Download PDF
Anästhesiol Intensivmed Notfallmed Schmerzther 2015; 50(2): 124-131
DOI: 10.1055/s-0041-100441
Fachwissen
Intensivmedizin: Topthema
© Georg Thieme Verlag Stuttgart · New York

Sepsis und Multiorganversagen – Blutkulturdiagnostik: Herausforderung oder Routine?

Blood culture diagnostic – Challenge or routine standard of care?
Robin Köck
,
Frank Kipp
,
Björn Ellger
Further Information

Publication History

Publication Date:
27 February 2015 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Die Untersuchung von Blutkulturen gehört zu den wichtigsten Elementen der Sepsisdiagnostik. Dennoch weisen Daten aus verschiedenen Studien darauf hin, dass im Vergleich zu anderen Ländern die Abnahmefrequenz von Blutkulturen in deutschen Krankenhäusern relativ gering ist. Mögliche Gründe hierfür könnten in der Wahrnehmung der Kliniker liegen, dass die Ergebnisse einer Blutkulturdiagnostik zu spät vorliegen oder, dass hohe Kontaminationsraten deren Aussagekraft einschränken. In diesem Artikel werden deshalb die wichtigsten Aspekte zur Qualitätssicherung der Blutkulturdiagnostik zusammengefasst, sowie innovative Ansätze vorgestellt.

Abstract

Blood cultures are an essential diagnostic tool to investigate suspected cases of sepsis. However, several studies indicate that (compared with other countries) blood culture diagnostics is only rarely performed in German healthcare facilities. Reasons for this are unknown, but could include clinicians' perception that the turn-around time of results is delayed or that contamination rates are high. Therefore, this article aims to summarize important aspects involved in assuring quality of blood culture diagnostics as well as innovative approaches.

Kernaussagen

Schlüsselwörter

Sepsis - Blutkultur - Diagnostik - Mikrobiologie

Key words

Sepsis - blood culture - diagnostics - microbiology

Ergänzendes Material

 

