Comparison Between the Yield of Different Number of Blood Cultures in Chronic Kidney Disease Patients With Suspected Septicemia

Objective: Our study aimed to evaluate the optimal and financially efficient numbers of blood cultures (BC) required in our chronic kidney disease (CKD) patients with suspected bloodstream infections (BSI). Design: This is a prospective, cross-sectional study. Place and duration of study: Department of Nephrology, The Kidney Center Post-Graduate-Training-Institute, Karachi from July 2020 to December 2020. Methods: Single, two, or three BC were taken from CKD patients with suspected BSI within the first 24 hours and were incubated in the BACTEC 1050 CMBCS for five days. A positive culture was reported as per standard protocol. Results: Four hundred and eighty-three BC sets were collected from 272 patients. A single set of BC was obtained from 111 (40.8%), two sets from 111 (40.8%), and three from 50 (18.4%) patients. BC from 93 patients showed growth of organisms in at least one set. Fifty-six (60.2%) episodes of BSI were detected with the first set, 34 (36.5%) with the second set, and 03 (3.2%) with the third set of BC. The detection rate of BSI was 60.2% with the first set, 97.7% with the first two sets, and 100% with the first three sets of BC. The most common source of infection was central line-associated bloodstream infection (CLABSI) (33.3%), followed by urinary tract (29%), lower respiratory tract infection (LRTI) (16%), and arteriovenous fistula (AVF) (7.5%). 93.5% episodes of BSI, were monomicrobial. The most common monomicrobial organism was methicillin-resistant Staphylococcus aureus (MRSA) (22.6%). Conclusion: Two properly collected BC sets might be sufficient for an adequate diagnosis of BSI, in CKD patients especially in resource-limited settings.