PERİFERİK KAN KÜLTÜRÜ VE YÖNETİMİ

Yıl 2017, Cilt: 33 Sayı: 2, 153 - 162, 27.12.2017

Seda Ardahan Sevgili Figen Yardımcı

Öz

Başlık: PERİFERİK KAN KÜLTÜRÜ VE YÖNETİMİ

Title: PERIPHERAL
BLOOD CULTURE AND MANAGEMENT

Özet: Kan
dolaşımı enfeksiyonları; enfeksiyona neden olan mikroorganizma ile etkilediği
canlı arasında birçok etkileşim sonucunda meydana gelen ve oldukça karmaşık bir
süreçtir. Bundan dolayı kan dolaşımı enfeksiyonlarının erken dönemde
tanılanması ve tanısına yönelik tedavisinin başlatılması yaşamsal önem
taşımaktadır. Kan kültürleri; ciddi kan dolaşımı enfeksiyonlarının tanımlanması
ve uygun antimikrobiyal tedavinin seçiminde kullanılan tanılama testlerinin en
önemlisidir. Teknolojinin gelişmesiyle birlikte, her geçen gün tanı ve tedavi
tekniklerinde yeni gelişmeler olmaktadır, ancak; bakteriyemi ve fungeminin
tespitinde kan kültürleri hala en uygun teknik olma niteliğini sürdürmektedir. Periferik kan kültürü alımı yaparken sağlık
çalışanlarının dikkat etmesi gereken durumlardan biri deri kontaminasyonuna
bağlı yalancı-pozitif kan kültürüdür. Yalancı-pozitif kan kültürlerinin hem
tedavi görmekte olan hastalar hem de sağlık sistemi açısından oldukça fazla
olumsuz etkisi bulunmaktadır. Test sonuçlarının yalancı-pozitif olduğu fark
edilmez ise, sağlık çalışanları tarafından aslında gerekli olmayan çok sayıda
tanı-tedavi yöntemi uygulanmak zorunda kalınmaktadır.

Abstract: Bloodstream
infection is a very complicated process that occurs as a result of many
interactions between the infecting microorganism and the living organism.
Therefore, it is essential to initiate early diagnosis of bloodstream
infections and treatment. Blood cultures are the most important diagnostic
tests used for identification of severe bloodstream infections and selection of
appropriate antimicrobial therapy. With the development of technology, there
are new developments in diagnosis and treatment techniques every passing day
but; blood cultures still remain the most appropriate technique for the detection
of bacteraemia and fungemia. One of the situations that health care workers
should be aware of when taking peripheral blood culture is a false-positive
blood culture due to skin contamination. False-positive blood cultures have
considerable negative effects on both the treated patients and the health
system. If it is not noticed that the test results are false-positive, a large
number of diagnostic and therapeutic methods that are not actually needed have
to be done by healthcare professionals. 

Anahtar kelimeler: yalancı-pozitif, kan dolaşımı enfeksiyonu,
enfeksiyon kontrolü

Keywords: false-positive,
bloodstream infection, infection control

Destekleyen kurumlar:

Kaynakça: 

Alahmadi YM, McElnay JC, Kearney MP ve ark. Tackling the
problem of blood culture contamination in the intensive care unit using an
educational intervention. Epidemiology&Infection 2015;143(9):1964-1971.

Bekeris LG, Tworek JA,
Walsh MK ve ark. Trends in blood culture contamination: a college of american
pathologists q-tracks study of 356 institutions. Archives of Pathology&Laboratory
Medicine 2005;129:1222–1225.

Boyce JM, Nadeau J,
Dumigan D ve ark. Obtaining blood cultures by venipuncture versus from central
lines: ımpact on blood culture contamination rates and potential effect on
central line–associated bloodstream infection reporting. Infection Control and
Hospital Epidemiology 2013;34(10):1042104-7.

Chang YT, Lin CY, Lu PL
ve ark. Stenotrophomonas maltophilia bloodstream infection: comparison between
community-onset and hospital-acquired infections. Journal of Microbiology,
Immunology and Infection 2014;47:28-35.

Clinical and Laboratory Standards Institute (CLSI). Principles And Procedures For Blood Cultures;
Approved Guideline. CLSI Document M47-A. Clinical & Laboratory Standards Institute 2007;27(17); [cited 2016 February 3]. Available frrom: http://shop.clsi.org/site/Sample_pdf/M47A_sample.pdf.

