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Laboratory: Clinical Microbiology
Test Name:
Test Code: BLD1, BLD2, BLD3
Clinical Information:
Test Indications:  Suspected bacteraemia or yeast fungemia (except Malassezia furfur). In the ED, the presence of ONE OF temp >39.5ºC, indwelling vascular catheter, or clinical suspicion of endocarditis or TWO OF temp 38.3-39.4ºC, age >65 yrs, chills, vomiting, systolic blood pressure <90mm Hg), neutrophil% >80%, white blood cell count >18.0, bands >5%, platelets <150,000k, and creatinine >175 umol/L has a 97% sensitivity for bacteraemia (J Emerg Med. 2008. 35:255-64). Common indications include febrile pneumonia, febrile urinary tract infection, suspected meningitis, endocarditis, endovascular infections, or line sepsis, febrile gastroenteritis in immunocompromised hosts, febrile neutropenia, febrile post-partum infections, febrile complicated intra-abdominal infections and febrile complicated skin and soft tissue infections. Blood cultures are typically NOT recommended for: febrile gastroenteritis in immunocompetent hosts, febrile uncomplicated skin infections or for screening purposes in asymptomatic patients. Recommendations: 1. All patients weighing more than 27 kg (approximately >9 yrs of age) must have 40mL of blood drawn from two different venipunctures or sites within one hour. The two sites should always be sampled at the same time (within 1 hour) and all specimens should be sent to the lab at the same time. Each site must collect 20mL of blood equally divided into one aerobic (blue) and one anaerobic (purple) bottle. Failure to collect sufficient volume from two different collections significantly impairs diagnosis and may lead to false-negative or false-positive results. 2. Do not place more than 12mL of blood in a single blood culture bottle. While lower volume collection in the bottle is not detrimental, the total collection of blood for a blood culture should not be less than 30mL. 3. Collection volumes for pediatric patients <27kg is weight-based. Age approximates are provided for reference only and all volumes should be based on exact weight. NEVER use pediatric (yellow) bottles for patients more than 9kg (approx 1 yr old).  
Weight   Age (appr.)  Total vol.   Bottle type
<4kg       0-6 months   0.5-1mL  1 Ped (yellow)
4-9kg    6-12 months   2-4mL     1 Ped (yellow)
9-27kg   1-9 years       10mL      1 Aerobic (Blue)
4. All samples MUST be taken by aseptic technique. Venipunctures sites must be washed TWICE for a minimum of 15 seconds with CHLORHEXIDINE-GLUCONATE-ALCOHOL swabs and allowed to dry completely before sampling. ALCOHOL SWABS AND POVIDONE ARE NOT ACCEPTABLE FOR SITE PREPARATION. The top of the blood culture bottle should be decontaminated with alcohol-chlorhexidine or alcohol swabs and allowed to dry completely.  5. For central line samples, always collect a peripheral culture AT THE SAME TIME and submit both samples together. When sampling lines, decontaminate the hub with chlorhexidine gluconate-alcohol. Discard 6mL from the central line if contains antimicrobial substances, including but not limited to heparin, EDTA, ethanol, antibiotics, citrate, taurolidine, hypertonic saline). Otherwise the blood should be drawn without a discard. 6. Label the bottles with the patient name, PHIN and site of collection. DO NOT COVER BOTTLE BARCODES WITH LABELS. Patient Prep Instructions:  Accurate patient identification must be made prior to sample collection. Samples and requisitions must be labeled/completed in accordance with the Shared Health Specimen Acceptance Policy. Specimens should be collected before antibacterials or antifungals are administered.
Collection Devices:
BacT/Alert Aerobic blood culture bottle AND BacT/Alert Anaerobic bottle (patients >27 kg)
BacT/Alert Aerobic bottle (patients 9-27 kg)
BacT/Alert pediatric bottle (patients less than 9 kg)
Specimens received in other collection devices will not be processed.
Specimen Required: Adult:  20 mL blood from site #1, 20 mL blood from site #2
Pediatric:  See Recommendations.
Reference Values:
Negative at 5 days incubation. For positive samples, a descriptive report will be provided.
See Also:
More Information:
Specimen Handling:
Specimens must be delivered to the laboratory as soon as possible and ideally within 24 hours of collection. Specimens received after 96 hours will not be processed. Hold specimens at room temperature. DO NOT REFRIGERATE. Ensure specimens are sent using appropriate packaging in accordance with Transportation of Dangerous Goods Regulation.

Indicate specifically on the test requisition if the blood culture is for Legionella or Bartonella.