Initiatives to quality improvement and standardization of blood culture protocols to enable clinical utility of blood cultures in a tertiary care cardiology hospital

Abstract Objective: To determine patient-specific risk factors and clinical outcomes associated with contaminated blood cultures. Design: A single-center, retrospective case-control risk factor and clinical outcome analysis performed on inpatients with blood cultures collected in the emergency department, 2014–2018. Patients with contaminated blood cultures (cases) were compared to patients with negative blood cultures (controls). Setting: A 509-bed tertiary-care university hospital. Methods: Risk factors independently associated with blood-culture contamination were determined using multivariable logistic regression. The impacts of contamination on clinical outcomes were assessed using linear regression, logistic regression, and generalized linear model with γ log link. Results: Of 13,782 blood cultures, 1,504 (10.9%) true positives were excluded, leaving 1,012 (7.3%) cases and 11,266 (81.7%) controls. The following factors were independently associated with blood-culture contamination: increasing age (adjusted odds ratio [aOR], 1.01; 95% confidence interval [CI], 1.01–1.01), black race (aOR, 1.32; 95% CI, 1.15–1.51), increased body mass index (BMI; aOR, 1.01; 95% CI, 1.00–1.02), chronic obstructive pulmonary disease (aOR, 1.16; 95% CI, 1.02–1.33), paralysis (aOR 1.64; 95% CI, 1.26–2.14) and sepsis plus shock (aOR, 1.26; 95% CI, 1.07–1.49). After controlling for age, race, BMI, and sepsis, blood-culture contamination increased length of stay (LOS; β = 1.24 ± 0.24; P < .0001), length of antibiotic treatment (LOT; β = 1.01 ± 0.20; P < .001), hospital charges (β = 0.22 ± 0.03; P < .0001), acute kidney injury (AKI; aOR, 1.60; 95% CI, 1.40–1.83), echocardiogram orders (aOR, 1.51; 95% CI, 1.30–1.75) and in-hospital mortality (aOR, 1.69; 95% CI, 1.31–2.16). Conclusions: These unique risk factors identify high-risk individuals for blood-culture contamination. After controlling for confounders, contamination significantly increased LOS, LOT, hospital charges, AKI, echocardiograms, and in-hospital mortality.

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Reducing the Contamination Rate and the Unnecessary Requesting of Blood Culture Test through Quality Improvement Project

10.51429/ejmm30111 ◽

2021 ◽

Vol 30 (1) ◽

pp. 87-91

Author(s):

Tamer Mohamed ◽

Ashraf A Askar ◽

Jamila Chahed

Keyword(s):

Quality Improvement ◽

Blood Culture ◽

Armed Forces ◽

Blood Cultures ◽

Quality Improvement Project ◽

Contamination Rate ◽

Improvement Project ◽

Culture Test ◽

Negative Results ◽

Before And After

Background: Blood stream infections are major leading causes of morbidity and mortality in hospitalized patients. Increasing the awareness of the clinicians and nurses about the proper protocol of blood culture test is very important in reducing the contamination rate and the unnecessary requesting of blood culture. Objectives: to reduce the contamination rate and the unnecessary requesting of blood culture from different departments through implementation of hospital wide Quality Improvement Project (QIP). Methodology: Blood cultures were tested in the Microbiology Laboratory of Najran Armed Forces hospital, Saudi Arabia, in the period from June 2019 to July 2020 and their results were compared before and after the implementation of the QIP. Results: The comparison between the blood cultures results before and after QIP implementation showed statistically significant (19.6%) reduction in the contamination rate, (14%) reduction in the total number of blood culture requests and (11.6%) reduction in the negative results rate. Conclusion: The reduction in the total number, negative results and contamination rate of blood culture test after QIP implementation were considered as performance indicators that the recommendations of QIP were effective and implemented strictly.

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Controlled Comparative Evaluation of BacT/Alert FAN and ESP 80A Aerobic Media as Means for Detecting Bacteremia and Fungemia

Journal of Clinical Microbiology ◽

10.1128/jcm.36.9.2686-2689.1998 ◽

1998 ◽

Vol 36 (9) ◽

pp. 2686-2689 ◽

Cited By ~ 14

Author(s):

Gary V. Doern ◽

Ann Barton ◽

Sudah Rao

Keyword(s):

