Präanalytik: Blutkultur, Urin, Stuhl

Anna Dudakova; Marco H. Schulze

doi:10.1055/s-0043-118640

Krankenhaushygiene up2date, Table of Contents

Krankenhaushygiene up2date 2018; 13(04): 451-469
DOI: 10.1055/s-0043-118640

Diagnostik

Georg Thieme Verlag KG Stuttgart · New York

Präanalytik: Blutkultur, Urin, Stuhl

Anna Dudakova

,

Marco H. Schulze

Abstract

All articles of this category

Die Probenqualität bestimmt ganz entscheidend das mikrobiologische Untersuchungsergebnis. Durch Fehler in der Präanalytik und mangelhaftes Probenmaterial sind die diagnostischen Möglichkeiten eingeschränkt. Inadäquate Therapieentscheidungen, zusätzliche Mehrkosten und eine Belastung des Patienten durch wiederholte Probenentnahmen sind vermeidbare Folgen. Nur eine optimale Präanalytik ermöglicht genaue, zeitnahe und klinisch relevante Ergebnisse.

Schlüsselwörter

Präanalytik - mikrobiologische Diagnostik - Transportzeit - Blutkultur - Urinprobe - Stuhlprobe

Full Text

References

Literatur
1 Fleischmann C, Thomas-Rueddel DO, Hartmann M. et al.. Hospital Incidence and Mortality Rates of Sepsis. Dtsch Arztebl Int 2016; 113: 159-166 doi:10.3238/arztebl.2016.0159
2 Bodmann K-F, Grabein B, Kresken M. et al.. S2 k Leitlinie: Kalkulierte parenterale Initialtherapie bakterieller Erkrankungen bei Erwachsenen – Update 2018. AWMF-Registernummer 082-006. Stand: 01.12.2017, gültig bis 31.12.2021 Hrsg.: Paul-Ehrlich-Gesellschaft für Chemotherapie e.V.; 2017. . Im Internet: www.awmf.org/leitlinien/detail/ll/082-006.html Stand: 11.10.2018
3 Singer M, Deutschman CS, Seymour CW. et al.. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016; 315: 801-810 doi:10.1001/jama.2016.0287
4 Prävention von Infektionen, die von Gefäßkathetern ausgehen – Hinweise zur Blutkulturdiagnostik. Informativer Anhang 1 zur Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60: 216-230 doi:10.1007/s00103-016-2485-6
5 https://www.uptodate.com/contents/blood-cultures-for-the-detection-of-bacteremia?search=blood culture&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1 Stand: 24.09.2018
6 Riedel S, Bourbeau P, Swartz B. et al.. Timing of specimen collection for blood cultures from febrile patients with bacteremia. J Clin Microbiol 2008; 46: 1381-1385 doi:10.1128/JCM.02033-07
7 Garcia RA, Spitzer ED, Beaudry J. et al.. Multidisciplinary team review of best practices for collection and handling of blood cultures to determine effective interventions for increasing the yield of true-positive bacteremias, reducing contamination, and eliminating false-positive central line-associated bloodstream infections. Am J Infect Control 2015; 43: 1222-1237 doi:10.1016/j.ajic.2015.06.030
8 Snyder SR, Favoretto AM, Baetz RA. 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
9 Dawson S. Blood culture contaminants. J Hosp Infect 2014; 87: 1-10 doi:10.1016/j.jhin.2014.02.009
10 Seifert H, Abele-Horn M, Fätkenheuer G. et al.. MiQ 3a: Blutkulturdiagnostik. Sepsis, Endokarditis, Katheterinfektionen, Teil I. 2. Aufl.. München: Elsevier, Urban & Fischer; 2007
11 Baron EJ, Miller JM, Weinstein MP. et al.. A guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2013 recommendations by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM)(a). Clin Infect Dis 2013; 57: e22-e121 doi:10.1093/cid/cit278
