Division of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland; Department of Clinical Research, University of Basel, Schanzenstrasse 55, 4056 Basel, Switzerland.
Division of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.
Eur J Intern Med. 2022 Sep;103:50-56. doi: 10.1016/j.ejim.2022.04.028. Epub 2022 Jun 14.
Guidance for blood culture (BC) collection is limited. Inappropriate BC collection may be associated with potentially harmful consequences for the patient such as unnecessary laboratory testing, treatment and additional costs. The aim of the study was to assess the appropriateness of BC collection and related knowledge and attitude of precribers.
We conducted a single-center quality control study to assess the appropriateness of BC collection according to the local guidelines in a Swiss university hospital in 2020 by combining three different approaches: point prevalence, patient-individual longitudinal and diseases-related analysis. Second, we conducted a survey regarding BC collection practices and knowledge among physicians in two non-university and one university hospital using an 18-item electronic questionnaire.
We analyzed 1114 BC collected in 344 patients. Approximately 40% of the BCs were collected inappropriately, in particular in diseases with low pretest probability of bacteremia such as non-severe community acquired pneumonia (CAP). Follow-up blood culture (FUBC) collection was inappropriate in 60%. Growth of a relevant pathogen was more frequently observed in appropriately than in inappropriately collected BCs (18% vs. 3%, p < 0.001). In the survey, uncertainty concerning the need of index BC collection was high in non-severe CAP and uncomplicated cellulitis.
Almost half of the BCs was not collected according to the guidelines, especially in non-severe CAP and in case of FUBCs. Substantial uncertainty among physicians regarding BC ordering practices was identified. The implementation of diagnostic stewardship programs may improve BC collection practices, increase adherence to local guidelines, and may help reducing unnecessary diagnostics and treatment.
血液培养（BC）采集的指南有限。不适当的 BC 采集可能会给患者带来潜在的有害后果，例如不必要的实验室检查、治疗和额外的费用。本研究的目的是评估 BC 采集的适当性以及开处方者的相关知识和态度。
我们在 2020 年在瑞士一所大学医院进行了一项单中心质量控制研究，结合了三种不同的方法，即点流行率、患者个体纵向和疾病相关分析，根据当地指南评估 BC 采集的适当性。其次，我们使用包含 18 个问题的电子问卷对两家非大学医院和一家大学医院的医生进行了关于 BC 采集实践和知识的调查。
我们分析了 344 名患者的 1114 份 BC。大约 40%的 BC 采集不适当，特别是在血培养前概率低的疾病中，如非重症社区获得性肺炎（CAP）。60%的随访血培养（FUBC）采集不适当。适当采集的 BC 中更常观察到相关病原体的生长（18%比 3%，p<0.001）。在调查中，非重症 CAP 和单纯性蜂窝织炎中，对索引 BC 采集必要性的不确定性很高。
几乎一半的 BC 采集不符合指南，特别是在非重症 CAP 和 FUBC 情况下。医生对 BC 开方实践存在很大的不确定性。实施诊断管理计划可能会改善 BC 采集实践，提高对当地指南的依从性，并有助于减少不必要的诊断和治疗。
