Optimizing the number of blood cultures for lower and middle income countries: a large scale study in a public sector tertiary care teaching hospital of Southern India
DOI:
https://doi.org/10.18203/2320-6012.ijrms20232103Keywords:
Blood stream infection, BacT/ALERT VIRTUO, Blood cultureAbstract
Background: Blood culture is widely accepted as the gold standard investigation for the diagnosis of blood stream infections (BSI). The number of blood cultures collected has a considerable impact on the organism isolation. This study aims to optimize the number of blood cultures needed, for an optimal diagnostic yield in BacT/ALERT VIRTUO system mainly in a resource limited setting.
Methods: All the blood cultures (BCs) obtained in BacT/Alert bottles per patient during a 24-h period were included as ‘one episode’ and categorized as single bottle, 1-set (2 aerobic bottles), 2 sets and 3 sets. BC bottles were incubated in the BacT/ALERT VIRTUO (bioMérieux) for a period of five days. Bottles flagged positive were subjected to Gram staining and culture plating. Colonies grown were identified by MALDI-TOF MS, VITEK MS, bioMérieux.
Results: Cumulative positivity rate increased (21.7%, 41.4%, 56.1%, 60.6%) and pathogen isolation rate increased (10.3%, 21.8%, 30.4% and 33.8%) progressively when collected in single bottle, 1, 2 and 3 sets respectively. The pathogen detection rate for GNB and GPC were 45.1% and 42.6% respectively with one bottle and this got upsurged to 85.6% and 98.9% for GNB and 83.6% and 98.2% for GPC when collected in ≤1 set and ≤2 sets respectively.
Conclusions: Two BC sets over a 24-h period can detect approximately 98% of the pathogens with a cumulative positivity rate of 60% and hence it is a justifiable alternative approach to the standard practice of 3-sets of BCs.
References
Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. Lancet. 2020;395(10219):200-11.
Peker N, Couto N, Sinha B, Rossen JW. Diagnosis of bloodstream infections from positive blood cultures and directly from blood samples: recent developments in molecular approaches. Clin Microbiol Infect. 2018;24(9):944-955.
Lamy B, Dargère S, Arendrup MC, Parienti JJ, Tattevin P. How to Optimize the Use of Blood Cultures for the Diagnosis of Bloodstream Infections? A State-of-the Art. Front Microbiol. 2016;7:697.
Gonzalez MD, Chao T, Pettengill MA. Modern blood culture: management decisions and method options. Clin Lab Med. 2020;40(4):379-392.
Willems E, Smismans A, Cartuyvels R, Coppens G, Van Vaerenbergh K, Van den Abeele AM, et al. The preanalytical optimization of blood cultures: a review and the clinical importance of benchmarking in 5 Belgian hospitals. Diagn Microbiol Infect Dis. 2012;73(1):1-8.
Rothe K, Spinner CD, Ott A, Querbach C, Dommasch M, Aldrich C, et al. Strategies for increasing diagnostic yield of community-onset bacteraemia within the emergency department: A retrospective study. PLoS One. 2019;14(9):e0222545.
Ombelet S, Barbé B, Affolabi D, Ronat JB, Lompo P, Lunguya O, et al. Best practices of blood cultures in low- and middle-income countries. Front Med (Lausanne). 2019;6:131.
Jacobs MR, Mazzulli T, Hazen KC, Good CE, Abdelhamed AM, Lo P, et al. Multicenter clinical evaluation of BacT/Alert virtuo blood culture system. J Clin Microbiol. 2017;55(8):2413-21.
Menchinelli G, Liotti FM, Fiori B, De Angelis G, D'Inzeo T, Giordano L, et al. In vitro Evaluation of BACT/ALERT® VIRTUO®, BACT/ALERT 3D®, and BACTEC™ FX automated blood culture systems for detection of microbial pathogens using simulated human blood samples. Front Microbiol. 2019;10:221.
WHO. Guidelines on drawing blood: best practices in phlebotomy, 2010. Available at: https://www.ncbi.nlm.nih.gov/books/NBK138650/pdf/Bookshelf_NBK138650.pdf.
Riley JA, Heiter BJ, Bourbeau PP. Comparison of recovery of blood culture isolates from two BacT/ALERT FAN aerobic blood culture bottles with recovery from one FAN aerobic bottle and one FAN anaerobic bottle. J Clin Microbiol. 2003;41(1):213-7.