Cockerill FR III, Wilson JW, Vetter EA ve ark. Optimal testing parameters
for blood cultures. Clinical Infectious Disease 2004; 38(12):1724-1730.

Çiçek A. Kan kültür
sonuçlarının değerlendirilmesinde etkili olan faktörler. İnönü Üniversitesi Tıp
Fakültesi Dergisi 2005;12(4):277-280.

Çöloğlu D. Yalancı Pozitif Üreme Sinyali Veren Otomatize Kan Kültürü
Şişelerinde Polimeraz Zincir Reaksiyonu (Pzr) Yöntemi İle Bakteri ve Mantar
Varlığının Araştırılması. [Tıpta Uzmanlık Tezi]. Ankara: Ankara
Üniversitesi Tıp Fakültesi; 2012.

Gander RM, Byrd L,
DeCrescenzo M  ve ark. Impact of blood
cultures drawn by phlebotomy on contamination rates and health care costs in a
hospital emergency department. Journal of Clinical Microbiology
2009;47(4):1021-4

Gilligan PH. Blood culture contamination: a clinical and financial
burden. Infection Control&Hospital Epidemiology 2013;34(1):22-23.

Hall KK, Lyman JA. Updated review of blood culture contamination.
Clinical Microbiology Reviews 2006;19:788-802.

Harbarth S, Garbino J,
Pugin J ve ark. Inappropriate initial antimicrobial therapy and its effect on
survival in a clinical trial of immunomodulating therapy for severe sepsis.
American Journal of Medicine 2003;115:529-535.

Isenberg HD. Clinical Microbiology Procedures Handbook [e-book].
Washington, DC: ASM Press; 2004. [cited
2016 January 10]. Available from:  http://en.bookfi.net/book/1306334.

Lee A, Mirrett S, Reller LB ve ark. Detection of bloodstream infections
in adults: how many blood cultures are needed? Journal of Clinical Microbiology
2007;45(11):3546-3548.

Liu W, Duan Y, Cui W ve ark. Skin antiseptics in venous puncture
site disinfection for preventing blood culture contamination: a bayesian
network meta-analysis of randomized controlled trials. International Journal of
Nursing Studies 2016;59:156-162.

Maiwald M, Chan SY. Pitfalls in evidence assessment: the case of
chlorhexidine and alcohol in skin antisepsis. Journal of Antimicrobial
Chemotheraphy 2014;69(8):2017-2021.

Maiwald M, Chan SY. The forgotten role of alcohol: a systematic review
and meta-analysis of the clinical efficacy and perceived role of chlorhexidine
in skin antisepsis. PLoS One 2012;7(9):e44277.

Murphy T, Maile D,
Barsch T. Investigating the ımpact of blood culture bundles on the incidence of
blood culture contamination rates, The
Art And Science of Infusion Nursing 2014;37(3):205-210.

Murray PR, Masur H. Current approaches to the diagnosis of bacterial and
fungal bloodstream infections in the intensive care unit. Critical Care
Medicine 2012;40:3277-3282.

Murty DS, Gyaneshwari M. Blood cultures in
paediatric patients: a study of clinical impact. Indian Journal of Medical
Microbiology 2007;25(3):2022-2024.

Mylotte JM, Tayara A.
Blood culture: clinical aspects and controversies. European
Journal of Clinical Microbiology&Infectious Diseases
2000;19:157-163.

O’Connor C, Philip RK, Powell J ve ark. Combined education and skin
antisepsis intervention for persistently high blood-culture contamination rates
in neonatal intensive care. Journal of Hospital Infection 2016; 93(1):105-107.

Pavlovsky M, Press J,
Peled N ve ark. Blood culture contamination in pediatric patients: young
children and young doctors. The Pediatric Infectious Disease Journal
2006;25(7):611–614.

Pien BC, Sundaram P,
Raoof N ve ark.  The clinical and
prognostic importance of positive blood cultures in adults. The American
Journal of Medicine 2010;123(9):819-828.

Self HW,  Mickanin J, Grijalva CG ve
ark. Reducing blood culture contamination in community
hospital emergency departments: multicenter evaluation of a quality improvement
intervention, Academic Emergency
Medicine 2014;21(3):274–282.

Self HW, Speroff T,
McNaughton CD ve ark. Blood culture collection through peripheral intravenous
catheters increases the risk of specimen contamination among adult emergency
department patients. Infection Control and Hospital Epidemiology
2012;33(5):524-526. 

Singhal T. Blood cultures revisited. Pediatric Infectious Disease 2012;4(1):25–27.

