Cojocaru Yaniv, Hassan Lior, Nesher Lior, Shafat Tali, Novack Victor
Clinical Research Center and Division of Internal Medicine, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva P.O. Box 84101, Israel.
Infectious Diseases Institute, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva P.O. Box 84101, Israel.
J Clin Med. 2025 Mar 30;14(7):2373. doi: 10.3390/jcm14072373.
: The injudicious use of blood cultures is associated with low cost-effectiveness and leads to unnecessary follow-up tests for false-positive results. In addition, false negatives can result in missed diagnoses, leading to delays in initiating appropriate treatment and potentially worsening patient outcomes. The timing of the blood culture tests related to the highest diagnostic yield is not fully elucidated. We hypothesized that a high proportion of the tests are done within non-optimal timing, resulting in a lower clinical yield. We specifically focused on the consequences of BC obtained in afebrile patients. : We assessed 73,787 blood cultures taken between 2014 and 2020 in patients hospitalized with a suspected infection. Blood cultures were considered taken at optimal timing if the per rectum temperature was 38.3 °C or more and no prior antibiotics were given. Only the first culture per patient was assessed. The primary outcome was a true bacteremia defined by the clinically important pathogen. : Therefore, 25,616 blood cultures were obtained at optimal timing (34.7%), with true bacteremia found in 6.15% vs. 5.15% in cultures obtained at non-optimal timing. In a multivariable model, optimal timing adjusted for the variety of the clinical, demographic, and laboratory findings' optimal timing was significantly associated with an increase in the odds of detecting true bacteremia (OR:1.23, 95% CI: 1.12-1.35). : Nearly two-thirds of patients hospitalized due to a suspected infection did not have their blood cultures taken at the optimal time. Our findings underscore the importance of integrating clinical judgment, patient-specific risk factors, and evidence-based criteria when deciding to perform blood cultures, rather than relying solely on fever as an indicator.
血液培养的不当使用与成本效益低下相关，并会因假阳性结果导致不必要的后续检查。此外，假阴性可能导致漏诊，从而延误开始适当治疗的时间，并可能使患者预后恶化。与最高诊断率相关的血液培养测试时间尚未完全阐明。我们假设很大一部分测试是在非最佳时间进行的，从而导致临床检出率较低。我们特别关注了在无发热患者中进行血培养的后果。
我们评估了2014年至2020年期间因疑似感染住院患者的73787份血液培养样本。如果直肠温度为38.3℃或更高且未使用过抗生素，则认为血液培养是在最佳时间进行的。每位患者仅评估第一次培养结果。主要结局是由具有临床重要意义的病原体定义的真正菌血症。
因此，在最佳时间获得了25616份血液培养样本（34.7%），其中真正菌血症的检出率在最佳时间培养的样本中为6.15%，而在非最佳时间培养的样本中为5.15%。在多变量模型中，根据各种临床、人口统计学和实验室检查结果调整后的最佳时间与检测到真正菌血症的几率增加显著相关（比值比：1.23，95%置信区间：1.12 - 1.35）。
近三分之二因疑似感染住院的患者没有在最佳时间进行血液培养。我们的研究结果强调了在决定进行血液培养时，综合临床判断、患者特定风险因素和循证标准的重要性，而不是仅仅依赖发热作为指标。
