scholarly journals The Impact of Transit Times on the Detection of Bacterial Pathogens in Blood Cultures: A College of American Pathologists Q-Probes Study of 36 Institutions

2019 ◽  
Vol 144 (5) ◽  
pp. 564-571
Author(s):  
Gary W. Procop ◽  
Suzanne K. Nelson ◽  
Barbara J. Blond ◽  
Rhona J. Souers ◽  
Larry W. Massie
Keyword(s):  
Blood Culture ◽  
Transit Time ◽  
Bacterial Pathogens ◽  
Culture Collection ◽  
Blood Cultures ◽  
Process Time ◽  
Clinical Microbiology Laboratory ◽  
Additional Information ◽  
Time To Detection ◽  
The Impact

Context.— Consolidation of clinical microbiology laboratory services has resulted in extended transit time for blood cultures from service points distant from the laboratory. Sepsis is critical; delays in identification of etiologic agents of diseases could adversely impact patient care. Objective.— To examine the effect of total preanalytic time and blood culture volume on the instrument time-to-detection for bacterial pathogens in blood cultures. A secondary objective was to obtain relevant blood culture information by questionnaire. Design.— Participants in this Q-Probes study recorded date, time, and volume information for the first 50 positive blood cultures collected during the 12-week study period. Additional information regarding blood culture collection practices was obtained through questionnaire. Results.— Prolonged overall time-to-detection was secondary to prolonged preanalytic time, particularly prolonged transit time, rather than slower organism growth once bottles were placed on the instrument. Among 1578 blood cultures, the overall time from collection to positive result was significantly less for blood cultures collected on-site than for off-site locations. Most institutions lack sufficient training programs and do not monitor preanalytic time metrics associated with blood cultures. Four hundred fifty-six of the 1580 blood cultures with blood volume adequacy reported (28.9%) were inadequately filled. Conclusions.— Overall process time (specimen collection to positive blood culture detection) is predicted to be higher for blood cultures collected off-site. Transit time is a variable that can be reduced to decrease overall time to detection. Thus, improved training and closer attention to preanalytic metrics associated with blood cultures could decrease hospital stays and mortality rates.

scholarly journals 107. Impact of a Rapid Blood Culture Identification Panel at a Community Teaching Hospital: a Pre-Post Quasi-Experiment

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S68-S69
Author(s):  
Catherine Trinh ◽  
Steven Richardson ◽  
Benjamin Ereshefsky
Keyword(s):  
Targeted Therapy ◽  
Blood Culture ◽  
Culture Collection ◽  
Blood Cultures ◽  
Gram Stain ◽  
Post Intervention ◽  
Gram Positive ◽  
Days Of Therapy ◽  
Culture Identification ◽  
The Impact

Abstract Background Rapid diagnostic tests (RDT) for positive blood cultures can lead to quicker identification of organisms and key resistance elements. As a result time to targeted therapy may decrease, thus reducing the duration of broad, empiric antibiotic use. The purpose of this study was to determine the impact of implementing the BioFire® FilmArray® Blood Culture Identification (BCID) Panel for gram-positive organisms on antimicrobial process measures and patient outcomes at an academic community hospital. Methods This was a single-center, pre-post intervention, quasi-experimental study evaluating hospitalized adult patients who had at least one positive blood culture with gram-positive organisms from June 1, 2018 to August 31, 2018 and June 1, 2019 to August 31, 2019. Patients in the pre-intervention group were randomized and post-intervention patients were matched by identified organism. The primary outcome was the time to targeted therapy from blood culture collection. Secondary outcomes included time to targeted therapy from positive Gram stain, vancomycin and anti-pseudomonal β-lactam length of therapy (LOT), institutional vancomycin days of therapy (DOT), length of stay (LOS), and estimated hospitalization costs. Results A total of 75 patients in each group were included. The time to targeted therapy from blood culture collection was significantly decreased after RDT implementation [32.9 (23.2–51.8) hours vs. 49.2 (37.1–76.3 hours, p < 0.001)], as was time to targeted therapy from Gram stain results [8.5 (0–25.2) hours vs. 30 (19.4–52.9) hours, p < 0.001]. No difference was found between the groups with respect to LOS or estimated hospitalization cost. Overall the vancomycin LOT [0.86 (0.09–2.38) days vs. 2.18 (1.37–4.34) days, p = 0.001] and anti-pseudomonal β-lactam LOT for MRSA, MSSA, Streptococcus, and Enterococcus subgroup [1.15 (0.06–2.07) vs. 1.78 (1.28–2.89) days, p = 0.026] were significantly decreased in the post-RDT group. Figure 1: Institutional Use of Vnacomycin Conclusion Implementation of a rapid diagnostic test on gram-positive blood cultures was associated with decreased time to targeted therapy from blood culture collection, time to targeted therapy from positive culture, and vancomycin LOT. Disclosures All Authors: No reported disclosures

scholarly journals In Vitro Evaluation of BacT/Alert FA Blood Culture Bottles and T2Candida Assay for Detection of Candida in the Presence of Antifungals

