Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
Emerg Med Australas. 2024 Apr;36(2):206-212. doi: 10.1111/1742-6723.14330. Epub 2023 Oct 16.
To benchmark blood culture (BC) quality in an Australian ED, explore groups at risk of suboptimal BC collection, and identify potential areas for improvement.
This retrospective observational study was undertaken to benchmark quality of BCs in a tertiary adult ED in terms of number of BC sets per patient and proportion of patients with false positive (contaminated) BC results.
A single BC set was taken for 55% of patients, with lower acuity patients being more likely to have a single BC set taken. BC false positives occurred in 3.4% of presentations, with higher frequency in some critically unwell patient groups. The true positive BC rate was 10.9%, with pathogens most frequently isolated in older patients, those with a haematological condition or genitourinary source, and those admitted to inpatient wards. Hospital length of stay did not differ between patients with negative and patients with false positive BCs.
BC quality standards in the ED such as false positive rate <3% and single culture rate <20% are required to facilitate benchmarking and prospective quality improvement. The sensitivity and specificity of this common and critical test can be improved. Patient subgroups associated with poor-quality BC collection can be identified and should be a focus of future work.
以澳大利亚急诊部（ED）为基准，评估血液培养（BC）质量，探索可能存在采集不佳风险的人群，并确定潜在的改进领域。
本回顾性观察研究旨在基准评估成人三级 ED 中 BC 的质量，具体涉及每位患者采集的 BC 套数和假阳性（污染）BC 结果的患者比例。
55%的患者仅采集了一套 BC，病情较轻的患者更可能仅采集一套 BC。3.4%的就诊患者出现 BC 假阳性，某些危重症患者群体中出现的频率更高。真正的阳性 BC 率为 10.9%，病原体最常分离于老年患者、血液系统疾病或泌尿生殖系统来源的患者，以及收入住院病房的患者。阴性 BC 患者和假阳性 BC 患者的住院时间无差异。
为促进基准评估和前瞻性质量改进，ED 中需要符合 BC 质量标准，如假阳性率<3%和单培养率<20%。该常用且关键检测的灵敏度和特异性可以提高。可以确定与采集不佳的 BC 相关的患者亚组，应成为未来工作的重点。
