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Cohen R, Tannous E, Natan OB, Vaknin A, Ganayem M, Reisfeld S, Lipman-Arens S, Mahamid L, Ishay L, Karisi E, Melnik N, Leibel M, Ashkar J, Freimann S. An emergency department intervention to improve earlier detection of community-onset bloodstream infection among hospitalized patients. Am J Infect Control 2024; 52:664-669. [PMID: 38232901 DOI: 10.1016/j.ajic.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/05/2024] [Accepted: 01/09/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND Blood cultures (BCs) are essential microbiologic tests, but blood culturing diagnostic stewardship is frequently poor. We aimed to study the process-related failures and to evaluate the effect of an emergency department (ED) intervention on BCs collection practices and yield. METHODS We implemented an ED-quality improvement intervention including educational sessions, phlebotomists addition, promoting single-site strategy for BC-collection and preanalytical data feedback. BC-bottles collected, positive BCs, blood volumes and documentation of collection times were measured, before (December 2021-August 2022) and after (September 2022-July 2023) intervention. Results were corrected to hospitalizations admissions or days. We used interrupted-time series analyses for comparisons. RESULTS A total of 64,295 BC bottles were evaluated, 26,261 before and 38,034 postintervention. The median ED-BCs collected per week increased from 88 to 105 BCs (P < .0001), resulting from increased early sampling (P = .0001). Solitary BCs decreased (95%-28%), documented times increased (2.8%-25%), and average blood volume increased (3 mL to 4.5 mL) postintervention. Community-onset Bloodstream infections (BSIs) increased (39.6-52 bottles/1,000 admissions, P = .0001), while Health care-associated BSIs decreased (39-27 bottles/10,000 days, P = .0042). Contamination rates did not change. CONCLUSIONS An ED-focused intervention based on the education sessions and single-site strategy improved culturing stewardship and facilitated the early identification of BSI without an increase in contamination.
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Affiliation(s)
- Regev Cohen
- Infection Control and Infectious Diseases Units, Hillel Yaffe Medical Centre, Hadera, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Elias Tannous
- Pharmacy Department, Hillel Yaffe Medical Centre, Hadera, Israel; Clinical Biochemistry and Pharmacology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Orna Ben Natan
- Infection Control and Infectious Diseases Units, Hillel Yaffe Medical Centre, Hadera, Israel
| | - Aliza Vaknin
- Infection Control and Infectious Diseases Units, Hillel Yaffe Medical Centre, Hadera, Israel
| | - Mohammed Ganayem
- Infection Control and Infectious Diseases Units, Hillel Yaffe Medical Centre, Hadera, Israel
| | - Sharon Reisfeld
- Infection Control and Infectious Diseases Units, Hillel Yaffe Medical Centre, Hadera, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Shelly Lipman-Arens
- Infection Control and Infectious Diseases Units, Hillel Yaffe Medical Centre, Hadera, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Lamis Mahamid
- Infection Control and Infectious Diseases Units, Hillel Yaffe Medical Centre, Hadera, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Linor Ishay
- Infection Control and Infectious Diseases Units, Hillel Yaffe Medical Centre, Hadera, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Erez Karisi
- Information Technology Department, Hillel Yaffe Medical Centre, Hadera, Israel
| | - Noa Melnik
- Information Technology Department, Hillel Yaffe Medical Centre, Hadera, Israel
| | - Mira Leibel
- Emergency Department, Hillel Yaffe Medical Centre, Hadera, Israel
| | - Jalal Ashkar
- Emergency Department, Hillel Yaffe Medical Centre, Hadera, Israel
| | - Sarit Freimann
- Department of Laboratories, Clinical Microbiology Laboratory, Hillel Yaffe Medical Centre, Hadera, Israel
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Mermel LA, Rupp ME. Should Blood Cultures Be Drawn Through an Indwelling Catheter? Open Forum Infect Dis 2024; 11:ofae248. [PMID: 38770214 PMCID: PMC11103617 DOI: 10.1093/ofid/ofae248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 04/30/2024] [Indexed: 05/22/2024] Open
Abstract
There is no practical way to definitively diagnose a catheter-related bloodstream infection in situ if blood cultures are only obtained percutaneously unless there is the rare occurrence of purulent drainage from a central venous catheter insertion site. That is why the Infectious Diseases Society of America guidelines for diagnosis and management of catheter-related bloodstream infections and Infectious Diseases Society of America guidelines for evaluation of fever in critically ill patients both recommend drawing blood cultures from a central venous catheter and percutaneously if the catheter is a suspected source of infection. However, central venous catheter-drawn blood cultures may be more likely to be positive reflecting catheter hub, connector, or intraluminal colonization, and many hospitals in the United States discourage blood culture collection from catheters in an effort to reduce reporting of central-line associated bloodstream infections to the Centers for Disease Control and Prevention. As such, clinical decisions are made regarding catheter removal or other therapeutic interventions based on incomplete and potentially inaccurate data. We urge clinicians to obtain catheter-drawn blood cultures when the catheter may be the source of suspected infection.
