American Society for Microbiology evidence-based laboratory medicine practice guidelines to reduce blood culture contamination rates: a systematic review and meta-analysis.

IF 19 1区 医学 Q1 MICROBIOLOGY Clinical Microbiology Reviews Pub Date : 2024-11-04 DOI:10.1128/cmr.00087-24
Robert L Sautter, James Scott Parrott, Irving Nachamkin, Christen Diel, Ryan J Tom, April M Bobenchik, Judith Young Bradford, Peter Gilligan, Diane C Halstead, P Rocco LaSala, A Brian Mochon, Joel E Mortensen, Lindsay Boyce, Vickie Baselski
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Abstract

SUMMARYBlood cultures (BCs) are one of the critical tests used to detect bloodstream infections. BC results are not 100% specific. Interpretation of BC results is often complicated by detecting microbial contamination rather than true infection. False positives due to blood culture contamination (BCC) vary from 1% to as high as >10% of all BC results. False-positive BC results may result in patients undergoing unnecessary antimicrobial treatments, increased healthcare costs, and delay in detecting the true cause of infection or other non-infectious illness. Previous guidelines from the Clinical and Laboratory Standards Institute, College of American Pathologists, and others, based on expert opinion and surveys, promoted a limit of ≤3% as acceptable for BCC rates. However, the data supporting such recommendations are controversial. A previous systematic review of BCC examined three practices for reducing BCC rates (venipuncture, phlebotomy teams, and pre-packaged kits). Subsequently, numerous studies on different practices including using diversion devices, disinfectants, and education/training to lower BCC have been published. The goal of the current guideline is to identify beneficial intervention strategies to reduce BCC rates, including devices, practices, and education/training by providers in collaboration with the laboratory. We performed a systematic review of the literature between 2017 and 2022 using numerous databases. Of the 11,319 unique records identified, 311 articles were sought for full-text review, of which 177 were reviewed; 126 of the full-text articles were excluded based on pre-defined inclusion and exclusion criteria. Data were extracted from a total of 49 articles included in the final analysis. An evidenced-based committee's expert panel reviewed all the references as mentioned in Data Collection and determined if the articles met the inclusion criteria. Data from extractions were captured within an extraction template in the US Agency for Healthcare Research and Quality's Systematic Review Data Repository (https://srdr.ahrq.gov/). BCC rates were captured as the number of events (contaminated samples) per arm (standard practice versus improvement practice). Modified versions of the National Heart, Lung, and Blood Institute Study Quality Assessment Tools were used for risk of bias assessment (https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools). We used Grading of Recommendations, Assessment, Development and Evaluations to assess strength of evidence. There are several interventions that resulted in significant reduction in BCC rates: chlorhexidine as a disinfectant for skin preparation, using a diversion device prior to drawing BCs, using sterile technique practices, using a phlebotomy team to obtain BCs, and education/training programs. While there were no substantial differences between methods of decreasing BCC, our results indicate that the method of implementation can determine the success or failure of the intervention. Our evidence-based systematic review and meta-analysis support several interventions to effectively reduce BCC by approximately 40%-60%. However, devices alone without an education/training component and buy-in from key stakeholders to implement various interventions would not be as effective in reducing BCC rates.

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美国微生物学会降低血液培养污染率的循证实验室医学实践指南:系统综述和荟萃分析。
摘要血液培养(BC)是用于检测血流感染的关键检测方法之一。血液培养结果并非 100%特异。由于检测到的是微生物污染而非真正的感染,BC 结果的解释往往会变得复杂。在所有 BC 结果中,因血液培养污染 (BCC) 而导致的假阳性率从 1% 到 >10% 不等。假阳性 BC 结果可能导致患者接受不必要的抗菌治疗,增加医疗成本,并延误感染或其他非感染性疾病真正病因的检测。临床与实验室标准研究所、美国病理学家学会等机构以前根据专家意见和调查制定的指南提倡将 BCC 率限制在≤3%,认为这是可以接受的。然而,支持这些建议的数据却存在争议。先前的 BCC 系统性回顾研究了降低 BCC 发生率的三种方法(静脉穿刺、抽血小组和预包装试剂盒)。随后,又发表了大量关于不同实践的研究,包括使用分流装置、消毒剂和教育/培训来降低 BCC。本指南的目标是确定有益的干预策略以降低 BCC 发生率,包括设备、实践以及由医疗服务提供者与实验室合作开展的教育/培训。我们利用众多数据库对 2017 年至 2022 年间的文献进行了系统性回顾。在确定的 11,319 条唯一记录中,我们对 311 篇文章进行了全文审阅,并审阅了其中的 177 篇;根据预先确定的纳入和排除标准,我们排除了其中的 126 篇全文文章。共从 49 篇文章中提取了数据,纳入最终分析。循证委员会的专家小组审查了数据收集中提到的所有参考文献,并确定文章是否符合纳入标准。提取的数据被纳入美国医疗保健研究与质量局系统综述数据存储库(https://srdr.ahrq.gov/)的提取模板中。BCC率以每组(标准实践与改进实践)的事件数(污染样本)来表示。国家心肺血液研究所研究质量评估工具的修订版用于偏倚风险评估(https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools)。我们使用 "建议、评估、发展和评价分级 "来评估证据的强度。有几种干预措施可显著降低 BCC 发生率:将洗必泰作为备皮消毒剂、在抽取 BCs 前使用分流装置、使用无菌技术操作、使用抽血小组获取 BCs 以及教育/培训计划。虽然减少 BCC 的方法之间没有实质性差异,但我们的结果表明,实施方法可以决定干预的成败。我们的循证系统综述和荟萃分析支持几种有效减少 BCC 约 40%-60% 的干预措施。但是,如果没有教育/培训部分和主要利益相关者的支持来实施各种干预措施,仅靠设备是无法有效降低 BCC 发生率的。
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来源期刊
Clinical Microbiology Reviews
Clinical Microbiology Reviews 医学-微生物学
CiteScore
54.20
自引率
0.50%
发文量
38
期刊介绍: Clinical Microbiology Reviews (CMR) is a journal that primarily focuses on clinical microbiology and immunology.It aims to provide readers with up-to-date information on the latest developments in these fields.CMR also presents the current state of knowledge in clinical microbiology and immunology.Additionally, the journal offers balanced and thought-provoking perspectives on controversial issues in these areas.
期刊最新文献
American Society for Microbiology evidence-based laboratory medicine practice guidelines to reduce blood culture contamination rates: a systematic review and meta-analysis. Lyme borreliosis in Brazil: a critical review on the Baggio-Yoshinari syndrome (Brazilian Lyme-like disease). Comprehensive analysis of the global impact and distribution of tick paralysis, a deadly neurological yet fully reversible condition. Molecular diagnostics in cerebrospinal fluid for the diagnosis of central nervous system infections. Harnessing the host response for precision infectious disease diagnosis.
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