Inefficiency in 6-Set Requests for Blood Culture Analysis of Cancer Patients with the Central Venous Catheter

Dong-Hyun Lee; Eun-ha Koh; Sunjoo Kim; In-Gyu Bae; Hoon-gu Kim; Myoung-hee Kang

doi:10.3343/lmo.2013.3.3.155

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Lee, Koh, Kim, Bae, Kim, and Kang: Inefficiency in 6-Set Requests for Blood Culture Analysis of Cancer Patients with the Central Venous Catheter

Original Article

Clinical Microbiology

Laboratory Medicine Online 2013; 3(3): 155-159.

Published online: 1 July 2013

DOI: https://doi.org/10.3343/lmo.2013.3.3.155

Inefficiency in 6-Set Requests for Blood Culture Analysis of Cancer Patients with the Central Venous Catheter

Dong-Hyun Lee, M.D.^1,³, Eun-ha Koh, M.D.^1,³, Sunjoo Kim, M.D.^1,³, In-Gyu Bae, M.D.², Hoon-gu Kim, M.D.², Myoung-hee Kang, M.D.²

¹Department of Laboratory Medicine, Gyeongsang National University School of Medicine, Jinju, Korea.

²Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea

³Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea.

Corresponding author: Sunjoo Kim, M.D. Department of Laboratory Medicine, Gyeongsang National University School of Medicine, 79 Gangnam-ro, Jinju 660-702, Korea. Tel: +82-55-750-8239, Fax: +82-55-762-2696, sjkim8239@hanmail.net

Received 17 August 2012 Revised 26 September 2012 Accepted 26 September 2012

(open-access):

This is anOpen Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

A central venous catheter (CVC) is commonly used for administering chemotherapy to cancer patients. The institutional guideline of the Gyeongsang National University Hospital (GNUH) for blood culture analysis of indwelling CVC patients recommended 6 sets (2 from the periphery and 4 from each lumen). We analyzed the usefulness of this guideline, because complying with this recommendation requires an abundant amount of the sample and it is both inconvenient and expensive.

Methods

Adult patients (age: ≥18 yr old) who were admitted to the cancer center of GNUH between January 2011 and April 2012 were requested to have their blood culture analysis done. The positive rate, contamination rate, and distribution of microorganisms were compared according to the number of requested sets. The positive results of the stipulated 6 sets were analyzed.

Results

A total of 5,263 blood cultures were analyzed during the study period; of them, 74.4% were requests of 2 sets and 20.0% were requests of 6 sets. The positive rates in 2 set requests and 6 set requests were 8.0% and 14.3%, respectively (P<0.001). The requests for 6 sets were repeated about 5 times. All 6 sets showed positive in 16 cases (9.1%), whereas a part of the 6 sets was positive in 18 cases (10.3%).

Conclusions

Although the positive rate was relatively high in the 6 set-requested groups, they had to be repeatedly requested. Microbial growth in a part of the 6-set requests was observed in a very small proportion (10.3%) of the patients, indicating that the benefit of blood culture of 6 sets is very low.

Keywords: Cancer, Sepsis, Central venous catheter, Blood culture

Figures and Tables

Table 1

Positive rate and contamination rate in blood cultures analyzed with respect to the requested frequency of blood cultures in the cancer center

^*The positive rates between 2 and 6 times of blood cultures were significantly different (P<0.001), while the contamination rates were not (P=0.051).

Table 2

Comparison of the isolates in blood cultures requested 1-2 times and 3-6 times in the cancer center

^*Frequency of gram-positive bacteria, gram-negative bacteria, and yeasts between 1-2 times and 3-6 times of cultures was significantly different (P<0.001).

Table 3

Organisms isolated from all 6 set requests of blood culture

^*Two patients continued to be positive for K. pneumoniae.

Table 4

Organisms isolated from a part of the 6-set requests of blood culture

^*Number of sets grown with organisms among the 6 sets; ^†Comma (,) indicates the same patient, and dash (/) means the different patient.

Notes

This article is available from http://www.labmedonline.org

References

1. Chatzinikolaou I, Hanna H, Darouiche R, Samonis G, Tarrand J, Raad I. Prospective study of the value of quantitative culture of organisms from blood collected through central venous catheters in differentiating between contamination and bloodstream infection. J Clin Microbiol. 2006; 44:1834–1835.

2. CLSI. Clinical and laboratory standards institute. M47-A. Principles and procedures for blood cultures; approved guideline. Wayne, PA: Clinical and laboratory standards institute;2007.

3. Shin JH, Song SA, Kim MN, Lee NY, Kim EC, Kim SJ, et al. Comprehensive analysis of blood culture performed at nine university hospitals in Korea. Korean J Lab Med. 2011; 31:101–106.

4. Mylotte JM, Tayara A. Blood cultures: clinical aspects and controversies. Eur J Clin Microbiol Infect Dis. 2000; 19:157–163.

5. Lee A, Mirrett S, Reller LB, Weinstein MP. Detection of bloodstream infections in adults: how many blood cultures are needed? J Clin Microbiol. 2007; 45:3546–3548.

6. Shin JH, Song SA, Kim MN, Kim S. Nationwide survey of blood culture performance regarding skin disinfection, blood collection and laboratory procedures. Korean J Clin Microbiol. 2011; 14:91–96.

7. Robinson JL. Sensitivity of a blood culture drawn through a single lumen of a multilumen, long-term, indwelling, central venous catheter in pediatric oncology patients. J Pediatr Hematol Oncol. 2002; 24:72–74.

8. Velasco E, Byington R, Martins CA, Schirmer M, Dias LM, Gonçalves VM. Prospective evaluation of the epidemiology, microbiology, and outcome of bloodstream infections in hematologic patients in a single cancer center. Eur J Clin Microbiol Infect Dis. 2003; 22:137–143.

9. Maschmeyer G, Noskin GA, Ribaud P, Sepkowitz KA. Changing patterns of infections and antimicrobial susceptibilities. Oncology. 2000; 14:9–16.

10. Rolston KV. The Infectious Diseases Society of America 2002 guidelines for the use of antimicrobial agents in patients with cancer and neutropenia: salient features and comments. Clin Infect Dis. 2004; 39:Suppl 1. S44–S48.

11. Scheinemann K, Ethier MC, Dupuis LL, Richardson SE, Doyle J, Allen U, et al. Utility of peripheral blood cultures in bacteremic pediatric cancer patients with a central line. Support Care Cancer. 2010; 18:913–919.

12. Guembe M, Rodríguez-Créixems M, Sánchez-Carrillo C, Pérez-Parra A, Martín-Rabadán P, Bouza E. How many lumens should be cultured in the conservative diagnosis of catheter-related bloodstream infections? Clin Infect Dis. 2010; 50:1575–1579.

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