  • Literaturverzeichnis

  • 1 Wacker C, Prkno A, Brunkhorst FM et al. Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis. Lancet Infect Dis 2013; 13: 426-435
    CrossrefPubMedGoogle Scholar
  • 2 Engel C, Brunkhorst FM, Bone HG et al. Epidemiology of sepsis in Germany: results from a national prospective multicenter study. Intensive Care Med 2007; 33: 606-618
    CrossrefPubMedGoogle Scholar
  • 3 Kumar A, Ellis P, Arabi Y et al. Initiation of inappropriate antimicrobial therapy results in a fivefold reduction of survival in human septic shock. Chest 2009; 136: 1237-1248
    CrossrefPubMedGoogle Scholar
  • 4 de With K, Allerberger F, Amann S et al. S3 Leitlinie: Strategien zur Sicherung rationaler Antibiotika-Anwendung im Krankenhaus. AWMF 2013; Registernummer 092/001, Version 15.12.2013.
    PubMedGoogle Scholar
  • 5 Seifert H, Abele-Horn M, Fätkenheuer G et al. MiQ 3a und 3b: Blutkulturdiagnostik – Sepsis, Endokarditis, Katheterinfektionen (Teil I und Teil II). München: Elsevier; 2007
    Google Scholar
  • 6 Clinical and Laboratory Standards Institute (CLSI). Principles and procedures for blood cultures; approved guideline. CLSI document M47-A. 2007;
    PubMedGoogle Scholar
  • 7 Hansen S, Schwab F, Behnke M et al. National influences on catheter-associated bloodstream infection rates: practices among national surveillance networks participating in the European HELICS project. J HospInfect 2009; 71: 66-73
    PubMedGoogle Scholar
  • 8 Gastmeier P, Schwab F, Behnke M et al. Wenige Blutkulturproben – wenige Infektionen?. Anaesthesist 2011; 60: 902-907
    CrossrefPubMedGoogle Scholar
  • 9 European Centre for Disease Prevention and Control. Antimicrobial resistance surveillance in Europe 2010. Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net). ECDC Stockholm 2011;
    PubMedGoogle Scholar
  • 10 Schmitz RP, Keller PM, Baier M et al. Quality of blood culture testing – a survey in intensive care units and microbiological laboratories across four European countries. Crit Care 2013; 17
    PubMedGoogle Scholar
  • 11 Fahr AM, Eigner U, Shah PM. Einfluss der verzögerten Transportdauer bei Raumtemperatur auf die Rate der falsch negativen Blutkulturen im BACTEC™ 9000 Gerät. J Lab Med 2005; 29: 130-135
    PubMedGoogle Scholar
  • 12 Kullberg BJ, Verweij PE, Akova M et al. European expert opinion on the management of invasive candidiasis in adults. ClinMicrobiol Infect 2011; 17 (Suppl. 05) 1-12
    PubMedGoogle Scholar
  • 13 Pappas PG, Kauffman CA, Andes D et al. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 2009; 48: 503-535
    CrossrefPubMedGoogle Scholar
  • 14 Köck R, Eissing LC, Boschin MG et al. Evaluation of bactec mycosis IC/F and Plus Aerobic/F blood culture bottles for detection of Candida in the presence of antifungal agents. J ClinMicrobiol 2013; 51: 3683-3687
    PubMedGoogle Scholar
  • 15 Willems E, Smismans A, Cartuyvels R et al. The preanalytical optimization of blood cultures: a review and the clinical importance of benchmarking in 5 Belgian hospitals. DiagnMicrobiolInfect Dis 2012; 73: 1-8
    PubMedGoogle Scholar
  • 16 Reinhart K, Bunkhorst FM, Bone HG et al. Prävention, Diagnose, Therapie und Nachsorge der Sepsis: 1. Revision der S-2k Leitlinien der Deutschen Sepsis-Gesellschaft e.V. (DSG) und der Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin (DIVI). Stuttgart: Thieme; 2010
    Google Scholar
  • 17 Souvenir D, Anderson Jr. DE, Palpant S et al. Blood cultures positive for coagulase-negative staphylococci: antisepsis, pseudobacteremia, and therapy of patients. J ClinMicrobiol 1998; 36: 1923-1926
    PubMedGoogle Scholar
  • 18 Lee CC, Lin WJ, Shih HI et al. Clinical significance of potential contaminants in blood cultures among patients in a medical center. MicrobiolImmunol Infect 2007; 40: 438-444
    PubMedGoogle Scholar
  • 19 Dawson S. Blood culture contaminants. J Hosp Infect 2014; 87: 1-10
    CrossrefPubMedGoogle Scholar
  • 20 Kim NH, Kim M, Lee S et al. Effect of routine sterile gloving on contamination rates in blood culture: a cluster randomized trial. Ann Intern Med 2011; 154: 145-151
