Skip to main content

Advertisement

SpringerLink
Log in

Deficits in knowledge, attitude, and practice towards blood culture sampling: results of a nationwide mixed-methods study among inpatient care physicians in Germany

  • Original Paper
  • Published:
Infection Aims and scope Submit manuscript

Abstract

Purpose

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.

Conclusion

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Engel C, Brunkhorst FM, Bone HG, Brunkhorst R, Gerlach H, Grond S, et al. Epidemiology of sepsis in Germany: results from a national prospective multicenter study. Intensive Care Med. 2007;33:606–18. doi:10.1007/s00134-006-0517-7.

    Article  PubMed  Google Scholar 

  2. Fleischmann C, Thomas-Rueddel DO, Hartmann M, Hartog CS, Welte T, Heublein S, et al. Hospital incidence and mortality rates of sepsis. Deutsches Arzteblatt Int. 2016;113:159–66. doi:10.3238/arztebl.2016.0159.

    Google Scholar 

  3. Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006;34:1589–96. doi:10.1097/01.CCM.0000217961.75225.E9.

    Article  PubMed  Google Scholar 

  4. Opota O, Croxatto A, Prod’hom G, Greub G. Blood culture-based diagnosis of bacteraemia: state of the art. Clin Microbiol Infect. 2015;21:313–22. doi:10.1016/j.cmi.2015.01.003.

    Article  CAS  PubMed  Google Scholar 

  5. Seifert H, Abele-Horn M, Fätkenheuer G, Glück T, Jansen B, Kern WV et al. Blutkulturdiagnostik. Sepsis, Endokarditis, Katheterinfektionen, Teil I. München: Urban & Fischer Verlag; 2007.

  6. Leitlinien der Deutschen Sepsis-Gesellschaft und der Deutschen Interdiszplinären Vereinigung für Intensiv- und Notfallmedizin. Prävention, Diagnose, Therapie und Nachsorge der Sepsis. 2010. http://www.awmf.org/uploads/tx_szleitlinien/079-001l_S2k_Sepsis_2010-abgelaufen.pdf. Accessed 04 Aug, 2016.

  7. Karch A, Castell S, Schwab F, Geffers C, Bongartz H, Brunkhorst FM, et al. Proposing an empirically justified reference threshold for blood culture sampling rates in intensive care units. J Clin Microbiol. 2015;53:648–52. doi:10.1128/JCM.02944-14.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Gastmeier P, Schwab F, Behnke M, Geffers C. Less blood culture samples: less infections? Der Anaesth. 2011;60:902–7. doi:10.1007/s00101-011-1889-9.

    Article  CAS  Google Scholar 

  9. Antimicrobial resistance surveillance in Europe http://ecdc.europa.eu/en/publications/Publications/antimicrobial-resistance-europe-2014.pdf. 2014. Accessed 23 Jan 2017.

  10. She RC, Alrabaa S, Lee SH, Norvell M, Wilson A, Petti CA. Survey of physicians’ perspectives and knowledge about diagnostic tests for bloodstream infections. PLoS One. 2015;10:e0121493. doi:10.1371/journal.pone.0121493.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Parada JP, Schwartz DN, Schiff GD, Weiss KB. Effects of type and level of training on variation in physician knowledge in the use and acquisition of blood cultures: a cross sectional survey. BMC Infect Dis. 2005;5:71. doi:10.1186/1471-2334-5-71.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Ojide C, Onwuezobe IA, Asuquo EE, Obiagwu CS. Knowledge, attitude and practice of blood culture: a cross sectional study among medical doctors in a Nigerian tertiary hospital. Afr J Clin Exp Microbiol. 2013;14:6.

    Google Scholar 

  13. Chew KS, Mohd Hashairi F, Jusoh AF, Aziz AA, Nik Hisamuddin NA, Siti AH. Knowledge of good blood culture sampling practice among healthcare staffs in an emergency department: are we getting it right? Med J Malays. 2013;68:323–5.

    CAS  Google Scholar 

  14. Creswell JW, Plano Clark VL, Gutmann ML, Hanson WE. Advanced mixed methods research designs. Handbook of mixed methods in social and behavioral research Thousands Oaks, CA: Sage; 2003.

  15. Krueger RA, Casyey MA. Focus Groups. A practical guide for Applied Research. 4th Edition. Thousands Oaks: Sage: 2009.

  16. Mayring P. Qualitative Inhaltsanalyse. Grundlagen und Techniken. 11., aktualisierte und überarbeitete Auflage. Weinheim und Basel: Beltz; 2010.

  17. Schmitz RP, Keller PM, Baier M, Hagel S, Pletz MW, Brunkhorst FM. Quality of blood culture testing - a survey in intensive care units and microbiological laboratories across four European countries. Crit Care. 2013;17:R248. doi:10.1186/cc13074.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Kim NH, Kim M, Lee S, Yun NR, Kim KH, Park SW, et al. Effect of routine sterile gloving on contamination rates in blood culture: a cluster randomized trial. Ann Int Med. 2011;154:145–51. doi:10.7326/0003-4819-154-3-201102010-00003.

