Pediatric Infection and Vaccine

The Korean Society of Pediatric Infectious Diseases (대한소아감염학회)
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Clinical Characteristics Associated with Blood Culture Contamination in Neonates

신생아에서 혈액 배양 오염과 관련된 임상적 특징

  • Jung, Min Young (Department of Pediatrics, Kosin University College of Medicine) ;
  • Son, Ok Sung (Department of Pediatrics, Kosin University College of Medicine) ;
  • Hong, Yoo Rha (Department of Pediatrics, Kosin University College of Medicine) ;
  • Oh, Chi Eun (Department of Pediatrics, Kosin University College of Medicine)
  • 정민영 (고신대학교 의과대학 소아과학교실) ;
  • 손옥성 (고신대학교 의과대학 소아과학교실) ;
  • 홍유라 (고신대학교 의과대학 소아과학교실) ;
  • 오지은 (고신대학교 의과대학 소아과학교실)
  • Received : 2015.05.04
  • Accepted : 2015.06.15
  • Published : 2015.12.25
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Abstract

Purpose: This study was aimed to investigate the contamination rates of blood culture in a neonatal intensive care unit (NICU) and to examine the clinical characteristics related to the contamination. Methods: Eight hundred thirty cases of blood culture performed from March 2013 to February 2014 were analyzed. We evaluated the contamination rates of blood culture by blood sampling sites and compared the clinical characteristics such as real name system and body weights of the contaminated cases and those of non-contaminated ones. The clinical characteristics were retrospectively reviewed by medical records. Results: The overall contamination rate was 3.6% (30/830). The contamination rates by blood sampling sites were as follows: peripheral vein 15.6% (10/64), peripheral artery 2.6% (20/759), and umbilical arterial catheter 0% (0/7). There was no difference in the contamination rates between cases with and without real name system (P=0.484). However, there were significant differences in the contamination rates by the physicians who performed the culture (P=0.038) and body weight (<1,000 g vs. ${\geq}1,000g$) at the time of blood culture (P<0.001). Conclusions: These results suggest that neonates with a body weight less than 1,000 g have more risks of the contamination of blood culture. Furthermore, there is a necessity to provide blood culture performers with active feedbacks and individualized education plans that can help diminish blood culture contamination rates. Prospective studies in a systematic manner that can be applied in actual clinical settings are needed in order to figure out factors that can diminish the contamination rates of blood culture in NICU.

목적: 본 연구는 신생아중환자실에 입원한 환자에서 혈액 배양 오염률을 조사하고, 오염유무에 따른 임상적 특성을 비교하고자 하였다. 방법: 고신대학교복음병원 신생아중환자실에 입원한 환자들을 대상으로 시행한 830건의 혈액 배양 검사 결과에 대해 분석하였다. 혈액 배양 오염률과 채혈부위별 오염률을 조사하였고, 말초혈액 배양 시 오염 유무에 따른 임상적인 특성을 비교하기 위해 의무기록을 조사하였다. 결과: 연구기간 중 오염률은 3.6%였다. 채혈 부위별 오염률은 말초정맥 15.6%, 말초동맥 2.6%, 배꼽동맥 도관 0%였다. 실명제가 시행되지 않았던 기간의 오염률은 2.7% (4/149), 시행 기간에는 4.4% (25/573)로 오염률의 차이가 없었다(P=0.484). 시술자별 오염률은 0-11.1%로 시술자간 차이가 있었다(P=0.038). 채혈 시 몸무게가 1,000 g 미만인 경우 오염률이 유의하게 높았다(P<0.001). 결론: 몸무게가 적은 미숙아에서 혈액 배양 오염률이 더 높을 수 있으므로 채혈 방법에 주의가 필요하며, 오염률이 높은 시술자를 관리해야 한다. 신생아에서 혈액 배양 오염률을 감소시킬 수 있는 인자들을 파악하고 실제 임상에서 적용하기 위한 전향적이고, 체계적인 연구가 필요할 것으로 보인다.