Smith BA, Peterson LR. Best way to prevent
blood culture contamination. Medscape 2014 SHEA Expert commentaries.

Snyder JW. Blood cultures: The importance of
meeting pre-analytical requirements in reducing contamination, optimizing sensitivity
of detection, and clinical relevance, Clinical Microbiology Newsletter
2015;37(7):53-57.

Stonecypher K. Going around in circles. Critical Care Nursing 2009;32:94-98.

Taneja D, Finney J, Nagaishi K. A performance improvement project:
reducing emergency department blood culture contamination rate using six sigma
methodology. American Journal of Infection Control 2014; 42: 29-166

Towns ML, Jarvis WR, Hsueh P. Guidelines on blood cultures. journal of microbiology,
İmmunology anf Infection 2010;43(4):347-349.

Wanga P, Hub B.
Strategies on reducing blood culture contamination, Reviews in Medical
Microbiology 2012;(23):63–66.

Willock J, Richardson
J, Brazier
A
ve ark. Peripheral venepuncture in infants and children. Nursing Standard
2004;18(27):43-50.

Youssef
D, Shams W, Bailey B ve ark. Effective strategy for decreasing blood culture
contamination rates: the experience of a veterans affairs medical centre.
Journal of Hospital Infection 2012;81:288-291.

Zarbo RJ, Jones BA, Friedberg RC ve
ark. Q-tracks:
a College of American Pathologists program of continuous laboratory monitoring
and longitudinal tracking. Archives of Pathology& Laboratory Medicine
2002;126:1036-1044.