12 Rhodes A, Evans LE, Alhazzani W. et al.. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2016. Crit Care Med 2017; 45: 486-552 doi:10.1097/CCM.0000000000002255
13 Park KH, Lee MS, Lee SO. et al.. Diagnostic usefulness of differential time to positivity for catheter-related candidemia. J Clin Microbiol 2014; 52: 2566-2572 doi:10.1128/jcm.00605-14
14 Blot F, Schmidt E, Nitenberg G. et al.. Earlier positivity of central-venous- versus peripheral-blood cultures is highly predictive of catheter-related sepsis. J Clin Microbiol 1998; 36: 105-109
15 Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege. TRBA 250 – Biologische Arbeitsstoffe im Gesundheitswesen und in der Wohlfahrtspflege, Ausgabe März 2014, 4. Änderung vom 2. Mai 2018. Im Internet: http://www.baua.de/DE/Angebote/Rechtstexte-und-Technische-Regeln/Regelwerk/TRBA/TRBA-250.html Stand: 11.10.2018
16 Händehygiene in Einrichtungen des Gesundheitswesens: Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut (RKI). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2016; 59: 1189-1220 doi:10.1007/s00103-016-2416-6
17 Calfee DP, Farr BM. Comparison of four antiseptic preparations for skin in the prevention of contamination of percutaneously drawn blood cultures: a randomized trial. J Clin Microbiol 2002; 40: 1660-1665
18 Washer LL, Chenoweth C, Kim HW. et al.. Blood culture contamination: a randomized trial evaluating the comparative effectiveness of 3 skin antiseptic interventions. Infect Control Hosp Epidemiol 2013; 34: 15-21 doi:10.1086/668777
19 Schifman RB, Strand CL, Meier FA. et al.. Blood culture contamination: a College of American Pathologists Q-Probes study involving 640 institutions and 497134 specimens from adult patients. Arch Pathol Lab Med 1998; 122: 216-221
20 Lamy B, Dargere S, Arendrup MC. et al.. How to Optimize the Use of Blood Cultures for the Diagnosis of Bloodstream Infections? A State-of-the Art. Front Microbiol 2016; 7: 697 doi:10.3389/fmicb.2016.00697
21 Reynes V. Densité de lʼinfection sanguine dans les bactériémies et septicémies. Comptes rendus des seances de la Societe de biologie et de ses filiales 1947; 141: 261
22 Arpi M, Bentzon MW, Jensen J. et al.. Importance of blood volume cultured in the detection of bacteremia. Eur J Clin Microbiol Infect Dis 1989; 8: 838-842
23 Jonsson B, Nyberg A, Henning C. Theoretical aspects of detection of bacteraemia as a function of the volume of blood cultured. APMIS 1993; 101: 595-601
24 Wain J, Diep TS, Ho VA. et al.. Quantitation of bacteria in blood of typhoid fever patients and relationship between counts and clinical features, transmissibility, and antibiotic resistance. J Clin Microbiol 1998; 36: 1683-1687
25 Pfeiffer CD, Samsa GP, Schell WA. et al.. Quantitation of Candida CFU in initial positive blood cultures. J Clin Microbiol 2011; 49: 2879-2883 doi:10.1128/jcm.00609-11
26 Cockerill 3rd FR, Wilson JW, Vetter EA. et al.. Optimal testing parameters for blood cultures. Clin Infect Dis 2004; 38: 1724-1730 doi:10.1086/421087
27 Bouza E, Sousa D, Rodriguez-Creixems M. et al.. Is the volume of blood cultured still a significant factor in the diagnosis of bloodstream infections?. J Clin Microbiol 2007; 45: 2765-2769 doi:10.1128/jcm.00140-07
28 Lee A, Mirrett S, Reller LB. et al.. Detection of bloodstream infections in adults: how many blood cultures are needed?. J Clin Microbiol 2007; 45: 3546-3548 doi:10.1128/jcm.01555-07
