Sepsis & Septic Shock

Contamination of Blood Cultures from Arterial Catheters and Peripheral Venipuncture in Critically Ill Patients

Blood cultures are crucial for detecting life-threatening bacteremia in critically ill patients. Contaminated blood cultures can lead to inappropriate antibiotic use, longer hospital stays, increased costs, and antimicrobial resistance risks. Strategies to reduce contamination include separate venipuncture sites or well-trained phlebotomy teams. In critically ill patients, using indwelling arterial catheters for blood culture collection is attractive due to reliable sampling and reduced invasiveness. Nakayama et al. conducted a multicenter trial comparing blood culture contamination rates between arterial catheters and peripheral venipuncture (0.3 vs 0.7%). The study found that obtaining cultures from arterial catheters is an acceptable alternative to venipuncture in critically ill adults with suspected bloodstream infections. More research is needed to consider other settings and patient groups.

Perspective:

The study by Nakayama et al. provides valuable insights into the use of arterial catheters as an alternative method for blood culture collection in critically ill adult patients. The findings support the non-inferiority of contamination rates between arterial catheters and peripheral venipuncture, indicating that arterial catheters can be a reliable option when venipuncture is challenging. However, there are certain limitations to consider, including potential selection bias due to the exclusion of some cultures, and the need for further investigations in different settings and patient populations. Overall, this study highlights the importance of considering alternative methods for blood culture sampling, which may improve patient care and reduce contamination risks in critically ill individuals.

Nakayama I, Izawa J, Gibo K, Murakami S, Akiyama T, Kotani Y, Katsurai R, Kishihara Y, Tsuchida T, Takakura S, Takayama Y, Narita M, Shiiki S. Contamination of Blood Cultures From Arterial Catheters and Peripheral Venipuncture in Critically Ill Patients: A Prospective Multicenter Diagnostic Study. Chest. 2023 Jul;164(1):90-100. doi: 10.1016/j.chest.2023.01.030. Epub 2023 Jan 30. PMID: 36731787. Link to the article