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Blood culture bottle culture of pleural fluid in pleural infection
  1. Sarah M Menzies1,
  2. Najib M Rahman1,
  3. John M Wrightson1,
  4. Helen E Davies1,
  5. Robert Shorten2,
  6. Stephen H Gillespie2,
  7. Christopher W H Davies3,
  8. Nick A Maskell4,
  9. Andrew A Jeffrey5,
  10. Y C Gary Lee1,
  11. Robert J O Davies1
  1. 1UKCRC Oxford Respiratory Trials Unit, Churchill Hospital, Oxford, UK
  2. 2Department of Medical Microbiology, Royal Free Hospital, London, UK
  3. 3Department of Respiratory Medicine, Royal Berkshire Hospital, Reading, UK
  4. 4Department of Respiratory Medicine, Southmead Hospital, Bristol, UK
  5. 5Chest Clinic, Northampton General Hospital, Northampton, UK
  1. Correspondence to S M Menzies, Wexham Park Hospital, Slough, Berkshire SL2 4HL, UK; drsmenzies{at}


Background Pleural infection is common, and has a >30% major morbidity and mortality—particularly when infection is caused by Gram-negative, Staphylococcus aureus or mixed aerobic pathogens. Standard pleural fluid culture is negative in ∼40% of cases. Culturing pleural fluid in blood culture bottles may increase microbial yield, and is cheap and easy to perform.

Objectives To determine whether inoculating pleural fluid into blood culture bottles increases the culture positivity of pleural infection over standard laboratory culture, and to assess the optimum volume of inoculum to introduce.

Methods 62 patients with pleural infection were enrolled. Pairs of aerobic and anaerobic blood culture bottles were inoculated at the bedside with 2, 5 or 10 ml of pleural fluid, and two pleural fluid specimens were sent for standard culture. Pleural fluid from nine control patients was cultured to test for ‘false-positive’ results.

Results The addition of blood culture bottle culture to standard culture increased the proportion of patients with identifiable pathogens by 20.8% (20/53 (37.7%) to 31/53 (58.5%) (difference 20.8%, 95% CI difference 8.9% to 20.8%, p<0.001)). The second standard culture did not similarly improve the culture positivity (19/49 (38.8%) to 22/49 (44.9%) (difference 6.1%, 95% CI difference −2.5% to 6.1%, p=0.08)). The culture inoculum volume did not influence bacterial isolation frequency. The control fluids were culture negative.

Conclusions Blood culture bottle culture of infected pleural fluid increases microbial yield when used in addition to standard culture. This technique should be part of routine care.

  • Empyema
  • pleural/aetiology
  • pleural effusion
  • culture media
  • microbiological techniques/methods
  • blood culture bottles
  • bacterial infection
  • pleural disease

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  • See Editorial, p 649

  • Linked articles 161315, 156406.

  • Funding This study was funded by the NIHR Oxford Biomedical Research Centre Programme.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Oxfordshire Regional Ethics Committee (reference 05/Q1605/5).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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