    Article  PubMed  Google Scholar 

  19. Bouza E, Sousa D, Rodriguez-Creixems M, Lechuz JG, Munoz P. Is the volume of blood cultured still a significant factor in the diagnosis of bloodstream infections? J Clin Microbiol. 2007;45:2765–9. doi:10.1128/JCM.00140-07.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Patel R, Vetter EA, Harmsen WS, Schleck CD, Fadel HJ, Cockerill FR 3rd. Optimized pathogen detection with 30- compared to 20-milliliter blood culture draws. J Clin Microbiol. 2011;49:4047–51. doi:10.1128/JCM.01314-11.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Snyder SR, Favoretto AM, Baetz RA, Derzon JH, Madison BM, Mass D, et al. Effectiveness of practices to reduce blood culture contamination: a Laboratory Medicine Best Practices systematic review and meta-analysis. Clin Biochem. 2012;45:999–1011. doi:10.1016/j.clinbiochem.2012.06.007.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Karch A, Schmitz RP, Rissner F, Castell S, Topel S, Jakob M, et al. Bloodstream infections, antibiotic resistance and the practice of blood culture sampling in Germany: study design of a Thuringia-wide prospective population-based study (AlertsNet). BMJ Open. 2015;5:e009095. doi:10.1136/bmjopen-2015-009095.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Reichardt C, Koniger D, Bunte-Schonberger K, van der Linden P, Monch N, Schwab F, et al. Three years of national hand hygiene campaign in Germany: what are the key conclusions for clinical practice? J Hosp Infect. 2013;83:S11–6. doi:10.1016/S0195-6701(13)60004-3.

    Article  PubMed  Google Scholar 

  24. Laupland KB, Church DL, Gregson DB. Blood cultures in ambulatory outpatients. BMC Infect Dis. 2005;5:35. doi:10.1186/1471-2334-5-35.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Kee PP, Chinnappan M, Nair A, Yeak D, Chen A, Starr M, et al. Diagnostic yield of timing blood culture collection relative to fever. Pediatr Infect Dis J. 2016;35:846–50. doi:10.1097/INF.0000000000001189.

    Article  PubMed  Google Scholar 

  26. Riedel S, Bourbeau P, Swartz B, Brecher S, Carroll KC, Stamper PD, et al. Timing of specimen collection for blood cultures from febrile patients with bacteremia. J Clin Microbiol. 2008;46:1381–5. doi:10.1128/JCM.02033-07.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Vincent JL, Opal SM, Marshall JC, Tracey KJ. Sepsis definitions: time for change. Lancet. 2013;381:774–5. doi:10.1016/S0140-6736(12)61815-7.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Seymour CW, Liu VX, Iwashyna TJ, Brunkhorst FM, Rea TD, Scherag A, et al. Assessment of clinical criteria for sepsis: for the third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA, J Am Med Assoc. 2016;315:762–74. doi:10.1001/jama.2016.0288.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We thank all study participants for their valuable time and the department directors for their support of our study. Furthermore, we would like to thank in particular the three hospitals which allowed us to perform focus groups with their staff and provided rooms free of charge. Finally, we thank Philipp Krajewski and his team at the “Centre for Quality and Management in Healthcare” at the Medical Association of Lower Saxony for their support of our study. We thank Paula Wilkening for her contribution to the supplementary material. This study was financed by internal funding of the Helmholtz Centre for Infection Research. MWP was supported by the German Ministry of Education and Research (BMBF), Grant Number 01KI1501.

Author information

Author notes

    Authors and Affiliations

    1. ESME - Epidemiological and Statistical Methods Research Group, Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124, Brunswick, Germany

      Heike Raupach-Rosin, Arne Duddeck, Maike Gehrlich, Charlotte Helmke, Rafael Mikolajczyk & André Karch

    2. German Center for Infection Research (DZIF), Hannover-Braunschweig Site, 30625, Hannover, Germany

      Rafael Mikolajczyk & André Karch

    3. Division of Pediatric Infectious Diseases, Dr. Von Hauner Children’s Hospital, Ludwig Maximilian University Munich, Munich, Germany

      Johannes Huebner

    4. Center for Infectious Diseases and Infection Control, Jena University Hospital, Erlanger Allee 101, 07747, Jena, Germany

      Mathias W. Pletz

    5. Institute for Medical Epidemiology, Biometry, and Informatics (IMEBI), Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle, Germany

      Rafael Mikolajczyk

    Authors
    1. Heike Raupach-Rosin
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Arne Duddeck
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Maike Gehrlich
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Charlotte Helmke
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Johannes Huebner
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Mathias W. Pletz
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. Rafael Mikolajczyk
      View author publications

      You can also search for this author in PubMed Google Scholar

    8. André Karch
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to André Karch.

    Ethics declarations

    Conflict of interest

    On behalf of all authors, the corresponding author states that there is no conflict of interest.

    Additional information

    H. Raupach-Rosin and A. Duddeck have contributed equally to this work.

    Electronic supplementary material

    Below is the link to the electronic supplementary material.

    Supplementary material 1 (PDF 344 kb)

    Supplementary material 2 (DOCX 51 kb)

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Raupach-Rosin, H., Duddeck, A., Gehrlich, M. et al. Deficits in knowledge, attitude, and practice towards blood culture sampling: results of a nationwide mixed-methods study among inpatient care physicians in Germany. Infection 45, 433–441 (2017). https://doi.org/10.1007/s15010-017-0990-7

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s15010-017-0990-7

    Keywords

    Search

    Navigation