Quality of blood culture testing - a survey in intensive care units and microbiological laboratories across four European countries.
Crit Care. 2013 Oct 21;17(5):R248
Authors: Schmitz RP, Keller PM, Baier M, Hagel S, Pletz MW, Brunkhorst FM
INTRODUCTION: Blood culture (BC) testing before initiation of antimicrobial therapy is recommended as a standard of care in international sepsis guidelines and has been shown to reduce intensive care unit (ICU)-stay, antibiotic use, and costs in hospitalized patients. Whereas microbiological laboratory practice has been highly standardized, shortfalls in the preanalytic procedures in the ICU (i.e. indication, time-to-incubation, blood volume and numbers of BC sets) have a significant effect on the diagnostic yield. The objective of this study was to gain insights into current practices regarding BC-testing in intensive care units.
METHODS: Qualitative survey, data collection by 138 semi-structured telephone interviews in four European countries (Italy, UK, France and Germany) between September and November 2009 in 79 clinical microbiology laboratories (LABs) and 59 ICUs.
RESULTS: Whereas BC testing is expected to remain the gold standard for sepsis diagnostics in all countries, there are substantial differences regarding preanalytic procedures. The decision to launch BC testing is carried out by physicians vs. ICU-nurses in the UK in 92 vs. 8%, in France in 75 vs. 25%, in Italy in 88 vs. 12% and in Germany in 92 vs. 8%. Physicians vs. nurses collect BC's in the UK in 77 vs. 23%, in France in 0 vs. 100%, in Italy in 6 vs. 94% and in Germany in 54 vs. 46%. The mean time from blood collection to incubation in the UK is 2 hrs, in France 3 hrs, in Italy 4 hrs, but 20 hrs in German remote LABs (2 hrs in in-house LABs), due to the large number of remote nonresident microbiological laboratories in Germany. There were major differences between the perception of the quality of BC-testing between ICUs and LABs. Among German ICU respondents, 62% reported that they have no problems with BC-testing, 15% reported time constraints, 15% cost pressure, and only 8% too long time-to-incubation. However, the corresponding LABs of these German ICUs reported too many false positive results due to preanalytical contaminations (49%), insufficient numbers of incoming BC sets (47%), long transportation time (41%) or cost pressure (18%).
CONCLUSIONS: There are considerable differences in the quality of BC-testing across European countries. In Germany, time to incubation is a considerable problem due to the increasing number of remote LABs. This is a major issue of concern to physicians aiming to implement sepsis guidelines in the ICUs.
PMID: 24144084 [PubMed - as supplied by publisher]