Walker Sarah V, Steffens Benedict, Sander David, Wetsch Wolfgang A
Faculty of Medicine, University of Cologne, 50923 Cologne, Germany.
Institute for Medical Microbiology, Immunology and Hygiene, University Hospital of Cologne, 50935 Cologne, Germany.
J Clin Med. 2022 Jun 25;11(13):3675. doi: 10.3390/jcm11133675.
: Bloodstream infections increase morbidity and mortality in hospitalized patients and pose a significant burden for health care systems worldwide. Optimal blood culture diagnostics are essential for early detection and specific treatment. After assessing the quality parameters at a surgical intensive care unit for six months, we implemented a diagnostic stewardship bundle (DSB) to optimize blood culture diagnostics and then reevaluated its effects after six months. All patients ≥18 years old and on the ward were included: pre-DSB 137 and post-DSB 158. The standard quality parameters were defined as the number of blood culture sets per diagnostic episode (≥2), the rate of contamination (2-3%), the rate of positivity (5-15%), the collection site (≥1 venipuncture per episode) and the filling volume of the bottles (8-10 mL, only post-DSB). The DSB included an informational video, a standard operating procedure, and ready-to-use paper crates with three culture sets. From pre- to post-interventional, the number of ≥2 culture sets per episode increased from 63.9% (257/402) to 81.3% (230/283), and venipunctures increased from 42.5% (171/402) to 77.4% (219/283). The positivity rate decreased from 15.1% (108/714) to 12.8% (83/650), as did the contamination rate (3.8% to 3.6%). The majority of the aerobic bottles were filled within the target range (255/471, 54.1%), but in 96.6%, the anaerobic bottles were overfilled (451/467). The implementation of DSB improved the quality parameters at the unit, thus optimizing the blood culture diagnostics. Further measures seem necessary to decrease the contamination rate and optimize bottle filling significantly.
血流感染会增加住院患者的发病率和死亡率，并给全球医疗保健系统带来巨大负担。最佳的血培养诊断对于早期检测和特异性治疗至关重要。在对外科重症监护病房的质量参数进行了六个月的评估后，我们实施了一个诊断管理包（DSB）以优化血培养诊断，然后在六个月后重新评估其效果。纳入了所有年龄≥18岁且在该病房的患者：DSB实施前137例，实施后158例。标准质量参数定义为每个诊断事件的血培养瓶数（≥2瓶）、污染率（2%-3%）、阳性率（5%-15%）、采集部位（每个事件≥1次静脉穿刺）以及培养瓶的填充量（8-10 mL，仅DSB实施后）。DSB包括一个信息视频、一份标准操作程序以及配有三套培养瓶的即用型纸箱。从干预前到干预后，每个事件≥2瓶培养瓶的数量从63.9%（257/402）增加到81.3%（230/283），静脉穿刺次数从42.5%（171/402）增加到77.4%（219/283）。阳性率从15.1%（108/714）降至12.8%（83/650），污染率也从3.8%降至3.6%。大多数需氧瓶的填充量在目标范围内（255/471，54.1%），但在厌氧瓶中，96.6%的培养瓶填充过量（451/467）。DSB的实施改善了该科室的质量参数，从而优化了血培养诊断。似乎需要采取进一步措施以降低污染率并显著优化培养瓶的填充量。
