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. 1990 Dec;66(782):1053–1058. doi: 10.1136/pgmj.66.782.1053

Contamination of blood cultures during venepuncture: fact or myth?

E Shahar 1, B S Wohl-Gottesman 1, L Shenkman 1
PMCID: PMC2429789  PMID: 2084653

Abstract

Contamination of blood cultures is believed to occur mainly during the venepuncture procedure. Consequently, meticulous preparation of the venepuncture site is widely recommended. To determine whether the contamination rate is indeed affected by the quality of the antiseptic procedure at the venepuncture site, 181 paired cultures were collected from 176 patients during a 6-month period after either strict antiseptic cleansing of skin with alcohol followed by povidone-iodine, or after brief disinfection with alcohol alone. The contamination rate was not influenced by the antiseptic procedure, and corresponded to the accepted percentage reported in most other studies. Eight false positive cultures (4.4%) were obtained after strict antisepsis of the skin and 6 (3.3%) after short simple cleansing with alcohol (P = 0.39). Our results suggest that contamination of blood cultures may not be related to the venepuncture procedure--regardless of the antiseptic technique used--but may be due to later stages of laboratory handling and processing of the specimens. Review of the literature has provided further indirect evidence to support this conclusion.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aronson M. D., Bor D. H. Blood cultures. Ann Intern Med. 1987 Feb;106(2):246–253. doi: 10.7326/0003-4819-106-2-246. [DOI] [PubMed] [Google Scholar]
  2. Beaman K. D., Kasten B. L., Gavan T. L. Rate of detection of bacteremia. Retrospective evaluation of 23,392 blood cultures. Cleve Clin Q. 1977 Fall;44(3):129–136. doi: 10.3949/ccjm.44.3.129. [DOI] [PubMed] [Google Scholar]
  3. Callihan D. R., Migneault P. C., Nolte F. S. Clinical and bacteriologic evaluation of BACTEC resin-containing blood culture medium. Am J Clin Pathol. 1984 Oct;82(4):465–469. doi: 10.1093/ajcp/82.4.465. [DOI] [PubMed] [Google Scholar]
  4. Carlson L. G., Plorde J. J. Influence of a blood culture inoculation technique on detection of bacteremia by the BACTEC system. J Clin Microbiol. 1982 Sep;16(3):590–592. doi: 10.1128/jcm.16.3.590-592.1982. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Champagne S., Fussell S., Scheifele D. Evaluation of skin antisepsis prior to blood culture in neonates. Infect Control. 1984 Oct;5(10):489–491. doi: 10.1017/s0195941700060902. [DOI] [PubMed] [Google Scholar]
  6. Craven D. E., Lichtenberg D. A., Browne K. F., Coffey D. M., Treadwell T. L., McCabe W. R. Pseudobacteremia traced to cross-contamination by an automated blood culture analyzer. Infect Control. 1984 Feb;5(2):75–78. doi: 10.1017/s0195941700058987. [DOI] [PubMed] [Google Scholar]
  7. Faris H. M., Jr, Sparling F. F. Mima polymorpha bacteremia. False-positive cultures due to contaminated penicillinase. JAMA. 1972 Jan;219(1):76–77. doi: 10.1001/jama.219.1.76. [DOI] [PubMed] [Google Scholar]
