Obtaining appropriate cultures before initiating
antimicrobial therapy is recommended, provided
that doing so does not delay the administration of
antimicrobial agents longer than 45 minutes (grade
1C). In order to optimize identification of causative
organisms, at least 2 sets of blood samples (both
aerobic and anaerobic bottles) should be cultured
before antibiotic therapy is started. As outlined in
the guidelines, at least one of the blood samples for
culture should be obtained percutaneously and one
sample should be obtained through each vascular
access device, although a blood sample need not be
obtained through a vascular device if the device was
inserted less than 48 hour earlier.1 Other samples such
as urine, respiratory secretions, wounds, or other
body fluids that may be the source of infection should
also be collected for culture before antibiotic therapy
if obtaining such samples is not associated with
significant delay in administration of the antibiotic
(grade 1C).
Nurses play a direct role in obtaining samples
for culture and in administering antibiotic therapy
and can therefore have a significant impact on maximizing
the identification of the source of infection
as well as ensuring that patients receive prompt
antibiotic therapy. As outlined in the guidelines, if
various culture results show the same organism, the
likelihood that the organism is causing the severe
sepsis is enhanced.1 The importance of obtaining 2
samples from different sources to maximize the potential
of obtaining a positive culture result cannot be
underestimated. Ensuring that samples are obtained
by using appropriate technique to prevent contamination
of the culture results also is important.