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ORIGINAL ARTICLE
Year : 2020  |  Volume : 18  |  Issue : 1  |  Page : 7-13

A prospective study on the comparison of contamination rate and risk factors of blood culture done in the emergency department and medical high-dependency unit/medicine intensive care units


1 Department of Emergency Medicine, NRI Academy of Medical Sciences, College of Mangalagiri, Guntur, Andhra Pradesh, India
2 Department of Emergency Medicine, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
3 Department of Critical Care, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
4 Department of Microbiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India

Correspondence Address:
Dr. Darpanarayan Hazra
Department of Emergency Medicine, CMC, Vellore - 632 004, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cmi.cmi_59_19

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Background: Blood culture (BC) is an important tool and also considered the “gold standard” for the diagnosis of bacteremia. Emergency departments (EDs) and medical high-dependency units/medicine intensive care units (MHDUs/MICUs) are particularly susceptible to contaminated BCs due to high staff turnover. However, the need to collect cultures in critically ill patients is essential before the first dose of antibiotics. Aim: This study aimed to calculate the rate and risk factors of contamination of BC in ED and MHDU/MICU. Materials and Methods: This is a 2-month prospective observational study with a total of 998 patients – 570 in ED and 428 in MHDU/MICUs. The primary investigator collected the data, and culture reports were followed up to 7 days. Categorical variables were presented as percentages, and quantitative variables were summarized using mean and standard deviation. Results: The mean age of the population in the ED culture arm was 51 years and in the MHDU/MICU was 46 years. There was a male predominance of 61%. From ED, the most common admission diagnosis was acute undifferentiated febrile illness accounting to 23% of total patients. Lung pathologies were the most common MHDU/MICU admission diagnosis encountered in the study comprising 193 (19.3%) cases. The most common site for culture in ED was the brachial vein (81%) followed by the dorsum of the hand (14%). The most common contaminant was coagulase-negative Staphylococcus (CoNS) with 26 cases, of which 16 were from MHDU/MICU. A total of 48 cases (4.8%) were contaminated in the study, of which 25 (4.4%) cases were from ED and 23 (5.4%) from MHDU/MICU. Conclusions: BC contamination is a common clinical problem and often leads to adverse impacts on both health care and costs. It is challenging to prevent contamination because of inadequate inpatient capacity, high severity of illness, the rapid turnover of staff, and the high workload and overcrowding.


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