Department of Emergency Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 596-8686, Japan.
Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Sci Rep. 2021 Mar 18;11(1):6211. doi: 10.1038/s41598-021-85614-7.
We aimed to determine whether puncture sites for blood sampling and topical disinfectants are associated with rates of contaminated blood cultures in the emergency department (ED) of a single institution. This single-center, prospective observational study of 249 consecutive patients aged ≥ 20 years proceeded in the ED of a university hospital in Japan during 6 months. Pairs of blood samples were collected for aerobic and anaerobic culture from all patients in the ED. Physicians selected puncture sites and topical disinfectants according to their personal preference. We found 50 (20.1%) patients with potentially contaminated blood cultures. Fifty-six (22.5%) patients were true bacteremia and 143 (57.4%) patients were true negatives. Multivariate analysis associated more frequent contamination when puncture sites were disinfected with povidone-iodine than with alcohol/chlorhexidine (adjusted risk difference, 12.9%; 95% confidence interval [CI] 8.8-16.9; P < 0.001). Sites of blood collection were also associated with contamination. Femoral and central venous with other sites were associated with contamination more frequently than venous sites (adjusted risk difference), 13.1% (95% CI 8.2-17.9; P < 0.001]) vs. 17.3% (95% CI 3.6-31.0; P = 0.013). Rates of contaminated blood cultures were significantly higher when blood was collected from femoral sites and when povidone-iodine was the topical antiseptic.
我们旨在确定在一家机构的急诊科（ED）中，采血部位和局部消毒剂与污染血培养的发生率之间是否存在关联。这项在日本一家大学医院 ED 进行的单中心、前瞻性观察研究共纳入了 249 例年龄≥20 岁的连续患者，持续 6 个月。所有 ED 患者均采集两份血样进行需氧和厌氧培养。医生根据个人偏好选择穿刺部位和局部消毒剂。我们发现 50 例（20.1%）患者的血培养可能受到污染。56 例（22.5%）患者为真性菌血症，143 例（57.4%）患者为真性阴性。多变量分析显示，与使用酒精/氯己定相比，使用聚维酮碘消毒穿刺部位时污染更频繁（调整风险差异，12.9%；95%置信区间 8.8-16.9；P<0.001）。采血部位也与污染有关。股静脉和中心静脉与其他部位比静脉部位更容易发生污染（调整风险差异），13.1%（95%置信区间 8.2-17.9；P<0.001）] vs. 17.3%（95%置信区间 3.6-31.0；P=0.013）。当从股静脉部位采集血液且使用聚维酮碘作为局部消毒剂时，污染血培养的发生率显著更高。