29 Patel R, Vetter EA, Harmsen WS. et al.. Optimized pathogen detection with 30- compared to 20-milliliter blood culture draws. J Clin Microbiol 2011; 49: 4047-4051 doi:10.1128/jcm.01314-11
30 Lamy B, Seifert H. Microbiological Diagnosis: Septicemia. In: Cornaglia G, Courcol R, Herrmann JL, Kahlmeter G, Peigue-Lafeuille H, Vila J. eds. European Manual of clinical Microbiology. Paris, Basel: SFM, ESCMID; 2012: 101-110
31 Vitrat-Hincky V, François P, Labarère J. et al.. Appropriateness of blood culture testing parameters in routine practice. Results from a cross-sectional study. Eur J Clin Microbiol Infect Dis 2011; 30: 533-539 doi:10.1007/s10096-010-1115-8
32 Lin HH, Liu YF, Tien N. et al.. Evaluation of the blood volume effect on the diagnosis of bacteremia in automated blood culture systems. J Microbiol Immunol Infect 2013; 46: 48-52 doi:10.1016/j.jmii.2012.03.012
33 Coorevits L, Van den Abeele AM. Evaluation of the BD BACTEC FX blood volume monitoring system as a continuous quality improvement measure. Eur J Clin Microbiol Infect Dis 2015; 34: 1459-1466 doi:10.1007/s10096-015-2373-2
34 Gaur A, Giannini MA, Flynn PM. et al.. Optimizing blood culture practices in pediatric immunocompromised patients: evaluation of media types and blood culture volume. Pediatr Infect Dis J 2003; 22: 545-552 doi:10.1097/01.inf.0000069762.44241.0d
35 Kellogg JA, Ferrentino FL, Liss J. et al.. Justification and Implementation of a Policy Requiring Two Blood Cultures When One Is Ordered. Laboratory Medicine 1994; 25: 323-330 doi:10.1093/labmed/25.5.323
36 Butterworth JF, Mackey DC, Wasnick JD. Fluid Management & Blood Component Therapy. In: Butterworth JF, Mackey DC, Wasnick JD. eds. Morgan and Mikhailʼs clinical Anesthesiology. New York: McGraw-Hill Education Ltd.; 2013: 1161-1181
37 Li J, Plorde JJ, Carlson LG. Effects of volume and periodicity on blood cultures. J Clin Microbiol 1994; 32: 2829-2831
38 Washington 2nd JA. Blood cultures: principles and techniques. Mayo Clin Proc 1975; 50: 91-98
39 Washington JA. An international multicenter study of blood culture practices. The International Collaborative Blood Culture Study Group. Eur J Clin Microbiol Infect Dis 1992; 11: 1115-1128
40 Reimer LG, Wilson ML, Weinstein MP. Update on detection of bacteremia and fungemia. Clin Microbiol Rev 1997; 10: 444-465
41 Schifman RB, Strand CL, Braun E. et al.. Solitary blood cultures as a quality assurance indicator. Qual Assur Util Rev 1991; 6: 132-137
42 Neves L, Marra AR, Camargo TZ. et al.. Correlation between mass and volume of collected blood with positivity of blood cultures. BMC Res Notes 2015; 8: 383 doi:10.1186/s13104-015-1365-8
43 Aronson MD, Bor DH. Blood cultures. Ann Intern Med 1987; 106: 246-253
44 Lamy B, Roy P, Carret G. et al.. What is the relevance of obtaining multiple blood samples for culture? A comprehensive model to optimize the strategy for diagnosing bacteremia. Clin Infect Dis 2002; 35: 842-850 doi:10.1086/342383
45 Bates DW, Goldman L, Lee TH. Contaminant blood cultures and resource utilization. The true consequences of false-positive results. JAMA 1991; 265: 365-369
46 Arendrup M, Jensen IP, Justesen T. Diagnosing bacteremia at a Danish hospital using one early large blood volume for culture. Scand J Infect Dis 1996; 28: 609-614
