• Diana M Verboom, Kirsten van de Groep, C H Edwin Boel, Pieter Jan A Haas, DerdeLennie P GLPGDepartment of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands., Olaf L Cremer, and BontenMarc J MMJMJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands.Department of Medical Microbiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
• Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands.
• Crit. Care Med. 2021 Jan 1; 49 (1): 60-69.

ObjectivesAlthough the Surviving Sepsis Campaign bundle recommends obtaining blood cultures within 1 hour of sepsis recognition, adherence is suboptimal in many settings. We, therefore, implemented routine blood culture collection for all nonelective ICU admissions (regardless of infection suspicion) and evaluated its diagnostic yield.DesignA before-after analysis.SettingA mixed-ICU of a tertiary care hospital in the Netherlands.PatientsPatients acutely admitted to the ICU between January 2015 and December 2018.Measurements And Main ResultsAutomatic orders for collecting a single set of blood cultures immediately upon ICU admission were implemented on January 1, 2017. Blood culture results and the impact of contaminated blood cultures were compared for 2015-2016 (before period) and 2017-2018 (after period). Positive blood cultures were categorized as bloodstream infection or contamination. Blood cultures were obtained in 573 of 1,775 patients (32.3%) and in 1,582 of 1,871 patients (84.5%) in the before and after periods, respectively (p < 0.0001), and bloodstream infection was diagnosed in 95 patients (5.4%) and 154 patients (8.2%) in both study periods (relative risk 1.5; 95% CI 1.2-2.0; p = 0.0006). The estimated number needed to culture for one additional patient with bloodstream infection was 17. Blood culture contamination occurred in 40 patients (2.3%) and 180 patients (9.6%) in the before period and after period, respectively (relative risk 4.3; 95% CI 3.0-6.0; p < 0.0001). Rate of vancomycin use or presumed episodes of catheter-related bloodstream infections treated with antibiotics did not differ between both study periods.ConclusionsImplementation of routine blood cultures was associated with a 1.5-fold increase of detected bloodstream infection. The 4.3-fold increase in contaminated blood cultures was not associated with an increase in vancomycin use in the ICU.Copyright © 2020 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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