Elantamilan D, Lyngdoh VW, Khyriem AB, Rajbongshi J, Bora I, Devi ST, et al. Comparative evaluation of the role of single and multiple blood specimens in the outcome of blood cultures using BacT/ALERT 3D (automated) blood culture system in a tertiary care hospital. Indian J Crit Care Med. 2016;20(9):530-3.
McHugh ML. Interrater reliability: the kappa statistic. Biochem Med (Zagreb). 2012;22(3):276-82.
Seifert H. The clinical importance of microbiological findings in the diagnosis and management of bloodstream infections. Clin Infect Dis. 2009;48 Suppl 4:S238-45.
Prowle JR, Echeverri JE, Ligabo EV, Sherry N, Taori GC, Crozier TM, et al. Acquired bloodstream infection in the intensive care unit: incidence and attributable mortality. Crit Care. 2011;15(2):R100.
Clinical and Laboratory Standards Institute (CLSI). Principles and Procedures for Blood Cultues; Approved Guideline. CLSI document M47-A. Wayne, PA: Clinical and Laboratory Standards Institute; 2007.
Lamy B, Roy P, Carret G, Flandrois JP, Delignette-Muller ML. What is the relevance of obtaining multiple blood samples for culture? A comprehensive model to optimize the strategy for diagnosing bacteremia. Clin Infect Dis. 2002;35(7):842-50.
Lin HH, Liu YF, Tien N, Ho CM, Hsu LN, Lu JJ. Evaluation of the blood volume effect on the diagnosis of bacteremia in automated blood culture systems. J Microbiol Immunol Infect. 2013;46(1):48-52.
MacGregor RR, Beaty HN. Evaluation of positive blood cultures. Guidelines for early differentiation of contaminated from valid positive cultures. Arch Intern Med. 1972;130(1):84-7.
Weinstein MP, Towns ML, Quartey SM, Mirrett S, Reimer LG, Parmigiani G, et al. The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults. Clin Infect Dis. 1997;24(4):584-602.
Lee A, Mirrett S, Reller LB, Weinstein MP. Detection of bloodstream infections in adults: how many blood cultures are needed?. J Clin Microbiol. 2007;45(11):3546.
Cockerill FR, Wilson JW, Vetter EA, Goodman KM, Torgerson CA, Harmsen WS, et al. Optimal testing parameters for blood cultures. Clin Infect Dis. 2004;38(12):1724-30.
Bouza E, Sousa D, Rodríguez-Créixems M, Lechuz JG, Muñoz P. Is the volume of blood cultured still a significant factor in the diagnosis of bloodstream infections? J Clin Microbiol. 2007;45(9):2765-9.
Lee A, Mirrett S, Reller LB, Weinstein MP. Detection of bloodstream infections in adults: how many blood cultures are needed? J Clin Microbiol. 2007;45(11):3546-8.
Patel R, Vetter EA, Harmsen WS, Schleck CD, Fadel HJ, Cockerill FR. Optimized pathogen detection with 30- compared to 20-milliliter blood culture draws. J Clin Microbiol. 2011;49(12):4047-51.
Li J, Plorde JJ, Carlson LG. Effects of volume and periodicity on blood cultures. J Clin Microbiol. 1994;32(11):2829-31.
Mermel LA, Maki DG. Detection of bacteremia in adults: consequences of culturing an inadequate volume of blood. Ann Intern Med. 1993;119(4):270-2.
Weinstein MP. Current blood culture methods and systems: clinical concepts, technology, and interpretation of results. Clin Infect Dis. 1996;23(1):40-6.
O'Grady NP, Barie PS, Bartlett JG, Bleck T, Carroll K, Kalil AC, et al. American College of Critical Care Medicine; Infectious Diseases Society of America. Guidelines for evaluation of new fever in critically ill adult patients: 2008 update from the American College of Critical Care Medicine and the Infectious Diseases Society of America. Crit Care Med. 2008;36(4):1330-49.
Baron EJ, Miller JM, Weinstein MP, Richter SS, Gilligan PH, Thomson RB, et al. A guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2013 recommendations by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM)(a). Clin Infect Dis. 2013;57(4):e22-e121.