Blood Culture ◽

Antimicrobial Therapy ◽

Enhanced Recovery ◽

Tertiary Care ◽

Blood Cultures ◽

Two Systems ◽

Absorbing Material ◽

Clinically Significant ◽

One Year ◽

Organism Group

During a one-year period, a total of 6,305 blood cultures were processed in a tertiary-care teaching hospital; 6 to 12 ml of blood was inoculated into both a BacT/Alert Fan aerobic bottle and an ESP 80A aerobic bottle. The FAN aerobic bottle contains an antimicrobial-absorbing material; the 80A aerobic bottle does not. Bottles were processed on their respective continuous-monitoring blood culture instruments for up to five days of incubation. Four hundred thirty-three cultures (6.9%) representing 301 septic episodes in 235 different patients yielded 490 bacteria or yeasts thought to be clinically significant. Two hundred seventy-five of the 433 presumed clinically significant positive cultures (63.5%) representing 195 septic episodes and yielding 301 isolates were positive in both FAN and 80A bottles. One hundred nine significant positive cultures (25.2%) (i.e., cultures positive with an organism judged to be of probable clinical significance) from 70 septic episodes yielded 126 isolates only in FAN bottles. Conversely, the 80A bottle was exclusively positive in 49 instances (11.3%), representing 36 septic episodes and yielding 63 isolates. The higher rates of significant positive blood cultures, numbers of septic episodes documented, and numbers of isolates recovered in FAN bottles versus 80A bottles were all statistically significant (P < 0.05). Enhanced rates of detection of presumed clinically significant isolates in FAN bottles were largely accounted for by Staphylococcus aureus, members of the Enterobacteriaceae, and non-Pseudomonas aeruginosa miscellaneous gram-negative bacilli from patients receiving antimicrobial therapy at the time blood cultures were obtained. Enhanced recovery of one organism group, the β-hemolytic streptococci, occurred in 80A. With one exception, detection times were essentially equivalent in the two systems. The single exception pertained to streptococci and enterococci, which were recovered significantly faster in 80A bottles. Three hundred thirty-eight of the 6,305 blood cultures evaluated in this study (5.4%) were judged likely to be contaminated. The percentages of probable contaminated cultures were as follows: 26.6% FAN and 80A; 42.3% FAN only; 31.1% 80A only (P < 0.05). Finally, the instrument false-positive rates for the two systems were 0.7% with FAN and 3.0% with 80A (P < 0.05). We conclude that while contamination rates were slightly higher with FAN than with 80A, use of FAN aerobic bottles in conjunction with the BacT/Alert system will yield significantly higher numbers of clinically significant blood culture isolates than 80A bottles and the ESP system. Furthermore, this enhanced detection is most conspicuous in patients receiving antimicrobial therapy at the time blood cultures are performed, probably due to the presence of an antimicrobial-absorbing material in FAN aerobic bottles.

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A retrospective analysis of community-onset bloodstream infections at a tertiary-care academic hospital in South Africa. Are current empiric antimicrobial practices appropriate?

Antimicrobial Stewardship & Healthcare Epidemiology ◽

10.1017/ash.2021.236 ◽

2021 ◽

Vol 1 (1) ◽

Author(s):

Vinitha Alex ◽

Trusha Nana ◽

Vindana Chibabhai

Keyword(s):

South Africa ◽

Blood Culture ◽

Antimicrobial Agents ◽

Tertiary Care ◽

Laboratory Data ◽

Blood Cultures ◽

Contamination Rate ◽

Older Children ◽

Academic Hospital ◽

Community Onset

Abstract Background: Community-onset bloodstream infection (CO-BSI) is associated with substantial morbidity and mortality. Knowledge of locally prevalent pathogens and antimicrobial susceptibility patterns can promptly guide appropriate empiric therapy and improve outcomes. Objectives: We sought to determine the epidemiology of CO-BSI, the blood culture positivity rate and the contamination rate. We also sought to establish appropriateness of current empiric antimicrobial therapy practices. Methods: We retrospectively analyzed blood cultures taken from January 2015 to December 2019 at the emergency departments (EDs) of a tertiary-care academic hospital in South Africa using extracted laboratory data. Results: The overall positivity rate of blood cultures taken at the EDs was 15% (95% confidence interval [CI], 0.15–0.16) and the contamination rate was 7% (95% CI, 0.06–0.07). Gram-positive bacteria predominated in the pediatric cohort: neonates, 52 (54%) of 96; infants, 57 (52%) of 109; older children, 63 (61%) of 103. Methicillin-susceptible Staphylococcus aureus was the predominant pathogen among older children: 30 (35%) of 85. Escherichia coli was the most common pathogen isolated among adults and the elderly: 225 (21%) of 1,060 and 62 (29%) of 214, respectively. Among neonates, the susceptibility of E. coli and Klebsiella pneumoniae to the combination of ampicillin and gentamicin was 17 (68%) of 25. Among adults, the susceptibility of the 5 most common pathogens to amoxicillin-clavulanate was 426 (78%) of 546 and their susceptibility to ceftriaxone was 481 (85%) of 565 (P = .20). The prevalence of methicillin-resistant S. aureus, extended-spectrum β-lactamase–producing and carbapenem-resistant Enterobacterales were low among all age groups. Conclusions: Review of blood culture collection techniques is warranted to reduce the contamination rate. High rates of resistance to currently prescribed empiric antimicrobial agents for CO-BSI warrants a re-evaluation of local guidelines.

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Limited Clinical Utility of Follow-up Blood Cultures in Patients With Streptococcal Bacteremia: An Opportunity for Blood Culture Stewardship

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa541 ◽

2020 ◽

Vol 7 (12) ◽

Author(s):

Emily A Siegrist ◽

Minkey Wungwattana ◽

Leyla Azis ◽

Patricia Stogsdill ◽

Wendy Y Craig ◽

...

Keyword(s):

Blood Culture ◽

Clinical Utility ◽

Epidural Abscess ◽

Vertebral Osteomyelitis ◽

Blood Cultures ◽

Inclusion Criteria ◽

Streptococcal Species ◽

Persistent Bacteremia ◽

Polymicrobial Bacteremia

Abstract Background The value of positive follow-up blood cultures (FUBCs) in streptococcal bacteremia has not been well defined. Therefore, we explored the frequency of and risk factors for positive FUBC in a retrospective cohort of patients with streptococcal bacteremia. Methods Adults ≥18 years of age, admitted with at least 1 positive blood culture for Streptococcus spp between 2013 and 2018 followed by at least 1 FUBC, were potentially eligible. Positive FUBCs were defined as cultures positive for the same streptococcal species drawn >24 hours after the index culture. We excluded patients with polymicrobial bacteremia. We compared the characteristics of patients with and without a positive FUBC. Results In our single-center cohort, we identified 590 patients with streptococcal bacteremia, and 314 patients met inclusion criteria. Ten patients had FUBC with Streptococcus spp (3.2%), 4 (1.3%) had a contaminant identified, and 3 (1.0%) had a new pathogen isolated. Endocarditis (5 of 10 [50.0%] vs 35 of 304 [11.5%]), epidural abscess (2 of 10 [20%] vs 4 of 304 [1.3%]), and discitis or vertebral osteomyelitis (3 of 10 [30.0%] vs 14 of 304 [4.6%]) were associated with positive FUBC. Patients with positive FUBC had a longer median length of stay (12.9 vs 7.1 days, P = .004) and longer duration of antibiotic treatment (14.9 vs 43.2 days, P = .03). Conclusions Follow-up blood cultures among patients with streptococcal BSI are rarely positive. Clinicians could consider limiting follow-up blood cultures in patients at low risk for deep-seated streptococcal infections, persistent bacteremia, or endovascular infection.

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Strengthening sepsis care at a tertiary care teaching hospital in New Delhi, India

BMJ Open Quality ◽

10.1136/bmjoq-2020-001335 ◽

2021 ◽

Vol 10 (Suppl 1) ◽

pp. e001335

Author(s):

Charu Malhotra ◽

Akshay Kumar ◽

Ankit Kumar Sahu ◽

Akshaya Ramaswami ◽

Sanjeev Bhoi ◽

...

Keyword(s):

Blood Culture ◽

Hospital Mortality ◽

Teaching Hospital ◽

Screening Tool ◽

Tertiary Care ◽

Blood Cultures ◽

Antibiotic Administration ◽

Suspected Sepsis ◽

Tertiary Care Teaching Hospital ◽

Care Teaching

IntroductionFailure of early identification of sepsis in the emergency department (ED) leads to significant delays in antibiotic administration which adversely affects patient outcomes.AimThe primary objective of our Quality Improvement (QI) project was to reduce the door-to-antibiotic time (DTAT) by 30% from the preintervention in patients with suspected sepsis. Secondary objectives were to increase the blood culture collection rate by 30% from preintervention, investigate the predictors of improving DTAT and study the effect of these interventions on 24-hour in-hospital mortality.MethodsThis QI project was conducted in the ED of a tertiary care teaching hospital of North India; the ED receives approximately 400 patients per day. Adult patients with suspected sepsis presenting to our ED were included in the study, between January 2019 and December 2020. The study was divided into three phases; preintervention phase (100 patients), intervention phase (100 patients) and postintervention phase (93 patients). DTAT and blood cultures prior to antibiotic administration was recorded for all patients. Blood culture yield and 24-hour in-hospital mortality were also recorded using standard data templates. Change ideas planned by the Sepsis QI Team were implemented after conducting plan-do-study-act cycles.ResultsThe median DTAT reduced from 155 min in preintervention phase to 78 min in postintervention phase. Drawing of blood cultures prior to antibiotic administration improved by 67%. Application of novel screening tool at triage was found to be an independent predictor of reduced DTAT.ConclusionOur QI project identified the existing lacunae in implementation of the sepsis bundle which were dealt with in a stepwise manner. The sepsis screening tool and on-site training improved care of patients with sepsis. A similar approach can be used to deal with complex quality issues in other high-volume low-resource settings.

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Assessment of clinical profile, antibiotic sensitivity and prescription pattern in blood culture positive enteric fever among pediatric and adult patients admitted in a tertiary care hospital: a prospective study

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20193696 ◽

2019 ◽

Vol 7 (9) ◽

pp. 3270

Author(s):

Swapnil Gautam ◽

Suraj Purushothaman ◽

Kinjal P. Patel ◽

Ajay P. Sankhe ◽

Madhuri R. Mahadik

Keyword(s):

Blood Culture ◽

Prospective Study ◽

Enteric Fever ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Antibiotic Sensitivity ◽

Multidrug Resistant ◽

Blood Cultures ◽

Care Hospital ◽

Prescription Pattern

Background: Asterion Introduction: Enteric fever is a major concern in developing country. It is predominantly caused by serovars typhi and paratyphi of Salmonella enterica. Recently, an upsurge in antimicrobial resistant strains has worsened the management of enteric fever. So, aim of present study is to evaluate the clinical profile, antibiotic sensitivity and prescription pattern in blood culture proven cases of enteric fever in pediatric and adult patients.Methods: Single centre, prospective study was conducted at a tertiary care hospital. Demographic and clinical details of blood culture proven enteric fever admitted in hospital were collected over the period from August 2016 to November 2018.Results: Total 58 blood cultures grew Salmonella spp. , amongst them 84.48 % had growth of Salmonella typhi. Blood culture was sent after a mean period of 9 days and 10 days of fever in pediatric and adult patients respectively. All isolates of S. paratyphi A were pansusceptible, whereas 36.73 % isolates of S. typhi were multidrug resistant and nalidixic acid resistant. 68.97% patients received antibiotics before admission. The difference between mean time to defervescence in patients who received ceftriaxone and those who received more than one antibiotic was not statistically significant. (P value 0.87)Conclusion: Blood cultures are the important diagnostic tool to identify multidrug resistant Salmonellae. Study showed that combination therapy was not statistically superior and awareness of local antimicrobial susceptibility pattern significantly helps for better management of the patients.

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103. An Association Between Abnormal CSF Analysis and Inpatient Mortality in Cryptococcal Meningitis, a Tertiary Care Center Experience

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.103 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S65-S65

Author(s):

Jordan Resnick ◽

Emad A Chishti ◽

Mahesh Bhatt ◽

Thein Myint

Keyword(s):

Blood Culture ◽

Cryptococcal Meningitis ◽

Care Center ◽

Tertiary Care ◽

Blood Cultures ◽

Tertiary Care Center ◽

Inclusion Criteria ◽

Inpatient Mortality ◽

Csf Analysis ◽

Survivor Group

Abstract Background Cryptococcal meningitis (CM) is a life-threatening condition that requires prompt recognition and management. With high morbidity in mind, we elected to compare the key CSF analysis, blood culture and serum cryptococcal antigen (CrAg) to prognosticate the probability of mortality in this population. Table 1. Comparison of demographics, serum and CSF analysis Methods We retrospectively reviewed all charts of patients admitted to our tertiary care center from 10/2005 to 10/2017. Inclusion criteria encompassed patients with positive CSF CrAg, positive CSF cultures, India ink, cytopathology, or CSF cell count >5 with CNS symptoms, positive serum CrAg titer or blood cultures. Results Sixty patients who met the inclusion criteria were divided into the survivor (n=41) and the non-survivor (n=19) groups based on the inpatient mortality. There was no difference in age, sex, and immune status between the two groups. The median CSF nucleated cell counts in the non-survivor group was 39 cells/µL with median lymphocyte 59.5% whereas in the survivor group was 72 cells/µL with median lymphocyte 76% (P< 0.001 and 0.04 respectively). The median CSF glucose was 27 mg/ml in the non-survivor compared to 35 mg/ml in the survivor group (P=0.02). Median CSF CrAg was higher at 1:1024 in the non-survivor group whereas the survivor group was 1:256 (P < 0.01). CSF opening pressure (cm H2O), blood culture, and serum CrAg level were not statistically significant between the two groups. Conclusion Low CSF cell count, low glucose, and high CSF CrAg were independently associated with inpatient mortality in CM. This is in line with the prior findings. A novel finding in this study is significantly decreased median CSF lymphocyte % in the non-survivor group. Serum CrAg titer, positive blood cultures, and median CSF protein were not statistically significant between the two groups. However, a study with a larger sample size may be needed to confirm these findings. Disclosures All Authors: No reported disclosures

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Education and coaching to optimise blood culture volumes: continuous quality improvement in microbiology

BMJ Open Quality ◽

10.1136/bmjoq-2017-000228 ◽

2018 ◽

Vol 7 (3) ◽

pp. e000228

Author(s):

Claudia R Libertin ◽

Keith A Sacco ◽

Joy H Peterson

Keyword(s):

Quality Improvement ◽

Blood Culture ◽

Blood Volume ◽

Continuous Quality Improvement ◽

Blood Cultures ◽

Aerobic Culture ◽

Continuous Quality ◽

Fill Volume ◽

Major Variable ◽

Improvement Programme

The blood volume cultured in the detection of bacteraemia is a major variable in treating patients with systemic inflammatory response syndrome. The fact that drawing optimal volumes (8–10 mL) of blood for culture increases the sensitivity of the method is well established. This study aimed to optimise the mean blood volumes (mBVs) to that recommended level in a small rural hospital by implementing a continuous quality improvement programme in clinical microbiology. The education of phlebotomists, followed by monthly feedback and coaching sessions, can influence the blood volume drawn by phlebotomists and improve the sensitivity of blood cultures. Statistically significant increase (p<0.001) in both mBVs and median blood culture volumes occurred within 5 months compared with the baseline values obtained in the preceding 10 months. This quality improvement was sustained over 1 year. The mBVs inoculated into aerobic culture bottles met the manufacturer’s instructions of a fill volume of 8 to 10 mL of blood per bottle and optimised the yield of isolation of organisms from blood cultures.

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Comparison of the Lysis Centrifugation Method with the Conventional Blood Culture Method in Cases of Sepsis in a Tertiary Care Hospital

Journal of Laboratory Physicians ◽

10.4103/0974-2727.105588 ◽

2012 ◽

Vol 4 (02) ◽

pp. 089-093 ◽

Cited By ~ 1

Author(s):

Harshal R Parikh ◽

Anuradha S De ◽

Sujata M Baveja

Keyword(s):

Blood Culture ◽

Tertiary Care ◽

Culture Method ◽

Blood Cultures ◽

P Value ◽

Care Hospital ◽

Culture Methods ◽

Centrifugation Method ◽

Considerable Morbidity ◽

Time Required

ABSTRACT Introduction: Physicians and microbiologists have long recognized that the presence of living microorganisms in the blood of a patient carries with it considerable morbidity and mortality. Hence, blood cultures have become critically important and frequently performed test in clinical microbiology laboratories for diagnosis of sepsis Objectives: To compare the conventional blood culture method with the lysis centrifugation method in cases of sepsis. Materials and Methods: Two hundred nonduplicate blood cultures from cases of sepsis were analyzed using two blood culture methods concurrently for recovery of bacteria from patients diagnosed clinically with sepsis – the conventional blood culture method using trypticase soy broth and the lysis centrifugation method using saponin by centrifuging at 3000 g for 30 minutes. Results: Overall bacteria recovered from 200 blood cultures were 17.5%. The conventional blood culture method had a higher yield of organisms, especially Gram positive cocci. The lysis centrifugation method was comparable with the former method with respect to Gram negative bacilli. The sensitivity of lysis centrifugation method in comparison to conventional blood culture method was 49.75% in this study, specificity was 98.21% and diagnostic accuracy was 89.5%. In almost every instance, the time required for detection of the growth was earlier by lysis centrifugation method, which was statistically significant. Contamination by lysis centrifugation was minimal, while that by conventional method was high. Time to growth by the lysis centrifugation method was highly significant (P value 0.000) as compared to time to growth by the conventional blood culture method. Conclusion: For the diagnosis of sepsis, combination of the lysis centrifugation method and the conventional blood culture method with trypticase soy broth or biphasic media is advocable, in order to achieve faster recovery and a better yield of microorganisms.

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