影响血培养分析前质量的因素——一家三级医疗中心的分析。
Factors impacting the pre-analytical quality of blood cultures-Analysis at a tertiary medical center.
机构信息
Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland.
Department Biomedicine, Applied Microbiology Research, University of Basel, Basel, Switzerland.
出版信息
PLoS One. 2023 Mar 16;18(3):e0282918. doi: 10.1371/journal.pone.0282918. eCollection 2023.
BACKGROUND
Blood cultures (BC) are critical for the diagnosis of bloodstream infections, pathogen identification, and resistance testing. Guidelines recommend a blood volume of 8-10 mL per bottle as lower volumes result in decreased sensitivity. We aimed to evaluate factors for non-adherence to recommended volumes and assess the effects on diagnostic performance.
METHODS
From February to April 2020, we measured collected blood volumes by weighing all BC containers from inpatient samples at the University Hospital Basel. Information on BC volumes was merged with clinical and microbiological data, as well as nursing staff schedules. We analyzed factors associated with (i) BC sampling volume, (ii) reaching recommended volumes (≥8 mL), (iii) BC positivity, and (iv) time to positivity using linear and generalized linear mixed effect models.
RESULTS
We evaluated a total of 4'118 BC bottles collected from 686 patients. A total of 1'495 (36.3%) of all bottles contained the recommended filling volume of ≥8 mL. Using a central venous and arterial catheter for drawing blood resulted in an increase of filling volume by 0.26 mL (95% CI 0.10, 0.41) and 0.50 mL (95% CI 0.31, 0.69) compared to peripheral venipuncture, respectively. Each additional nursing staff working at the time of blood drawing was associated with 6% higher odds of achieving the recommended filling volume. We found no significant correlation between the filling volume and the positivity rate.
CONCLUSION
Our results indicate critical pre-analytical quality markers linked to BC collection procedures to reach recommended collection volumes. No significant impact on the positivity rate was found.
背景
血培养（BC）对于诊断血流感染、病原体鉴定和耐药性检测至关重要。指南建议每个瓶的采血量为 8-10 毫升，因为较低的采血量会降低灵敏度。我们旨在评估不符合推荐采血量的因素，并评估其对诊断性能的影响。
方法
在 2020 年 2 月至 4 月期间，我们通过称重巴塞尔大学医院住院患者样本中的所有 BC 容器来测量采集的血液量。BC 体积的信息与临床和微生物学数据以及护理人员的时间表合并。我们使用线性和广义线性混合效应模型分析了与以下因素相关的因素：（i）BC 采样量，（ii）达到推荐量（≥8 毫升），（iii）BC 阳性率，和（iv）阳性时间。
结果
我们评估了来自 686 名患者的总共 4118 个 BC 瓶。共有 1495 个（36.3%）瓶子包含≥8 毫升的推荐填充量。与外周静脉穿刺相比，使用中央静脉和动脉导管采血分别使填充量增加了 0.26 毫升（95%CI 0.10，0.41）和 0.50 毫升（95%CI 0.31，0.69）。采血时每增加一名护理人员，达到推荐填充量的可能性就会增加 6%。我们没有发现填充量与阳性率之间存在显著相关性。
结论
我们的结果表明与 BC 采集程序相关的关键分析前质量标志物可达到推荐的采集量。没有发现填充量对阳性率有显著影响。
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