Ann Clin Microbiol.  2021 Sep;24(3):75-81. 10.5145/ACM.2021.24.3.2.

Comparison of Blood Culture Parameters between 2 and 10 mL Aerobic Bottles from Patients with Sepsis

• Kim SC
• Kim S

• KMID: 2520134
• DOI: http://doi.org/10.5145/ACM.2021.24.3.2

Abstract

Background
Blood volume is the most important parameter for an optimal blood culture; however, the effect of blood volume on blood culture is not clearly understood from patients with sepsis.
Methods
Blood cultures were obtained from 1,049 patients (≥ 15 years old) who visited the emergency department (ED). Two sets of 20 mL each was collected from each patient, 12 mL of which was transferred to 2 and 10 mL FA Plus (aerobic) bottles (bioMérieux, USA) and the remaining into an FN Plus (anaerobic) bottle. Medical records were reviewed to confirm the diagnosis and clinical significance of the blood culture isolates. The positive rate and time-todetection (TTD) were compared between the 2 and 10 mL groups.
Results
Among the 2,098 sets collected, 612 sets (29.2%) were excluded due to inadequate (either too much or too little) blood volume. The positive rate of clinically significant pathogens was lower in the 2 mL group (6.1%) than in the 10 mL group (7.5%) (P = 0.003) among the 1,486 sets. However, there was no significant difference in the positive rate (11.0% vs. 12.5%, P= 0.152) and TTD (15.7 hours vs. 14.2 hours, P = 0.299) among the 585 (39.4%) patients with sepsis.
Conclusion
The positive rate and TTD were similar between the 2 and 10 mL groups from patients with sepsis who visited the ED, suggesting a high concentration of bacteremia in this group. Therefore, a smaller blood volume should be carefully considered in patients with sepsis in the ED.

Keyword

Bacteremia; Blood culture; Blood volume; Detection; Sepsis

Reference

1. Clinical and Laboratory Standards Institute (CLSI). Principles and procedures for blood cultures; approved guideline. CLSI document M47-A. Wayne;PA, 2007.

2. Lamy B, Dargere 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.

3. Ilstrup DM and Washington JA, Jr. The importance of volume of blood cultured in the detection of bacteremia and fungemia. Diagn Microbiol Infect Dis 1983;1:107-10.

4. Cockerill FR 3rd, Wilson JW, Vetter EA, Goodman KM, Torgerson CA, Harmsen WS, et al. Optimal testing parameters for blood cultures. Clin Infect Dis 2004;38:1724-30.

5. Kim SC, Kim S, Lee DH, Choi SR, Kim JS. Effect of blood volume in standard anaerobic blood culture bottles of the BacT/ALERT 3D system used for the detection of pathogens and time to detection. PLoS One 2015;10:e0116728.

6. Tenney JH, Reller LB, Mirrett S, Wang WL, Weinstein MP. Controlled evaluation of the volume of blood cultured in detection of bacteremia and fungemia. J Clin Microbiol 1982;15:558-61.

7. Li J, Plorde JJ, Carlson LG. Effects of volume and periodicity on blood cultures. J Clin Microbiol 1994;32:2829-31.

8. Weinstein MP, Mirrett S, Wilson ML, Reimer LG, Reller LB. Controlled evaluation of 5 versus 10 milliliters of blood cultured in aerobic BacT/Alert blood culture bottles. J Clin Microbiol 1994;32:2103-6.

9. Shapiro NI, Wolfe RE, Wright SB, Moore R, Bates DW. Who needs a blood culture? A prospectively derived and validated prediction rule. J Emerg Med 2008;35:255-64.

10. Abe T, Tokuda Y, Ishimatsu S, Birrer RB. Usefulness of initial blood cultures in patients admitted with pneumonia from an emergency department in Japan. J Infect Chemother 2009;15:180-6.

11. Mayr FB, Yende S, Angus DC. Epidemiology of severe sepsis. Virulence 2014;5:4-11.

12. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Intensive Care Med 2013;39:165-228.

13. Self WH, Speroff T, Grijalva CG, McNaughton CD, Ashburn J, Liu D, et al. Reducing blood culture contamination in the emergency department: an interrupted time series quality improvement study. Acad Emerg Med 2013;20:89-97.

14. Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 2003;348:1546-54.

15. Shin JH, Song SA, Kim MN, Lee NY, Kim EC, Kim S, et al. Comprehensive analysis of blood culture performed at nine university hospitals in Korea. Korean J Lab Med 2011;31:101-6.

16. Whittle J and Walker D. The new international sepsis guidelines (sepsis-3): the central message remains. Br J Hosp Med 2016;77:208-11.