47 Hall KK, Lyman JA. Updated review of blood culture contamination. Clin Microbiol Rev 2006; 19: 788-802 doi:10.1128/cmr.00062-05
48 Alahmadi YM, Aldeyab MA, McElnay JC. et al.. Clinical and economic impact of contaminated blood cultures within the hospital setting. J Hosp Infect 2011; 77: 233-236 doi:10.1016/j.jhin.2010.09.033
49 Gibson T, Norris W. Skin fragments removed by injection needles. Lancet 1958; 2: 983-985
50 de Korte D, Marcelis JH, Verhoeven AJ. et al.. Diversion of first blood volume results in a reduction of bacterial contamination for whole-blood collections. Vox Sang 2002; 83: 13-16
51 Patton RG, Schmitt T. Innovation for reducing blood culture contamination: initial specimen diversion technique. J Clin Microbiol 2010; 48: 4501-4503 doi:10.1128/jcm.00910-10
52 Habib G, Lancellotti P, Antunes MJ. et al.. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015; 36: 3075-3128 doi:10.1093/eurheartj/ehv319
53 Kirn TJ, Weinstein MP. Update on blood cultures: how to obtain, process, report, and interpret. Clin Microbiol Infect 2013; 19: 513-520 doi:10.1111/1469-0691.12180
54 Dicheva S. Harnwegsinfekte bei Frauen. In: Glaeske G, Schicktanz C. Hrsg. Barmer GEK Arzneimittelreport 2015. Siegburg: BEK; 2015: 107-137
55 Behnke M, Aghdassi SJ, Hansen S. et al.. Prävalenz von nosokomialen Infektionen und Antibiotika-Anwendung in deutschen Krankenhäusern. Dtsch Arztebl Int 2017; 114: 851-857 doi:10.3238/arztebl.2017.0851
56 Leitlinienprogramm DGU. Interdisziplinäre S3-Leitlinie: Epidemiologie, Diagnostik, Therapie, Prävention und Management unkomplizierter, bakterieller, ambulant erworbener Harnwegsinfektionen bei erwachsenen Patienten. Langversion 1.1–2, 2017 AWMF Registernummer: 043/044. Im Internet: http://www.awmf.org/leitlinien/detail/ll/043-044.html Stand: 12.10.2018
57 Fätkenheuer G. Asymptomatische Bakteriurie. Dtsch Med Wochenschr 2016; 141: 173-175 doi:10.1055/s-0041-107949
58 Flokas ME, Andreatos N, Alevizakos M. et al.. Inappropriate Management of Asymptomatic Patients With Positive Urine Cultures: A Systematic Review and Meta-analysis. Open Forum Infect Dis 2017; 4: ofx207 doi:10.1093/ofid/ofx207
59 Zhang Q, Liu L, Sun W. et al.. Research progress of asymptomatic bacteriuria before arthroplasty: A systematic review. Medicine 2018; 97: e9810 doi:10.1097/md.0000000000009810
60 Utsch B, Klaus G. Urinanalyse im Kindes- und Jugendalter. Dtsch Arztebl Int 2014; 111: 617-625 doi:10.3238/arztebl.2014.0617 quiz 626
61 Tosif S, Baker A, Oakley E. et al.. Contamination rates of different urine collection methods for the diagnosis of urinary tract infections in young children: an observational cohort study. J Paediatr Child Health 2012; 48: 659-664 doi:10.1111/j.1440-1754.2012.02449.x
62 Gatermann S, Fünfstück R, Handrick W. et al.. MiQ 2: Harnwegsinfektionen. München: Elsevier, Urban & Fischer; 2005
63 Graham JC, Galloway A. ACP Best Practice No 167: the laboratory diagnosis of urinary tract infection. J Clin Pathol 2001; 54: 911-919
64 Knottnerus BJ, Geerlings SE, Moll van Charante EP. et al.. Toward a simple diagnostic index for acute uncomplicated urinary tract infections. Ann Fam Med 2013; 11: 442-451
65 Kist M, Ackermann G, Autenrieth IB. et al.. MiQ 9: Gastrointestinale Infektionen. 2. Aufl.. München: Elsevier, Urban & Fischer; 2013
66 Robert Koch-Institut. Infektionsepidemiologisches Jahrbuch meldepflichtiger Krankheiten für 2016. Berlin; 2017