Original Title: Utilisation judicieuse des hémocultures

Authors' objectives: Blood cultures are used to detect and identify microorganisms in the blood and to determine their susceptibility to anti-infectives. They play a major role among microbiological tests, since the presence of pathogenic agents in the blood has a direct impact on morbidity and the risk of death. Reportedly, in practice, most blood cultures are negative, and those that are positive are sometimes contaminated. There are, therefore, various concerns, particularly with regard to the clinical context in which they are ordered and the blood sampling method used. The Direction de la biovigilance et de la biologie médicale at the Ministère de la Santé et des Services sociaux therefore asked the Institut national d’excellence en santé et en services sociaux to draw up clinical recommendations in order to optimize and harmonize blood culture practices.

Authors' results and conclusions: RESULTS: Upon the completion of the data analysis and the iterative process carried out with the advisory committee’s members, the following key findings and messages were considered to be helpful for optimizing blood culture practices. (#1 INITIAL BLOOD CULTURE REQUEST): In order for blood culture requests to be made in an appropriate clinical context, the decision regarding such a request should take into account the entire clinical picture, not only the mere presence of fever. Given the importance of the blood culture result for the prognosis, it is preferable to order blood cultures upon the least suspicion of bacteremia than to put off ordering them or to no order any at all. (#2 BLOOD SPECIMENS): The blood sampling method has an impact on the diagnostic value of blood cultures. Although these specimens should be obtained before specimens for other tests, the timely initiation of antibiotic therapy is the priority. Special attention should be given to prepping the skin and to the total amount of blood drawn. When all the requirements for a proper blood draw cannot be met, clinical judgment should be used to strike a balance between good blood draw practices and the downsides for the patient. (#3 FOLLOW-UP): In general, follow-up blood cultures are not necessary when the person’s clinical status improves, except in the context of Staphylococcus aureus bacteremia, candidemia and a few other conditions. In order for follow-up blood cultures to be ordered in an appropriate clinical context, the decision to order or not order blood cultures should be based on an assessment of the entire clinical picture, and the first request should be made 48 to 72 hours after initiating antibiotic therapy or upon receiving the results of the initial blood cultures if there are concerns about them. Furthermore, no additional requests should be made if blood cultures are presently being incubated. (#4 ENVIRONMENTAL ISSUES): The use of blood culture requests in the appropriate clinical context is part of a broader view of the responsible use of diagnostic tests and of an ecologically sustainable healthcare system. Responsible blood culture use can be fostered by following the recommendations in this report. Separating blood cultures from a septic workup request could also be an avenue to explore. CONCLUSION: Blood cultures are useful in the initial workup for certain clinical conditions and sometimes need to be repeated during the follow-up. To maximize their diagnostic value, blood culture should be ordered in the appropriate clinical context, and the blood specimens should be obtained properly. While not a substitute for clinical judgment, this work should foster more judicious blood culture use and thereby promote responsible resource utilization and the benefits for patients and the environment. The potential impact will, however, depend on the dissemination of the clinical tool stemming from this report and on the uptake of the clinical data and the recommendations by the health professionals concerned. In this regard, different avenues were suggested by the stakeholders to support the implementation of the recommendations in practice.

Authors' recommendations: Following the iterative process with the advisory committee’s members, during which the clinical data and recommendations from the literature, the contextual information and the perspectives of different stakeholders were triangulated, a series of findings and recommendations were drawn up. At the core of this report, these recommendations have also been incorporated into the decision support tool created in this project, which tool is intended primarily for physicians and nurses.

Authors' methods: Two systematic reviews of publications containing clinical information or recommendations were carried out in collaboration with a scientific information consultant (librarian) to document the best clinical practices. The literature searches were conducted in the following databases: MEDLINE, Embase and EBM Reviews - Cochrane Database of Systematic Reviews. A manual literature search was performed as well by consulting, among other things, the websites of specialized learned societies and health technology assessment agencies in areas relating to the topic of interest. Document selection, data extraction and the assessment of the methodological quality of the selected documents were carried out independently by two scientific professionals. The clinical recommendations drafted are based on an assessment of the data, positions and recommendations in the literature, the stakeholders’ perspectives, and contextual information specific to Québec. An advisory committee consisting of clinicians from different specialties and areas of expertise was used to gather the stakeholders’ perspectives and the contextual information. Lastly, the overall quality of the work, its acceptability and its applicability were assessed by external reviewers and key informers who are specialists in the field of interest and by future users who did not participate in the project.

Authors' identified further research: The advisability of updating the recommendations will be determined in four years from the date of publication on the basis of the advances in scientific data, the clinical practice changes, and the health and social services system’s needs in terms of future work concerning blood cultures.

Project Status: Completed

URL for project: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/utilisation-judicieuse-des-hemocultures.html

Year Published: 2024

URL for published report: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/utilisation-judicieuse-des-hemocultures.html

English language abstract: An English language summary is available

Publication Type: Other

Country: Canada

Province: Quebec

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: L'Institut national d'excellence en sante et en services sociaux (INESSS)