title: Deficits in knowledge, attitude, and practice towards blood culture sampling: results of a nationwide mixed-methods study among inpatient care physicians in Germany.
abstract: OBJECTIVE
  Blood culture (BC) sampling rates in Germany are considerably lower than recommended. Aim of our study was to assess knowledge, attitudes, and practice of physicians in Germany regarding BC diagnostics.
  
  
  METHODS
  We conducted a cross-sectional mixed-methods study among physicians working in inpatient care in Germany. Based on the results of qualitative focus groups, a questionnaire-based quantitative study was conducted in 2015-2016. In total, 706 medical doctors and final-year medical students from 11 out of 16 federal states in Germany participated.
  
  
  RESULTS
  BC sampling was considered an important diagnostic tool by 95% of the participants. However, only 23% of them would collect BCs in three scenarios for which BC ordering is recommended by present guidelines in Germany; almost one out of ten physicians would not have taken blood cultures in any of the three scenarios. The majority of participants (74%) reported not to adhere to the guideline recommendation that blood culture sampling should include at least two blood culture sets from two different injection sites. High routine in blood culture sampling, perceived importance of blood culture diagnostics, the availability of an in-house microbiological lab, and the department the physician worked in were identified as predictors for good blood culture practice.
  
  
  CONCLUSIONS
  Our study suggests that there are substantial deficits in BC ordering and the application of guidelines for good BC practice in Germany. Based on these findings, multimodal interventions appear necessary for improving BC diagnostics.
authors.affiliation: ESME - Epidemiological and Statistical Methods Research Group, Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124, Brunswick, Germany.
authors.forename: Heike
authors.identifier: http://orcid.org/0000-0002-8372-3911
authors.initials: H
authors.lastname: Raupach-Rosin
authors.affiliation: ESME - Epidemiological and Statistical Methods Research Group, Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124, Brunswick, Germany.
authors.forename: Arne
authors.initials: A
authors.lastname: Duddeck
authors.affiliation: ESME - Epidemiological and Statistical Methods Research Group, Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124, Brunswick, Germany.
authors.forename: Maike
authors.initials: M
authors.lastname: Gehrlich
authors.affiliation: ESME - Epidemiological and Statistical Methods Research Group, Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124, Brunswick, Germany.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Helmke
authors.affiliation: Division of Pediatric Infectious Diseases, Dr. Von Hauner Children's Hospital, Ludwig Maximilian University Munich, Munich, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Huebner
authors.affiliation: Center for Infectious Diseases and Infection Control, Jena University Hospital, Erlanger Allee 101, 07747, Jena, Germany.
authors.forename: Mathias W
authors.initials: MW
authors.lastname: Pletz
authors.affiliation: ESME - Epidemiological and Statistical Methods Research Group, Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124, Brunswick, Germany.|German Center for Infection Research (DZIF), Hannover-Braunschweig Site, 30625, Hannover, Germany.|Institute for Medical Epidemiology, Biometry, and Informatics (IMEBI), Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle, Germany.
authors.forename: Rafael
authors.initials: R
authors.lastname: Mikolajczyk
authors.affiliation: ESME - Epidemiological and Statistical Methods Research Group, Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124, Brunswick, Germany. andre.karch@helmholtz-hzi.de.|German Center for Infection Research (DZIF), Hannover-Braunschweig Site, 30625, Hannover, Germany. andre.karch@helmholtz-hzi.de.
authors.forename: André
authors.initials: A
authors.lastname: Karch
mesh_terms: D001291:Attitude of Health Personnel; D000071997:Blood Culture; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D010820:Physicians / Q000523:psychology*
keywords: Blood culture; Bloodstream infection; Focus groups; KAP survey; Sepsis