On-site blood culture incubation shortens the time to knowledge of positivity and microbiological results in septic patients


Autoři: Julika Schwarzenbacher aff001;  Sven-Olaf Kuhn aff001;  Marcus Vollmer aff002;  Christian Scheer aff001;  Christian Fuchs aff001;  Sebastian Rehberg aff003;  Veronika Balau aff004;  Klaus Hahnenkamp aff001;  Jürgen A. Bohnert aff005;  Matthias Gründling aff001
Působiště autorů: Department of Anesthesiology, University Hospital of Greifswald, Greifswald, Germany aff001;  Institute of Bioinformatics, University Medicine Greifswald, Greifswald, Germany aff002;  Department of Anesthesiology, Intensive Care, Emergency Medicine, Transfusion Medicine and Pain Therapy, Protestant Hospital of the Bethel Foundation, Bielefeld, Germany aff003;  IMD Labor Greifswald, MVZ Labor Greifswald GmbH, Greifswald, Germany aff004;  Friedrich Loeffler Institute of Microbiology, University Hospital Greifswald, Greifswald, Germany aff005
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225999

Souhrn

Introduction

To determine whether on-site incubation of blood cultures at the intensive care unit (ICU) improves not only the time to incubation but also time to positivity, time to knowledge of positivity and time to results (identification and antibiotic susceptibility testing).

Methods

This observational single-centre study in ICU patients with severe sepsis and septic shock investigated the impact of blood culture incubation immediately on-site at the ICU (ICU group) by comparison with traditional processing in a remote laboratory (LAB group) on different time intervals of blood culture diagnostics from obtaining blood to clinician notification of final result. The effect of on-site incubation was evaluated in Kaplan-Meier estimates for the time to positivity, time to knowledge of positivity and time to microbiological results and a linear mixed model was built.

Results

A total of 3,549 blood culture sets from 657 ICU patients were analysed: 2,381 in the LAB group and 1,168 in the ICU group. Overall, 660 (18.6%) blood culture sets were positive and 2,889 (81.4%) sets remained negative. On-site incubation was associated with reduced time to knowledge of positivity (46.9 h [CI 43.4–50.8 h] vs. 28.0 h [CI 23.6–32.2 h], p < 0.001) and reduced time to result (61.4 h [CI 58.4–64.8 h] vs. 42.1 h [CI 39.1–47.5 h], p < 0.001). In blood cultures processed instantaneously at the ICU compared to incubation in the remote laboratory within 4 h, the time to microbiological result was significantly reduced by 8.5 h (p < 0.001). Pre-existing anti-infective therapy had no significant impact on diagnostic time intervals.

Conclusions

Instantaneous incubation of blood cultures in the ICU compared to incubation in a remote laboratory significantly improves time to knowledge to positivity and time to result. These effects are even more pronounced during off-hours of the microbiological laboratory. The results underline the importance of 24/7 diagnostics to provide round-the-clock processing of blood culture samples in patients with sepsis and septic shock and an immediate to communication of the results to the clinicians.

Klíčová slova:

Antibiotics – Blood – Diagnostic medicine – Intensive care units – Microbiology – Respiratory infections – Sepsis – Severe sepsis


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