  8. Gill V. J., Zierdt C. H., Wu T. C., Stock F., Pizzo P. A., MacLowry J. D. Comparison of lysis-centrifugation with lysis-filtration and a conventional unvented bottle for blood cultures. J Clin Microbiol. 1984 Nov;20(5):927–932. doi: 10.1128/jcm.20.5.927-932.1984. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Griffin M. R., Miller A. D., Davis A. C. Blood culture cross contamination associated with a radiometric analyzer. J Clin Microbiol. 1982 Apr;15(4):567–570. doi: 10.1128/jcm.15.4.567-570.1982. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Hall M. M., Ilstrup D. M., Washington J. A., 2nd Comparison of three blood culture media with tryptic soy broth. J Clin Microbiol. 1978 Sep;8(3):299–301. doi: 10.1128/jcm.8.3.299-301.1978. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Hall M., Warren E., Washington J. A., 2nd Comparison of two liquid blood culture media containing sodium polyanethole sulfonate: tryptic soy and Columbia. Appl Microbiol. 1974 Apr;27(4):699–702. doi: 10.1128/am.27.4.699-702.1974. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Hall M., Warren E., Washington J. A., 2nd Detection of bacteremia with liquid media containing sodium polyanetholsulfonate. Appl Microbiol. 1974 Jan;27(1):187–191. doi: 10.1128/am.27.1.187-191.1974. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Horan T. C., White J. W., Jarvis W. R., Emori T. G., Culver D. H., Munn V. P., Thornsberry C., Olson D. R., Hughes J. M. Nosocomial infection surveillance, 1984. MMWR CDC Surveill Summ. 1986;35(1):17SS–29SS. [PubMed] [Google Scholar]
  14. Houang E. T., Gilmore O. J., Reid C., Shaw E. J. Absence of bacterial resistance to povidone iodine. J Clin Pathol. 1976 Aug;29(8):752–755. doi: 10.1136/jcp.29.8.752. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Ihde D. C., Armstrong D. Clinical spectrum of infection due to Bacillus species. Am J Med. 1973 Dec;55(6):839–845. doi: 10.1016/0002-9343(73)90266-0. [DOI] [PubMed] [Google Scholar]
  16. Kelly M. T., Fojtasek M. F., Abbott T. M., Hale D. C., Dizikes J. R., Boshard R., Buck G. E., Martin W. J., Matsen J. M. Clinical evaluation of a lysis-centrifugation technique for the detection of septicemia. JAMA. 1983 Oct 28;250(16):2185–2188. [PubMed] [Google Scholar]
  17. Kirchhoff L. V., Sheagren J. N. Epidemiology and clinical significance of blood cultures positive for coagulase-negative staphylococcus. Infect Control. 1985 Dec;6(12):479–486. doi: 10.1017/s0195941700063591. [DOI] [PubMed] [Google Scholar]
  18. Lynch J. M., Anderson A., Camacho F. R., Winters A. K., Hodges G. R., Barnes W. G. Pseudobacteremia caused by Clostridium sordellii. Arch Intern Med. 1980 Jan;140(1):65–68. [PubMed] [Google Scholar]
  19. MacGregor R. R., Beaty H. N. Evaluation of positive blood cultures. Guidelines for early differentiation of contaminated from valid positive cultures. Arch Intern Med. 1972 Jul;130(1):84–87. [PubMed] [Google Scholar]
  20. Maki D. G. Through a glass darkly. Nosocomial pseudoepidemics and pseudobacteremias. Arch Intern Med. 1980 Jan;140(1):26–28. [PubMed] [Google Scholar]
  21. Meites S., Levitt M. J. Skin-puncture and blood-collecting techniques for infants. Clin Chem. 1979 Jan;25(1):183–189. [PubMed] [Google Scholar]
  22. Noble R. C., Reeves S. A. Bacillus species pseudosepsis caused by contaminated commercial blood culture media. JAMA. 1974 Nov 18;230(7):1002–1004. [PubMed] [Google Scholar]
  23. Ponce de Leon S., Wenzel R. P. Hospital-acquired bloodstream infections with Staphylococcus epidermidis. Review of 100 cases. Am J Med. 1984 Oct;77(4):639–644. doi: 10.1016/0002-9343(84)90354-1. [DOI] [PubMed] [Google Scholar]
  24. Reller L. B. Recent and innovative methods for detection of bacteremia and fungemia. Am J Med. 1983 Jul 28;75(1B):26–30. doi: 10.1016/0002-9343(83)90069-4. [DOI] [PubMed] [Google Scholar]
