU。
2015 年 1 月至 2018 年 12 月期间急性入住 ICU 的患者。
2017 年 1 月 1 日，我们实施了自动医嘱，即在 ICU 入院时立即采集一组血培养。我们比较了 2015-2016 年（前一阶段）和 2017-2018 年（后一阶段）的血培养结果和污染血培养的影响。阳性血培养结果分为血流感染或污染。前一阶段和后一阶段分别有 573 例（32.3%）和 1582 例（84.5%）患者获得血培养（p < 0.0001），两研究阶段均诊断出血流感染 95 例（5.4%）和 154 例（8.2%）（相对风险 1.5；95%CI 1.2-2.0；p = 0.0006）。估计每培养 17 例患者即可多检出 1 例血流感染患者。前一阶段和后一阶段分别有 40 例（2.3%）和 180 例（9.6%）患者发生血培养污染（相对风险 4.3；95%CI 3.0-6.0；p < 0.0001）。两研究阶段万古霉素使用率或疑似导管相关血流感染用抗生素治疗的情况并无差异。
常规血培养的实施使检出血流感染的比例增加了 1.5 倍。血培养污染增加了 4.3 倍，但 ICU 万古霉素使用率并未增加。