2018 ◽  
Vol 56 (8) ◽  
Author(s):  
Nicholas D. Beyda ◽  
Jonathan Amadio ◽  
Jose R. Rodriguez ◽  
Karen Malinowski ◽  
Kevin W. Garey ◽  
...  
Keyword(s):  
Blood Culture ◽  
Whole Blood ◽  
Blood Cultures ◽  
Assay Sensitivity ◽  
Content Type ◽  
High Inoculum ◽  
Culture Sensitivity ◽  
Time To Detection ◽  
The Impact

ABSTRACT The T2Candida assay is a novel, non-culture-based assay for the diagnosis of candidemia directly from whole blood. The impact of antifungals on the performance of the T2Candida assay and blood culture bottles has not been well described. In this study, the performance of the T2Candida assay was compared to that of blood culture in detecting Candida spp. in spiked blood cultures with or without the presence of antifungals. Clinical bloodstream isolates of Candida spp. were inoculated into human whole blood at low (1 to 5 cells/ml) and high (10 to 50 cells/ml) concentrations with or without the presence of caspofungin and fluconazole. Time to detection (TTD) was assessed for prepared samples using BacT/Alert FA aerobic blood culture bottles or the T2Candida assay. In the absence of antifungals, T2Candida assay sensitivity was comparable to that of blood culture at both the low inoculum and the high inoculum (95% versus 97.5% and 100% versus 100%, respectively) and the assay had an average TTD that was significantly shorter (5.1 h versus 27.2 to 30 h, respectively). Neither caspofungin nor fluconazole was observed to impact the sensitivity or TTD of the T2Candida assay, while fluconazole reduced the overall blood culture sensitivity by 7.5% to 12.5% (at the low inoculum and high inoculum, respectively) and significantly increased the TTD of Candida albicans, C. tropicalis, and C. parapsilosis by 14.8 to 67 h. Neither caspofungin nor fluconazole impacted the performance of the T2Candida assay in vitro, and the assay may be useful for the diagnosis of candidemia in patients receiving antifungal therapy.

scholarly journals 1350. Optimizing Blood Culture Use in Critically Ill Children: Year One of a Multi-Center Diagnostic Stewardship Collaborative

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S685-S686
Author(s):  
Charlotte Z Woods-Hill ◽  
Danielle W Koontz ◽  
Annie Voskertchian MPH ◽  
Anping Xie PhD ◽  
Marlene R Miller ◽  
...  
Keyword(s):  
Blood Culture ◽  
Critically Ill ◽  
Culture Collection ◽  
Blood Cultures ◽  
Bright Star ◽  
Critically Ill Children ◽  
Site Specific ◽  
Phone Calls ◽  
The Mean ◽  
The Impact

Abstract Background Overuse of blood cultures can lead to false positives and unnecessary antibiotics. Our objective was to describe the implementation and 12-month impact of a multi-site quality improvement collaborative to reduce unnecessary blood cultures in pediatric intensive care unit (PICU) patients. Methods In 2018, 14 PICUs joined the Blood Culture Improvement Guidelines and Diagnostic Stewardship for Antibiotic Reduction in Critically Ill Children (Bright STAR) Collaborative, designed to understand and improve blood culture practices in PICUs. Guided by a multidisciplinary study team, sites 1) reviewed existing evidence for safe blood culture reduction, 2) assessed local practices and barriers to change, and 3) developed and implemented new blood culture practices informed by local context. We facilitated and monitored project progress through phone calls, site visits, and collaborative-wide teleconferences. We collected monthly blood culture rates and monitored for delays in culture collection as a safety balancing metric. We compared 24 months of baseline data to post-implementation data (2-14 months) using a Poisson regression model accounting for the site-specific patient days and correlation of culture use within a site over time. Results Across 14 sites, there were 41,986 pre-implementation blood cultures collected over 238,182 PICU patient days. The mean pre-implementation site-specific blood culture rate was 19.42 cultures/100 patient days (range 9.59 to 48.18 cultures/100 patient days). Post-implementation, there were 12,909 blood cultures collected over 118,600 PICU patient days. The mean post-implementation rate was 14.02 cultures/100 patient days (range 5.40 to 37.57 cultures/100 patient days), a 23% decrease (relative rate 0.77, 95% CI: 0.60, 0.99, p = 0.04). In 12 months post-implementation, sites reviewed 463 positive blood cultures, and identified only one suspected delay in culture collection possibly attributable to the site’s culture reduction program. Bright STAR Collaborative Site Blood Culture Rate 100 Patient Days Conclusion Multidisciplinary teams facilitated a 23% average reduction in blood culture use in 14 PICUs. Future work will determine the impact of blood culture diagnostic stewardship on antibiotic use and other important patient safety outcomes. Disclosures James C. Fackler MD, MD, Rubicon Health LLC (Other Financial or Material Support, Founder)

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

2018 ◽  
Vol 3 (1) ◽  
pp. 1-7 ◽  
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.