Keywords

References

  1. Baron EJ, Weinstein MP, Dunne WM Jr, Yagupsky P, Welch DF, Wilson DM. Cumitech 1C: Blood Cultures IV. Washington DC: ASM Press 2005.
  2. Clinical and Laboratory Standards Institute. Principles and procedures for blood culture. Approved guideline. Document M47-A. Wayne, PA: Clinical and Laboratory Standards Institute; 2007.
  3. Snyder SR, Favoretto AM, Baetz RA, Derzon JH, Madison BM, Mass D, et al. Effectiveness of practices to reduce blood culture contamination: a Laboratory Medicine Best Practices systematic review and meta-analysis. Clin Biochem 2012;45: 999-1011. https://doi.org/10.1016/j.clinbiochem.2012.06.007
  4. Lin CM, Lee WS, Lin FY, Yu FL, Ou TY, Teng SO. Reducing blood culture contamination rates by educational intervention and one-on-one feedback in the emergency department. J Exp Clin Med 2012;4:154-6. https://doi.org/10.1016/j.jecm.2012.04.005
  5. Self WH, Speroff T, McNaughton CD, Wright PW, Miller G, Johnson JG, et al. Blood culture collection through peripheral intravenous catheters increases the risk of specimen contamination among adult emergency department patients. Infect Control Hosp Epidemiol 2012;33:524-6. https://doi.org/10.1086/665319
  6. Stohl S, Benenson S, Sviri S, Avidan A, Block C, Sprung CL, et al. Blood cultures at central line insertion in the intensive care unit: comparison with peripheral venipuncture. J Clin Microbiol 2011;49:2398-403. https://doi.org/10.1128/JCM.02546-10
  7. Kim NH, Kim M, Lee S, Yun NR, Kim KH, Park SW, et al. Effect of routine sterile gloving on contamination rates in blood culture: a cluster randomized trial. Ann Intern Med 2011;154:145-51. https://doi.org/10.7326/0003-4819-154-3-201102010-00003
  8. Schifman RB, Strand CL, Meier FA, Howanitz PJ. Blood culture contamination: a College of American Pathologists Q-Probes study involving 640 institutions and 497134 specimens from adult patients. Arch Pathol Lab Med 1998;122: 216-21.
  9. Gander RM, Byrd L, DeCrescenzo M, Hirany S, Bowen M, Baughman J. Impact of blood cultures drawn by phlebotomy on contamination rates and health care costs in a hospital emergency department. J Clin Microbiol 2009;47:1021-4. https://doi.org/10.1128/JCM.02162-08
  10. Weightman NC, Kerr KG. Blood culture contamination: having your cake and eating it. J Hosp Infect 2012;80:101-2. https://doi.org/10.1016/j.jhin.2011.08.023
  11. Hopkins K, Huynh S, McNary C, Walker A, Nixon R, Craighead JE. Reducing blood culture contamination rates: a systematic approach to improving quality of care. Am J Infect Control 2013;41:1272-4. https://doi.org/10.1016/j.ajic.2013.02.019
  12. Harding AD, Bollinger S. Reducing blood culture contamination rates in the emergency department. J Emerg Nurs 2013;39:e1-e6. https://doi.org/10.1016/j.jen.2012.10.009
  13. Dawson S. Blood culture contaminants. J Hosp Infect 2014; 87:1-10. https://doi.org/10.1016/j.jhin.2014.02.009
  14. Youssef D, Shams W, Bailey B, O'Neil TJ, Al-Abbadi MA. Effective strategy for decreasing blood culture contamination rates: the experience of a Veterans Affairs Medical Centre. J Hosp Infect 2012;81:288-91. https://doi.org/10.1016/j.jhin.2012.05.014
  15. Hall KK, Lyman JA. Updated review of blood culture contamination. Clin Microbiol Rev 2006;19:788-802. https://doi.org/10.1128/CMR.00062-05
  16. American Academy of Pediatrics. Staphylococcal Infections. In: Pickering LK, Baker CJ, Kimberlin DW, Long SS, eds. Red $Book^{(R)}$: 2012 Report of the committee on infectious diseases. American Academy of Pediatrics 2012; 653-68.
  17. Kerur B, Salvador A, Arbeter A, Schutzman DL. Neonatal blood cultures: survey of neonatologists' practices. World J Pediatr 2012;8:260-2. https://doi.org/10.1007/s12519-012-0368-y
  18. Weinstein MP. Current blood culture methods and systems: clinical concepts, technology, and interpretation of results. Clin Infect Dis 1996;23:40-6. https://doi.org/10.1093/clinids/23.1.40
  19. Pavlovsky M, Press J, Peled N, Yagupsky P. Blood culture contamination in pediatric patients: young children and young doctors. Pediatr Infect Dis J 2006;25:611-4. https://doi.org/10.1097/01.inf.0000220228.01382.88
  20. Min H, Park CS, Kim DS, Kim KH. Blood culture contamination in hospitalized pediatric patients: a single institution experience. Korean J Pediatr 2014;57:178-85. https://doi.org/10.3345/kjp.2014.57.4.178

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