  25. Richet H., Escande M. C., Lagrange P. H. Lysis centrifugation and slide blood culture systems for diagnosis of bacteremia in immunocompromised patients. Eur J Clin Microbiol. 1987 Feb;6(1):64–67. doi: 10.1007/BF02097197. [DOI] [PubMed] [Google Scholar]
  26. STORY P. Testing of skin disinfectants. Br Med J. 1952 Nov 22;2(4794):1128–1130. doi: 10.1136/bmj.2.4794.1128. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Schmidt B. K., Kirpalani H. M., Corey M., Low D. E., Philip A. G., Ford-Jones E. L. Coagulase-negative staphylococci as true pathogens in newborn infants: a cohort study. Pediatr Infect Dis J. 1987 Nov;6(11):1026–1031. [PubMed] [Google Scholar]
  28. Selwyn S., Ellis H. Skin bacteria and skin disinfection reconsidered. Br Med J. 1972 Jan 15;1(5793):136–140. doi: 10.1136/bmj.1.5793.136. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Sullivan N. M., Sutter V. L., Carter W. T., Attebery H. R., Finegold S. M. Bacteremia after genitourinary tract manipulation: bacteriological aspects and evaluation of various blood culture systems. Appl Microbiol. 1972 Jun;23(6):1101–1106. doi: 10.1128/am.23.6.1101-1106.1972. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Szymczak E. G., Barr J. T., Durbin W. A., Goldmann D. A. Evaluation of blood culture procedures in a pediatric hospital. J Clin Microbiol. 1979 Jan;9(1):88–92. doi: 10.1128/jcm.9.1.88-92.1979. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Thomson R. B., Jr, Vanzo S. J., Henry N. K., Guenther K. L., Washington J. A., 2nd Contamination of cultures processed with the isolator lysis-centrifugation blood culture tube. J Clin Microbiol. 1984 Feb;19(2):97–99. doi: 10.1128/jcm.19.2.97-99.1984. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Tilton R. C. The laboratory approach to the detection of bacteremia. Annu Rev Microbiol. 1982;36:467–493. doi: 10.1146/annurev.mi.36.100182.002343. [DOI] [PubMed] [Google Scholar]
  33. UPDEGRAFF D. M. A CULTURAL METHOD OF QUANTITATIVELY STUDYING THE MICROORGANISMS IN THE SKIN. J Invest Dermatol. 1964 Aug;43:129–137. doi: 10.1038/jid.1964.130. [DOI] [PubMed] [Google Scholar]
  34. Washington J. A., 2nd Blood cultures: principles and techniques. Mayo Clin Proc. 1975 Feb;50(2):91–98. [PubMed] [Google Scholar]
  35. Washington J. A., 2nd Comparison of two commercially available media for detection of bacteremia. Appl Microbiol. 1971 Oct;22(4):604–607. doi: 10.1128/am.22.4.604-607.1971. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Washington J. A., 2nd, Ilstrup D. M. Blood cultures: issues and controversies. Rev Infect Dis. 1986 Sep-Oct;8(5):792–802. doi: 10.1093/clinids/8.5.792. [DOI] [PubMed] [Google Scholar]
  37. Weinstein M. P., Reller L. B., Murphy J. R., Lichtenstein K. A. The clinical significance of positive blood cultures: a comprehensive analysis of 500 episodes of bacteremia and fungemia in adults. I. Laboratory and epidemiologic observations. Rev Infect Dis. 1983 Jan-Feb;5(1):35–53. doi: 10.1093/clinids/5.1.35. [DOI] [PubMed] [Google Scholar]
  38. Weinstein R. A., Stamm W. E. Pseudoepidemics in hospital. Lancet. 1977 Oct 22;2(8043):862–864. doi: 10.1016/s0140-6736(77)90793-0. [DOI] [PubMed] [Google Scholar]
  39. Wilson J. A., Barratt A. J., Gray J., Statham G. B. Comparison of conventional and single bottle system for blood cultures. J Clin Pathol. 1988 Jun;41(6):679–682. doi: 10.1136/jcp.41.6.679. [DOI] [PMC free article] [PubMed] [Google Scholar]

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