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Comparing blood culture contamination rates by different sampling methods in a paediatric emergency department
Orli Megged1,2,3, Sara Dorembus2, Efrat Ben-Shalom2,4
1Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Insights
Using an open blood collection system in pediatric emergency departments significantly increases blood culture contamination (BCC) rates. Adhering to collection guidelines is crucial for reducing BCC in children.
Area of Science:
- Clinical Microbiology
- Pediatric Emergency Medicine
- Infection Control
Background:
- Blood culture contamination (BCC) leads to unnecessary hospitalizations and antibiotic overuse.
- Identifying risk factors for BCC is essential for improving diagnostic accuracy and patient care.
Purpose of the Study:
- To identify risk factors associated with BCC in pediatric patients.
- To compare BCC rates between open and closed blood culture collection systems.
Main Methods:
- Prospective data collection of blood cultures in a pediatric emergency department (Feb-Sep 2020).
- Comparison of contaminated vs. non-contaminated blood cultures.
- Analysis of contamination composition compared to the previous year.
Main Results:
- Out of 512 blood cultures, 33 (6.4%) were contaminated.
- The 'open' blood collection system, using a syringe and needle, was significantly associated with increased BCC (2.34-fold increase, P=0.028).
- Contaminations from oral flora decreased by 44.7% compared to the previous year (13% vs. 23.5%, P=0.056).
Conclusions:
- The 'open system' method for blood culture collection in pediatric emergency settings is linked to higher BCC rates.
- Strict adherence to blood culture collection guidelines is vital for reducing BCC in children, even if it requires additional blood draws.
Aim:
Blood culture contamination (BCC) can cause unnecessary hospitalisations and inappropriate use of antibiotics. The aim of this study was to find risk factors associated with BCCs in children and to compare contamination rates between open and closed blood culture collection systems.
Methods:
Data were prospectively collected regarding blood cultures obtained in the paediatric emergency department from February 26, 2020, to September 30, 2020, based on the method of drawing blood reported by the obtaining physician. A comparison between contaminated and non-contaminated blood cultures was performed. We also compared the composition of the contaminations in the study period to the same period in 2019.
Results:
A total of 512 blood cultures were included, 33 (6.4%) of which were contaminated. The only parameter that was associated with an increased rate of contamination by 2.34 fold (95% CI 1.1-4.99, P = 0.028) was obtaining blood through an 'open' system, using a syringe connected to a needle in order to draw blood from an open ended needle. The proportion of contaminations originating from oral flora decreased in the study period by 44.7% as compared to the same period in the previous year (13% vs. 23.5%, P = 0.056).
Conclusions:
'Open system' method, which is commonly used in paediatric emergency departments for blood culture obtainment, was associated with an increase in BCC. Adherence to blood cultures obtainment guidelines, even at the price of two different blood tests, is important in order to reduce BCC rates in children.
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