危重症患者经动脉导管采血与静脉穿刺或经静脉导管采血的血培养污染情况：一项系统评价和荟萃分析。

Contamination of blood cultures drawn from arterial catheters versus venipuncture or venous catheters in critically ill patients: a systematic review and meta-analysis.

作者信息

Koroki Takatoshi, Fujii Motoki, Kotani Yuki, Yaguchi Takahiko, Shibata Taisuke, Hirata Chihiro, Okawa Naoki, Ota Koshi, Tonai Mayuko, Karumai Toshiyuki, Kataoka Yuki, Hayashi Yoshiro

机构信息

Department of Intensive Care Medicine, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, 296-8602, Japan.

Department of Infectious Diseases, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, 296-8602, Japan.

出版信息

Clin Infect Dis. 2025 May 20. doi: 10.1093/cid/ciaf260.

DOI:10.1093/cid/ciaf260

PMID:40394840

Abstract

BACKGROUND

Arterial catheter-drawn blood culture sampling may reduce patient discomfort and healthcare providers' workload. Guidelines discourage transcatheter blood culture collection due to contamination risks, mainly derived from data on venous catheter-drawn cultures. However, contamination rates of arterial catheter-drawn cultures have not been comprehensively evaluated compared with venipuncture- or venous catheter-drawn cultures.

METHODS

We searched MEDLINE, Embase, and the Cochrane Library from inception through December 5, 2023, for studies comparing arterial catheter-drawn blood cultures with venipuncture- or venous catheter-drawn blood cultures. The primary outcome was blood culture contamination rate. We performed a random-effects meta-analysis and evaluated the certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology.

RESULTS

We included six studies involving 8533 blood cultures. When comparing arterial catheter- with venipuncture-drawn cultures, the crude contamination rates were 28/1355 (2.1%) and 103/4539 (2.3%), respectively. Arterial catheter-drawn cultures may not increase contamination rates compared to venipuncture-drawn cultures (risk difference [RD], 0.01; 95% confidence interval [CI], -0.01 to 0.02; low certainty). When comparing arterial catheter- with venous catheter-drawn cultures, the crude contamination rates were 15/489 (3.1%) and 211/2639 (8.0%), respectively. Compared to venous catheter-drawn cultures, arterial catheter-drawn cultures may have lower contamination rates (RD, -0.05; 95% CI, -0.11 to 0.01; low certainty).

CONCLUSIONS

In critically ill patients, arterial catheter-drawn blood cultures may have contamination rates comparable to venipuncture-drawn cultures and potentially lower than venous catheter-drawn cultures.

CLINICAL TRIALS REGISTRATION

Prospero (CRD42023486227).

摘要

背景

通过动脉导管采集血培养样本可能会减轻患者不适并减少医护人员的工作量。由于存在污染风险，指南不鼓励经导管采集血培养样本，这些风险主要源于静脉导管采集培养样本的数据。然而，与静脉穿刺或静脉导管采集的培养样本相比，动脉导管采集培养样本的污染率尚未得到全面评估。

方法

我们检索了从数据库建立至2023年12月5日的MEDLINE、Embase和Cochrane图书馆，以查找比较动脉导管采集血培养样本与静脉穿刺或静脉导管采集血培养样本的研究。主要结局是血培养污染率。我们进行了随机效应荟萃分析，并使用推荐分级评估、制定和评价（GRADE）方法评估证据的确定性。

结果

我们纳入了6项研究，涉及8533份血培养样本。在比较动脉导管采集与静脉穿刺采集的培养样本时，粗污染率分别为28/1355（2.1%）和103/4539（2.3%）。与静脉穿刺采集的培养样本相比，动脉导管采集的培养样本可能不会增加污染率（风险差异[RD]，0.01；95%置信区间[CI]，-0.01至0.02；低确定性）。在比较动脉导管采集与静脉导管采集的培养样本时，粗污染率分别为15/489（3.1%）和211/2639（8.0%）。与静脉导管采集的培养样本相比，动脉导管采集的培养样本可能污染率更低（RD，-0.05；95%CI，-0.11至0.01；低确定性）。