Title : Single-site sampling strategy versus multi-site sampling strategy in blood culture collection within the hospital setting: A systematic review
Abstract:
Background: Bloodstream infections (BSI) carry substantial morbidity and mortality, requiring prompt antimicrobial administration. Many global infectious disease and sepsis guidelines suggest a multi-site sampling strategy of blood cultures to diagnose BSI, however, a growing body of literature suggests that single-site sampling (SSS) may be a viable alternative. This systematic review aims to identify the current state of literature comparing SSS to multi-site sampling (MSS) in terms of bacteraemia diagnosis as well as contamination rate.
Methods: A systematic review was conducted to compare SSS with MSS amongst adult population within hospital settings. MEDLINE, CINAHL, Pubmed, Web of Science, Scopus, and Google Scholar were searched from inception to August 2023. The JBI Critical Appraisal Checklist was used to assess the quality of the studies and their risk of bias. Meta-analysis was not conducted due to study heterogeneity.
Results: Seven studies met the inclusion criteria and were selected, with patient populations ranging from 312 – 5248 participants. Four out of seven studies collected 40mls of total blood, divided into 2 sets of blood cultures. The other three studies proposed varying recommendations regarding total blood volume and the number of blood culture sets. Despite differences in methods, all authors agreed that increased blood volume using the SSS technique improves pathogen detection and lowers contamination rates. Most studies were of high quality with low risk of bias.
Conclusions: This review demonstrates that the SSS technique for blood culture collection provides similar, if not improved rates of bacteraemia detection without increase in contamination. Increased blood volume in SSS technique demonstrated higher true-positive rates and minimised false-positive rates by lowering contamination rates. SSS further enhances patient outcomes by enabling faster antibiotic administration, reducing clinical workload, and conserving procedural time and resources, thereby increasing patient satisfaction. We recommend that the above evidence is considered in future guideline publication.