    CrossrefPubMedGoogle Scholar
  • 21 Self WH, Mickanin J, Grijalva CG et al. Reducing blood culture contamination in community hospital emergency departments: a multicenter evaluation of a quality improvement intervention. AcadEmerg Med 2014; 21: 274-282
    PubMedGoogle Scholar
  • 22 van der Velden LB, Vos FJ, Mouton JW et al. Clinical impact of preincubation of blood cultures at 37 degrees C. J ClinMicrobiol 2011; 49: 275-280
    PubMedGoogle Scholar
  • 23 Lemming L, Holt HM, Petersen IS et al. Bactec 9240 blood culture system: to preincubate at 35 degrees C or not?. ClinMicrobiol Infect 2004; 10: 1089-1091
    CrossrefPubMedGoogle Scholar
  • 24 Seegmuller I, Eschenbach U, Kamereck K et al. Sensitivity of the BacT/ALERT FA-medium for detection of Pseudomonas aeruginosa in pre-incubated blood cultures and its temperature-dependence. J Med Microbiol 2004; 53: 869-874
    CrossrefPubMedGoogle Scholar
  • 25 Schwetz I, Hinrichs G, Reisinger EC et al. Delayed processing of blood samples influences time to positivity of blood cultures and results of Gram stain-acridine orange leukocyte Cytospin test. J ClinMicrobiol 2007; 45: 2691-2694
    PubMedGoogle Scholar
  • 26 Sautter RL, Bills AR, Lang DL et al. Effects of delayed-entry conditions on the recovery and detection of microorganisms from BacT/ALERT and BACTEC blood culture bottles. J ClinMicrobiol 2006; 44: 1245-1249
    PubMedGoogle Scholar
  • 27 Akan OA, Yildiz E. Comparison of the effect of delayed entry into 2 different blood culture systems (BACTEC 9240 and BacT/ALERT 3D) on culture positivity. DiagnMicrobiol Infect Dis 2006; 54: 193-196
    PubMedGoogle Scholar
  • 28 Bengtsson J, Wahl M, Larsson P. Assessment of the BacT/Alert blood culture system: rapid bacteremia diagnosis with loading throughout the 24 h. ClinMicrobiol Infect 1998; 4: 33-37
    CrossrefPubMedGoogle Scholar
  • 29 Kerremans JJ, van der Bij AK, Goessens W et al. Immediate incubation of blood cultures outside routine laboratory hours of operation accelerates antibiotic switching. J ClinMicrobiol 2009; 47: 3520-3523
    PubMedGoogle Scholar
  • 30 Wieser A, Schneider L, Jung J et al. MALDI-TOF MS in microbiological diagnostics-identification of microorganisms and beyond (mini review). ApplMicrobiolBiotechnol 2012; 93: 965-974
    PubMedGoogle Scholar
  • 31 Chen JH, Ho PL, Kwan GS et al. Direct bacterial identification in positive blood cultures by use of two commercial matrix-assisted laser desorption ionization-time of flight mass spectrometry systems. J ClinMicrobiol 2013; 51: 1733-1739
    PubMedGoogle Scholar
  • 32 Loonen AJ, Wolffs PF, Bruggeman CA et al. Developments for improved diagnosis of bacterial bloodstream infections. Eur J ClinMicrobiol Infect Dis 2014;
    PubMedGoogle Scholar
  • 33 Hrabak J, Chudackova E, Walkova R. Matrix-assisted laser desorption ionization-time of flight (maldi-tof) mass spectrometry for detection of antibiotic resistance mechanisms: from research to routine diagnosis. ClinMicrobiol Rev 2013; 26: 103-114
    PubMedGoogle Scholar
  • 34 Loonen AJ, de Jager CP, Tosserams J et al. Biomarkers and molecular analysis to improve bloodstream infection diagnostics in an emergency care unit. PLoS One 2014; 9
    PubMedGoogle Scholar
  • 35 Skvarc M, Stubljar D, Rogina P et al. Non-culture-based methods to diagnose bloodstream infection: Does it work?. European journalofmicrobiology &immunology 2013; 3: 97-104
    PubMedGoogle Scholar
  • 36 Chang SS, Hsieh WH, Liu TS et al. Multiplex PCR system for rapid detection of pathogens in patients with presumed sepsis - a systemic review and meta-analysis. PLoSOne 2013; 8
    PubMedGoogle Scholar
  • 37 Weston VC, Jones AC, Bradbury N et al. Clinical features and outcome of septic arthritis in a single UK Health District 1982-1991. Annalsoftherheumaticdiseases 1999; 58: 214-219
    PubMedGoogle Scholar
  • 38 Garcia-Porrua C, Gonzalez-Gay MA, Ibanez D et al. The clinical spectrum of severe septic bursitis in northwestern.
    PubMedGoogle Scholar