How reliable is a negative blood culture result? Volume of blood submitted for culture in routine practice in a children's hospital.
OBJECTIVE
The primary aims of this study were to determine the volume of blood submitted for culture in routine clinical practice and to establish the proportion of blood cultures with a blood volume inadequate for reliable detection of bacteremia.


METHODS
The volumes of blood samples submitted for culture from infants and children up to 18 years of age were measured over a 6-month period. Blood cultures were deemed adequate submissions if they contained an appropriate (age-related) volume of blood and were submitted in the correct blood culture bottle type. During the study, an educational intervention designed to increase the proportion of adequate blood culture submissions was undertaken.


RESULTS
The volume of blood submitted in 1358 blood culture bottles from 783 patients was analyzed. Of the 1067 preintervention blood cultures, 491 (46.0%) contained an adequate blood volume and only 378 (35.4%) were adequate submissions on the basis of collection into the correct blood culture bottle type. After the intervention, there were significant increases in both the proportion of blood cultures containing an adequate blood volume (186 [63.9%] of 291 cultures) and the proportion of adequate submissions (149 [51.2%] of 291 cultures). Overall, blood cultures with an adequate blood volume were more likely than those with an inadequate blood volume to yield positive blood culture results (34 [5.2%] of 655 cultures vs 14 [2.1%] of 648 cultures). Similarly, adequate blood culture submissions were more likely than inadequate submissions to yield positive blood culture results (26 [5.1%] of 506 cultures vs 22 [2.8%] of 797 cultures).


CONCLUSIONS
In routine clinical practice, a negative blood culture result is almost inevitable for a large proportion of blood cultures because of the submission of an inadequate volume of blood. Even after an educational intervention, nearly one half of blood cultures were inadequate submissions.
Connell
Thomas G
TG
Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, Australia.
Rele
Mhisti
M
Cowley
Donna
D
Buttery
Jim P
JP
Curtis
Nigel
N
D000293:Adolescent; D016470:Bacteremia / Q000097:blood* / Q000175:diagnosis; D001431:Bacteriological Techniques / Q000379:methods / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D005188:False Negative Reactions; D006761:Hospitals / Q000592:standards*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn