“Blood Culture Utilization in the Hospital Setting: A Call for Diagnostic Stewardship”.

Journal of Clinical Microbiology ◽

10.1128/jcm.01005-21 ◽

2021 ◽

Author(s):

Valeria Fabre ◽

Karen C. Carroll ◽

Sara E. Cosgrove

Keyword(s):

Blood Culture ◽

Hospital Setting ◽

Bloodstream Infections ◽

Culture Collection ◽

Blood Cultures ◽

Negative Consequences ◽

Detection Systems ◽

Molecular Tests ◽

Collection Practices ◽

Organism Identification

There has been significant progress in detection of bloodstream pathogens in recent decades with the development of more sensitive automated blood culture detection systems and availability of rapid molecular tests for faster organism identification and detection of resistance genes. However, most blood cultures in clinical practice do not grow organisms, suggesting that suboptimal blood culture collection practices (e.g., suboptimal blood volume) or suboptimal selection of patients to culture (i.e., blood cultures ordered for patients with low likelihood of bacteremia) may be occurring. A national blood culture utilization benchmark does not exist, nor do specific guidelines on when blood cultures are appropriate or when blood cultures are of low value and waste resources. Studies evaluating the potential harm associated with excessive blood cultures have focused on blood culture contamination which has been associated with significant increases in healthcare costs and negative consequences for patients related to exposure to unnecessary antibiotics and additional testing. Optimizing blood culture performance is important to ensure bloodstream infections (BSIs) are diagnosed while minimizing adverse events from overuse.

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1169. Preventing Central Line-Associated Bloodstream Infections in Long-Term Acute Care

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1032 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S418-S419

Author(s):

Jerry Jacob ◽

Ann Morace ◽

Jisuk Park ◽

Nina Renzi

Keyword(s):

Blood Culture ◽

Bloodstream Infections ◽

Central Line ◽

Culture Collection ◽

Blood Cultures ◽

Fiscal Year ◽

Intervention Period ◽

Central Lines ◽

Clabsi Rate

Abstract Background Long-term acute care hospitals (LTACHs) care for chronically, critically ill patients with high utilization of central lines and high risk for morbidity from central line-associated bloodstream infections (CLABSIs). Our 38-bed LTACH noted a substantial increase in the incidence of CLABSIs (as defined by the National Healthcare Safety Network) between fiscal year (FY) 2016 and FY 2018 (Figure 1). Detailed case review identified a large number of CLABSIs which were clinically consistent with blood culture contaminants from central lines. Feedback from bedside staff also suggested gaps between practice and evidence-based measures for central line care. Methods A three-pronged CLABSI prevention project was implemented in July 2018 consisting of (1) staff education regarding daily chlorhexidine (CHG) bathing for all patients, combined with an electronic audit report to identify patients without active CHG orders; (2) change in practice to the use of venipuncture alone for blood culture collection, combined with an electronic audit report to identify blood cultures collected from central lines; and (3) a recurring 6-part educational series for nurses focused on central line care. The pre-intervention period was defined as the 12-month period between July 1, 2017 and June 30, 2018 (FY 2018). The primary outcome was the fiscal year CLABSI rate. A secondary outcome was the proportion of blood cultures drawn from central lines. Results After 9 months of the intervention, one CLABSI had been reported for FY 2019 year-to-date at a rate of 0.4 per 1,000 CL-days, representing an 86% decrease from the FY 2018 rate of 2.8 per 1,000 CL-days. The 12-month rolling CLABSI rate decreased to 1.6 per 1,000 CL-days (Figure 2). The proportion of blood cultures collected from central lines decreased from 10.5% (69/658) to 4.5% (15/334), representing a 57% reduction. The proportion of patients ordered and receiving CHG bathing in the intervention period was >95%. Conclusion A multidisciplinary effort focused on CHG bathing, central line care, and blood culture collection led to a substantial reduction in CLABSIs in our LTACH. The use of electronic audit reports was particularly useful in achieving high adherence to practice changes. Disclosures All authors: No reported disclosures.

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908. Evaluation of Blood Culture Submission Rates in Japan

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1096 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S487-S488

Author(s):

Taichi Tajima ◽

Shinya Tsuzuki ◽

Yusuke Asai ◽

Mio Endo ◽

Nobuaki Matsunaga ◽

...

Keyword(s):

Blood Culture ◽

Bloodstream Infection ◽

Hospital Setting ◽

Bloodstream Infections ◽

Median Number ◽

Antimicrobial Treatment ◽

Blood Cultures ◽

Significant Difference ◽

Acute Hospitals ◽

Median Incidence

Abstract Background Blood culture tests are useful for accurate diagnosis of bacteremia and selection of antimicrobial treatment, and they are essential for instituting antimicrobial resistance (AMR) countermeasures. This study investigated blood culture submission rates in Japan and their association with the incidence of bloodstream infections. Methods Blood culture data recorded in the Japan Surveillance for Infection Prevention and Healthcare Epidemiology (J-SIPHE) database from January to December 2019 and data submitted for consecutive 12 months from acute care hospitals (hospitals with a mean length of patient stay of ≤19 days) were included for analysis. Samples comprised 1 set of blood culture samples (aerobic and anaerobic bottles) defined as one submission. The annual blood culture submission rate was calculated as the total number of submitted blood cultures per 1000 patients/day. The incidence of bloodstream infections was calculated as the number of positive blood cultures excluding contaminated specimens per 1000 patients/day. The blood culture submission rate was then divided into four categories, respectively: category 1: 0–15; category 2: 15–30; category 3: 30–45; and category 4: 45–80. The Kruskal-Wallis test was performed to determine overall difference among 4 submission rate categories and the Dunn test with Bonferroni correction was used to compare pairs of submission rate categories. Filtering of facilities for data analysis Results A total of 117 hospitals were included in the analysis. The median number of beds was 415.0 (interquartile ratio [IQR]: 274.5–549.5). The median incidence of bloodstream infection was 2.78 (2.17–3.87). The median blood culture submission rate was 26.18 (17.20–35.76). The median incidence of bloodstream infection by category of blood culture submission rate was 1.39, 2.53, 3.61, and 4.48, respectively; with a significant difference observed among the four categories overall (p< 0.01). Significant differences were observed between categories 1 and 2 and between categories 2 and 3 (both p< 0.01) but not between categories 3 and 4 (p=0.758). Characteristics of the acute hospitals by category of blood culture submission rate Incidence of bloodstream infections by category of blood culture submission rate Conclusion The blood culture submission rate is considered to be around 45 in the acute hospital setting in Japan. The incidence of bloodstream infections is greatly affected by submission rates. Disclosures All Authors: No reported disclosures

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Scanning Electron Microscope: A New Potential Tool to Replace Gram Staining for Microbe Identification in Blood Cultures

Microorganisms ◽

10.3390/microorganisms9061170 ◽

2021 ◽

Vol 9 (6) ◽

pp. 1170

Author(s):

Gabriel Haddad ◽

Sara Bellali ◽

Tatsuki Takakura ◽

Anthony Fontanini ◽

Yusuke Ominami ◽

...

Keyword(s):

Electron Microscope ◽

Blood Culture ◽

Scanning Electron Microscope ◽

Sample Preparation ◽

Bloodstream Infections ◽

Blood Cultures ◽

Preliminary Identification ◽

Gram Staining ◽

Micro Organisms ◽

Scanning Electron

Blood culture is currently the most commonly used method for diagnosing sepsis and bloodstream infections. However, the long turn-around-time to achieve microbe identification remains a major concern for clinical microbiology laboratories. Gram staining for preliminary identification remains the gold standard. We developed a new rapid strategy using a tabletop scanning electron microscope (SEM) and compared its performance with Gram staining for the detection of micro-organisms and preliminary identification directly from blood cultures. We first optimised the sample preparation for twelve samples simultaneously, saving time on imaging. In this work, SEM proved its ability to identify bacteria and yeasts in morphotypes up to the genus level in some cases. We blindly tested 1075 blood cultures and compared our results to the Gram staining preliminary identification, with MALDI-TOF/MS as a reference. This method presents major advantages such as a fast microbe identification, within an hour of the blood culture being detected positive, low preparation costs, and data traceability. This SEM identification strategy can be developed into an automated assay from the sample preparation, micrograph acquisition, and identification process. This strategy could revolutionise urgent microbiological diagnosis of infectious diseases.

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A Sterile Collection Bundle Intervention Reduces the Recovery of Bacteria from Neonatal Blood Culture

Biomedicine Hub ◽

10.1159/000486703 ◽

2018 ◽

Vol 3 (1) ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Linze F. Hamilton ◽

Helen E. Gillett ◽

Adam Smith-Collins ◽

Jonathan W. Davis

Keyword(s):

Intensive Care ◽

Blood Culture ◽

False Positive ◽

Neonatal Intensive Care ◽

Intervention Group ◽

Group Versus ◽

Antibiotic Use ◽

Culture Collection ◽

Blood Cultures ◽

Before And After

Background: In neonatal intensive care, coagulase-negative Staphylococcus species can be both blood culture contaminants and pathogens. False-positive cultures can result in clinical uncertainty and unnecessary antibiotic use. Objective: This study sought to assess whether a sterile blood culture collection bundle would reduce the incidence of false-positive blood cultures in a regional neonatal intensive care unit. Method: Clinical data was collected from all infants who had blood cultures taken before and after the introduction of the sterile blood culture collection bundle intervention. This intervention required 2% chlorhexidine and full sterile precautions for blood culture collection. False-positive blood culture rates (presence of skin commensals and ≥3 clinical infection signs) were compared before and after the intervention. The number of days of unnecessary antibiotics associated with false-positive blood cultures was also analysed. Results: In the pre-intervention group (PRE) 197 cultures were taken from 161 babies. In the post-intervention group (POST) 170 cultures from 133 babies were acquired. Baseline demographics were similar in both groups. The rate of false-positive cultures in the PRE group versus the POST group was 9/197 (4.6%) compared to 1/170 (0.6%) (p < 0.05). Unnecessary antibiotic exposure was reduced in the PRE group in comparison to the POST group (27 vs. 0 days, p < 0.01). Conclusions: Implementation of sterile blood culture collection intervention reduced the number of false-positive results. This has potential benefit in reducing unnecessary antibiotic use.

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Identification of Potentially Unnecessary Micafungin Use Patterns: Opportunities for Antifungal Stewardship Interventions

Antimicrobial Stewardship & Healthcare Epidemiology ◽

10.1017/ash.2021.60 ◽

2021 ◽

Vol 1 (S1) ◽

pp. s32-s33

Author(s):

Miguel Chavez Concha ◽

Kevin Hsueh ◽

Michael Durkin ◽

Andrej Spec

Keyword(s):

Blood Culture ◽

Urine Culture ◽

Tracheal Aspirate ◽

Culture Collection ◽

Blood Cultures ◽

Urine Specimen ◽

Antifungal Stewardship ◽

Microbiological Test ◽

First Line Therapy ◽

Patterns Of Use

Background: Echinocandins are used as first-line therapy for suspected and confirmed Candida spp, and its indiscriminate use may drive selection for echinocandin resistance. We evaluated patterns of use of micafungin to identify opportunities for antifungal stewardship. Methods: We identified all micafungin completed orders and microbiological test result data from July 2018 to November 2020 among hospitalized patients in Barnes-Jewish Hospital. Continuous micafungin courses with <48 hours of interruption were considered independent courses. We evaluated micafungin use in 3 scenarios in which its use may be unnecessary: (1) patients with blood cultures negative for Candida spp, (2) patients with recovery of yeast or Candida spp from tracheal aspirates, and (3) patients with recovery of yeast or Candida spp from urine cultures. We only included micafungin courses if they were initiated within 5 days of blood culture collection or up to 4 days after tracheal or urine culture collection to account for incubation and decision to initiate treatment. Results: We found 3,381 micafungin courses in 3,287 admissions. Of these, 2,532 courses had blood culture collection around micafungin initiation and were included in the first analysis: 1,879 (74%) were negative, 149 (6%) had Candida spp isolated in the blood, and 504 (20%) had positive blood cultures for other organisms. Micafungin was given for a median duration of 3 days (IQR, 2–7) to those with negative blood cultures and for 3 days (IQR, 1–5) to those with positive blood cultures without candidemia (p < 0.001), and prolonged durations of more than 5 days was seen in 768/1879 (41%) and 143/504 (28%) of courses, respectively (p <0.001). A total of 487 micafungin courses were initiated after tracheal aspirate culture collection. Those with yeast isolated (n = 100, 21%) received similar micafungin duration compared to those that had no yeast isolated [3 (2-7 IQR) vs. 3 (2-7) days, respectively; p = 0.56). Finally, a total of 844 micafungin courses started after urine culture collection. A total of 49 (6%) had yeast isolated from the urine and treatment duration was similar to those that did not [3 (1-6 IQR) vs. 3 (2-6) days, respectively; p = 0.87). Conclusions: Echinocandin treatment courses did not differ when a yeast was identified from a tracheal isolate or urine specimen. However, a substantial proportion of treatment courses were prolonged in those with negative Candida spp in the blood, suggesting opportunities for antifungal stewardship interventions.Funding: NoDisclosures: None

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Molecular epidemiology of catheter-related bloodstream infections caused by coagulase-negative staphylococci in haematological patients with neutropenia

Epidemiology and Infection ◽

10.1017/s0950268804002584 ◽

2004 ◽

Vol 132 (5) ◽

pp. 921-925 ◽

Cited By ~ 9

Author(s):

M. MÜLLER-PREMRU ◽

P. ČERNELČ

Keyword(s):

Blood Culture ◽

Staphylococcus Epidermidis ◽

Clinical Signs ◽

Bloodstream Infections ◽

Venous Catheter ◽

Blood Cultures ◽

Peripheral Vein ◽

Central Venous ◽

Coagulase Negative Staphylococci ◽

Haematological Patients

Catheter-related bloodstream infection (CRBSI) caused by coagulase-negative staphylococci (CNS) is common in haematological patients with febrile neutropenia. As the clinical signs of CRBSI are usually scarce and it is difficult to differentiate from blood culture contamination, we tried to confirm CRBSI by molecular typing of CNS isolated from paired blood cultures (one from a peripheral vein and another from the central venous catheter hub). Blood cultures were positive in 59 (36%) out of 163 patients. CNS were isolated in 24 (40%) patients; in 14 from paired blood cultures (28 isolates) and in 10 from a single blood culture. CNS from paired blood cultures were identified as Staphylococcus epidermidis. Antimicrobial susceptibility was determined and bacteria were typed by pulsed-field gel electrophoresis (PFGE) of bacterial genomic DNA. In 13 patients, the antibiotic susceptibility of isolates was identical. The PFGE patterns from paired blood cultures were identical or closely related in 10 patients, thus confirming the presence of CRBSI. In the remaining four patients they were unrelated, and suggested a mixed infection or contamination. Since CNS isolates from three patients had identical PFGE patterns, they were probably nosocomially spread amongst them.

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Clinical Evaluation of the iCubate iC-GPC Assay for Detection of Gram-Positive Bacteria and Resistance Markers from Positive Blood Cultures

Journal of Clinical Microbiology ◽

10.1128/jcm.00485-18 ◽

2018 ◽

Vol 56 (9) ◽

Cited By ~ 5

Author(s):

Paul A. Granato ◽

Melissa M. Unz ◽

Raymond H. Widen ◽

Suzane Silbert ◽

Stephen Young ◽

...

Keyword(s):

Blood Culture ◽

Staphylococcus Epidermidis ◽

Bloodstream Infections ◽

Blood Cultures ◽

Gram Positive ◽

Content Type ◽

Gram Positive Bacteria ◽

Sequencing Method ◽

Resistance Markers ◽

Gram Positive Cocci

ABSTRACT The iC-GPC Assay (iCubate, Huntsville, AL) is a qualitative multiplex test for the detection of five of the most common Gram-positive bacteria (Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae, Enterococcus faecalis, and Enterococcus faecium) responsible for bacterial bloodstream infections, performed directly from positive blood cultures. The assay also detects the presence of the mecA, vanA, and vanB resistance determinants. This study comparatively evaluated the performance of the iC-GPC Assay against the Verigene Gram-positive blood culture (BC-GP) assay (Luminex Corp., Austin, TX) for 1,134 patient blood culture specimens positive for Gram-positive cocci. The iC-GPC Assay had an overall percent agreement with the BC-GP assay of 95.5%. Discordant specimens were further analyzed by PCR and a bidirectional sequencing method. The results indicate that the iC-GPC Assay together with the iCubate system is an accurate and reliable tool for the detection of the five most common Gram-positive bacteria and their resistance markers responsible for bloodstream infections.

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The Addition of Anaerobic Blood Cultures for Pediatric Patients with Concerns for Bloodstream Infections: Prevalence and Time to Positive Cultures

Journal of Clinical Microbiology ◽

10.1128/jcm.01844-19 ◽

2020 ◽

Vol 58 (9) ◽

Author(s):

Jennifer Dien Bard ◽

Todd P. Chang ◽

Rebecca Yee ◽

Keya Manshadi ◽

Nhan Lichtenfeld ◽

...

Keyword(s):

Blood Culture ◽

Pediatric Patients ◽

Bloodstream Infections ◽

Pediatric Emergency ◽

Blood Cultures ◽

Secondary Outcome ◽

Culture Positivity ◽

Blood Culture Positivity ◽

Anaerobic Bottle ◽

Clinically Significant

ABSTRACT Anaerobes are an important but uncommon cause of bloodstream infections (BSIs). For pediatric patients, routine inclusion of an anaerobic blood culture alongside the aerobic remains controversial. We implemented automatic anaerobic blood culture alongside aerobic blood cultures in a pediatric emergency department (ED) and sought to determine changes in recovery of obligate and facultative anaerobes. This was a cohort study in a pediatric ED (August 2015 to July 2018) that began in February 2017. Blood culture positivity results for true pathogens and contaminants were assessed, along with a secondary outcome of time to positivity (TTP) of blood culture. A total of 14,180 blood cultures (5,202 preimplementation and 8,978 postimplementation) were collected, with 8.8% (456) and 7.1% (635) positive cultures in the pre- and postimplementation phases, respectively. Of 635 positive cultures in the postimplementation phase, aerobic blood cultures recovered 7.6% (349/4,615), whereas anaerobic blood cultures recovered 6.6% (286/4,363). In 211/421 (50.0%) paired blood cultures, an organism was recovered in both cultures. The number of cases where organisms were only recovered from an aerobic or an anaerobic bottle in the paired cultures were 126 (30.0%) and 84 (20.0%), respectively. The TTP was comparable regardless of bottle type. Recovery of true pathogens from blood cultures was approximately 7 h faster than recovery of contaminants. Although inclusion of anaerobic blood cultures only recovered 2 (0.69%) obligate anaerobes, it did allow for recovery of clinically significant pathogens that were negative in aerobic blood cultures and supports the routine collection of both bottles in pediatric patients with a concern of bloodstream infections.

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Drawing blood cultures through intravascular catheters: Controversy and update

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2019.37 ◽

2019 ◽

Vol 40 (4) ◽

pp. 457-459 ◽

Cited By ~ 1

Author(s):

Leonard A. Mermel

Keyword(s):

Blood Culture ◽

Central Venous Catheter ◽

Venous Catheter ◽

Culture Collection ◽

Blood Cultures ◽

Central Venous ◽

Intravascular Catheters

AbstractStudies published between 1999 and 2011 demonstrated increased blood culture contamination with catheter-drawn cultures compared with percutaneously-drawn cultures. Studies published between 2012 and 2015 reported that use of antiseptic barrier caps on central venous catheter hubs significantly reduces the incidence of catheter-drawn blood culture contamination. Local guidelines regarding sites for blood culture collection should reflect institution-level blood culture contamination rates for percutaneously-drawn and catheter-drawn cultures using currently available technologies that reduce contamination at both sites.

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