Anahtar Kelimeler

yalancı-pozitif, kan dolaşımı enfeksiyonu, enfeksiyon kontrolü

Kaynakça

• Alahmadi YM, McElnay JC, Kearney MP ve ark. Tackling the problem of blood culture contamination in the intensive care unit using an educational intervention. Epidemiology&Infection 2015;143(9):1964-1971.
• Bekeris LG, Tworek JA, Walsh MK ve ark. Trends in blood culture contamination: a college of american pathologists q-tracks study of 356 institutions. Archives of Pathology&Laboratory Medicine 2005;129:1222–1225.
• Boyce JM, Nadeau J, Dumigan D ve ark. Obtaining blood cultures by venipuncture versus from central lines: ımpact on blood culture contamination rates and potential effect on central line–associated bloodstream infection reporting. Infection Control and Hospital Epidemiology 2013;34(10):1042104-7.
• Chang YT, Lin CY, Lu PL ve ark. Stenotrophomonas maltophilia bloodstream infection: comparison between community-onset and hospital-acquired infections. Journal of Microbiology, Immunology and Infection 2014;47:28-35.
• Clinical and Laboratory Standards Institute (CLSI). Principles And Procedures For Blood Cultures; Approved Guideline. CLSI Document M47-A. Clinical & Laboratory Standards Institute 2007;27(17); [cited 2016 February 3]. Available frrom: http://shop.clsi.org/site/Sample_pdf/M47A_sample.pdf.
• Cockerill FR III, Wilson JW, Vetter EA ve ark. Optimal testing parameters for blood cultures. Clinical Infectious Disease 2004; 38(12):1724-1730.
• Çiçek A. Kan kültür sonuçlarının değerlendirilmesinde etkili olan faktörler. İnönü Üniversitesi Tıp Fakültesi Dergisi 2005;12(4):277-280.
• Çöloğlu D. Yalancı Pozitif Üreme Sinyali Veren Otomatize Kan Kültürü Şişelerinde Polimeraz Zincir Reaksiyonu (Pzr) Yöntemi İle Bakteri ve Mantar Varlığının Araştırılması. [Tıpta Uzmanlık Tezi]. Ankara: Ankara Üniversitesi Tıp Fakültesi; 2012.
• Gander RM, Byrd L, DeCrescenzo M ve ark. Impact of blood cultures drawn by phlebotomy on contamination rates and health care costs in a hospital emergency department. Journal of Clinical Microbiology 2009;47(4):1021-4
• Gilligan PH. Blood culture contamination: a clinical and financial burden. Infection Control&Hospital Epidemiology 2013;34(1):22-23.
• Hall KK, Lyman JA. Updated review of blood culture contamination. Clinical Microbiology Reviews 2006;19:788-802.
• Harbarth S, Garbino J, Pugin J ve ark. Inappropriate initial antimicrobial therapy and its effect on survival in a clinical trial of immunomodulating therapy for severe sepsis. American Journal of Medicine 2003;115:529-535.
• Isenberg HD. Clinical Microbiology Procedures Handbook [e-book]. Washington, DC: ASM Press; 2004. [cited 2016 January 10]. Available from: http://en.bookfi.net/book/1306334.
• Lee A, Mirrett S, Reller LB ve ark. Detection of bloodstream infections in adults: how many blood cultures are needed? Journal of Clinical Microbiology 2007;45(11):3546-3548.
• Liu W, Duan Y, Cui W ve ark. Skin antiseptics in venous puncture site disinfection for preventing blood culture contamination: a bayesian network meta-analysis of randomized controlled trials. International Journal of Nursing Studies 2016;59:156-162.
• Maiwald M, Chan SY. Pitfalls in evidence assessment: the case of chlorhexidine and alcohol in skin antisepsis. Journal of Antimicrobial Chemotheraphy 2014;69(8):2017-2021.
• Maiwald M, Chan SY. The forgotten role of alcohol: a systematic review and meta-analysis of the clinical efficacy and perceived role of chlorhexidine in skin antisepsis. PLoS One 2012;7(9):e44277.
• Murphy T, Maile D, Barsch T. Investigating the ımpact of blood culture bundles on the incidence of blood culture contamination rates, The Art And Science of Infusion Nursing 2014;37(3):205-210.
• Murray PR, Masur H. Current approaches to the diagnosis of bacterial and fungal bloodstream infections in the intensive care unit. Critical Care Medicine 2012;40:3277-3282.
• Murty DS, Gyaneshwari M. Blood cultures in paediatric patients: a study of clinical impact. Indian Journal of Medical Microbiology 2007;25(3):2022-2024.
• Mylotte JM, Tayara A. Blood culture: clinical aspects and controversies. European Journal of Clinical Microbiology&Infectious Diseases 2000;19:157-163.
• O’Connor C, Philip RK, Powell J ve ark. Combined education and skin antisepsis intervention for persistently high blood-culture contamination rates in neonatal intensive care. Journal of Hospital Infection 2016; 93(1):105-107.
• Pavlovsky M, Press J, Peled N ve ark. Blood culture contamination in pediatric patients: young children and young doctors. The Pediatric Infectious Disease Journal 2006;25(7):611–614.
• Pien BC, Sundaram P, Raoof N ve ark. The clinical and prognostic importance of positive blood cultures in adults. The American Journal of Medicine 2010;123(9):819-828.
• Self HW, Mickanin J, Grijalva CG ve ark. Reducing blood culture contamination in community hospital emergency departments: multicenter evaluation of a quality improvement intervention, Academic Emergency Medicine 2014;21(3):274–282.
• Self HW, Speroff T, McNaughton CD ve ark. Blood culture collection through peripheral intravenous catheters increases the risk of specimen contamination among adult emergency department patients. Infection Control and Hospital Epidemiology 2012;33(5):524-526.
• Singhal T. Blood cultures revisited. Pediatric Infectious Disease 2012;4(1):25–27.
• Smith BA, Peterson LR. Best way to prevent blood culture contamination. Medscape 2014 SHEA Expert commentaries.
• Snyder JW. Blood cultures: The importance of meeting pre-analytical requirements in reducing contamination, optimizing sensitivity of detection, and clinical relevance, Clinical Microbiology Newsletter 2015;37(7):53-57.
• Stonecypher K. Going around in circles. Critical Care Nursing 2009;32:94-98.
• Taneja D, Finney J, Nagaishi K. A performance improvement project: reducing emergency department blood culture contamination rate using six sigma methodology. American Journal of Infection Control 2014; 42: 29-166
• Towns ML, Jarvis WR, Hsueh P. Guidelines on blood cultures. journal of microbiology, İmmunology anf Infection 2010;43(4):347-349.
• Wanga P, Hub B. Strategies on reducing blood culture contamination, Reviews in Medical Microbiology 2012;(23):63–66.
• Willock J, Richardson J, Brazier A ve ark. Peripheral venepuncture in infants and children. Nursing Standard 2004;18(27):43-50.
• Youssef D, Shams W, Bailey B ve ark. Effective strategy for decreasing blood culture contamination rates: the experience of a veterans affairs medical centre. Journal of Hospital Infection 2012;81:288-291.
• Zarbo RJ, Jones BA, Friedberg RC ve ark. Q-tracks: a College of American Pathologists program of continuous laboratory monitoring and longitudinal tracking. Archives of Pathology& Laboratory Medicine 2002;126:1036-1044.