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

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

Blood Culture Contamination in the Clinical Microbiology Laboratory of a Teaching Hospital

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S133-S133
Author(s):  
Kemin Xu ◽  
Sarwat Gilani ◽  
Hank Wang ◽  
John Fallon
Keyword(s):  
Blood Culture ◽  
Teaching Hospital ◽  
Clinical Microbiology ◽  
Diagnostic Errors ◽  
Blood Cultures ◽  
Bacillus Species ◽  
Contamination Rate ◽  
Clinical Microbiology Laboratory ◽  
Current Guideline ◽  
Tertiary Teaching

Abstract Objectives Blood culture is one of the most important tests performed in clinical microbiology laboratories. However, blood culture contamination remains a problematic cause of diagnostic errors for laboratory diagnosis and patient management. This aim of this study was to determine blood culture contamination rates and tendency at Westchester Medical Center (WMC), a tertiary teaching hospital in suburban New York City. Methods All blood culture tests at WMC received from January 2017 to December 2018, as well as some historical data from 2007 to 2014, were retrospectively retrieved. Blood culture contamination rates were determined according to the laboratory’s predefined criteria. Results From 2007 to 2014, a total of 209,750 blood cultures were performed with an average contamination rate of 1.6% (ranging from 0.4% to 3.5% monthly). The total numbers of blood cultures performed in 2017 and 2018 were 27,863 and 28,047, respectively. The overall positive rate of blood culture was 6.8% in 2017 and 7.6% in 2018. The contamination rate of blood culture was 0.6% in 2017 and 0.9% in 2018 with very few variations among different months of the year, which was significantly lower than that of the national benchmark (~2.5%) on blood culture contamination. The majority of contaminants were Staphylococcus epidermidis, accounting for 87% of source contamination, followed by Corynebacterium species (5.5%), Bacillus species and Micrococcus species (3.5% each), and Propionibacterium species (0.5%). Conclusion Adherence to current guideline on appropriate blood collection techniques and monthly monitoring and timely feedback to phlebotomists should be continued to keep a low contamination rate for blood culture, which is not only from the perspective of individual patient care but also from the standpoint of hospital epidemiology and public health.

Drawing blood cultures through intravascular catheters: Controversy and update

2019 ◽  
Vol 40 (4) ◽  
pp. 457-459 ◽  
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.

Yield of positive blood cultures in pediatric oncology patients by a new method of blood culture collection

1996 ◽  
Vol 15 (7) ◽  
pp. 615-620 ◽  
Author(s):  
ATHANASIOS G. KADITIS ◽  
AENGUS S. O'MARCAIGH ◽  
K. HABLE RHODES ◽  
AMY L. WEAVER ◽  
NANCY K. HENRY
Keyword(s):  
Blood Culture ◽  
Pediatric Oncology ◽  
Culture Collection ◽  
Blood Cultures ◽  
New Method ◽  
Oncology Patients

Use of simulated blood cultures for time to detection comparison between BacT/ALERT™ and BACTEC™ 9240 blood culture systems

2002 ◽  
Vol 44 (3) ◽  
pp. 235-240 ◽  
Author(s):  
Egidio Francesco Viganò ◽  
Emanuela Vasconi ◽  
Carlo Agrappi ◽  
Pierangelo Clerici
Keyword(s):  
Blood Culture ◽  
Blood Cultures ◽  
Culture Systems ◽  
Time To Detection

scholarly journals Evaluation of an Initial Specimen Diversion Device (ISDD) on Rates of Blood Culture Contamination in the Emergency Department

2021 ◽  
Vol 14 ◽  
pp. 73-76
Author(s):  
Blake Buzard ◽  
Patrick Evans ◽  
Todd Schroeder
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Blood Culture ◽  
Blood Cultures ◽  
Contamination Rate ◽  
Total Hospital Cost ◽  
Initial Specimen ◽  
Significant Difference ◽  
Secondary Outcomes ◽  
The Impact

Introduction: Blood cultures are the gold standard for identifying bloodstream infections. The Clinical and Laboratory Standards Institute recommends a blood culture contamination rate of <3%. Contamination can lead to misdiagnosis, increased length of stay and hospital costs, unnecessary testing and antibiotic use. These reasons led to the development of initial specimen diversion devices (ISDD). The purpose of this study is to evaluate the impact of an initial specimen diversion device on rates of blood culture contamination in the emergency department.  Methods: This was a retrospective, multi-site study including patients who had blood cultures drawn in an emergency department. February 2018 to April 2018, when an ISDD was not utilized, was compared with June 2019 to August 2019, a period where an ISDD was being used. The primary outcome was total blood culture contamination. Secondary outcomes were total hospital cost, hospital and intensive care unit length of stay, vancomycin days of use, vancomycin serum concentrations obtained, and repeat blood cultures obtained.  Results: A statistically significant difference was found in blood culture contamination rates in the Pre-ISDD group vs the ISDD group (7.47% vs 2.59%, p<0.001). None of the secondary endpoints showed a statistically significant difference. Conclusions: Implementation of an ISDD reduces blood culture contamination in a statistically significant manner. However, we were unable to capture any statistically significant differences in the secondary outcomes.

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