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Affiliation(s)
- Leonard A Mermel
- Division of Infectious Diseases, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Epidemiology and Infection Prevention, Lifespan Hospital System, Providence, Rhode Island, USA
| | - Mark E Rupp
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Chakraborty D, Dutta S. Enterobacter aerogenes and a Storm in Brain. Neurol India 2024; 72:447-448. [PMID: 38691503 DOI: 10.4103/neurol-india.neurol-india-d-24-00169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/29/2024] [Indexed: 05/03/2024]
Affiliation(s)
- Debabrata Chakraborty
- Department of Neurology, Apollo Multi-Speciality Hospital, Kolkata, West Bengal, India
| | - Soma Dutta
- Department of Microbiology, Apollo Multi-Speciality Hospital, Kolkata, West Bengal, India
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Palavecino EL, Campodónico VL, She RC. Laboratory approaches to determining blood culture contamination rates: an ASM Laboratory Practices Subcommittee report. J Clin Microbiol 2024; 62:e0102823. [PMID: 38051070 PMCID: PMC10865823 DOI: 10.1128/jcm.01028-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
Blood culture contamination (BCC) is the presence of specific commensal and environmental organisms cultivated from a single blood culture set out of a blood culture series and that do not represent true bacteremia. BCC can impact quality of care and lead to negative outcomes, unnecessary antibiotic exposure, prolonged hospital stays, and substantial costs. As part of the laboratory's quality management plan, microbiology laboratory personnel are tasked with monitoring BCC rates, preparing BCC rate reports, and providing feedback to the appropriate committees within their healthcare system. The BCC rate is calculated by the laboratory using pre-set criteria. However, pre-set criteria are not universally defined and depend on the individual institution's patient population and practices. This mini-review provides practical recommendations on elaborating BCC rate reports, the parameters to define for the pre-set criteria, how to collect and interpret the data, and additional analysis to include in a BCC report.
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Affiliation(s)
- Elizabeth L. Palavecino
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Victoria L. Campodónico
- Department of Pathology, Division of Medical Microbiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rosemary C. She
- Department of Pathology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
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5
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Nelson SE, Tsetsou S, Liang J. Leaving no culture undrawn: Time to revisit the CLABSI and CAUTI metrics. J Crit Care 2024; 79:154442. [PMID: 37797403 DOI: 10.1016/j.jcrc.2023.154442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/18/2023] [Accepted: 09/26/2023] [Indexed: 10/07/2023]
Abstract
Central line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) are quality metrics for many ICUs, and financial ramifications can be applied to hospitals and providers who perform poorly on these measures. Despite some perceived benefits to tracking these metrics, there are a range of issues associated with this practice: lack of a solid evidence base that documenting them has led to decreased infection rates, moral distress associated with identifying these infections, problems with their definitions, and others. We discuss each of these concerns while also including international perspectives then recommend practical steps to attempt to remediate use of the CLABSI and CAUTI metrics. Specifically, we suggest forming a task force consisting of key stakeholders (e.g., providers, Centers for Medicare & Medicaid Services (CMS), patients/families) to review CLABSI and CAUTI-related issues and then to create a summary statement containing recommendations to improve the use of these metrics.
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Affiliation(s)
- Sarah E Nelson
- Departments of Neurosurgery and Neurology, Mount Sinai West, 1000 10(th) Avenue, Suite 10B-65, New York, NY 10019, USA; Department of Neurology, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA; Department of Neurology and Anesthesiology/Critical Care Medicine, Johns Hopkins University, 1800 Orleans Street, Baltimore, MD 21287, USA.
| | - Spyridoula Tsetsou
- Departments of Neurosurgery and Neurology, Mount Sinai West, 1000 10(th) Avenue, Suite 10B-65, New York, NY 10019, USA; Departments of Neurology and Neurosurgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - John Liang
- Departments of Neurosurgery and Neurology, Mount Sinai West, 1000 10(th) Avenue, Suite 10B-65, New York, NY 10019, USA
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Schinkel M, Boerman A, Carroll K, Cosgrove SE, Hsu YJ, Klein E, Nanayakkara P, Schade R, Wiersinga WJ, Fabre V. Impact of Blood Culture Contamination on Antibiotic Use, Resource Utilization, and Clinical Outcomes: A Retrospective Cohort Study in Dutch and US Hospitals. Open Forum Infect Dis 2024; 11:ofad644. [PMID: 38312218 PMCID: PMC10836193 DOI: 10.1093/ofid/ofad644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/20/2023] [Indexed: 02/06/2024] Open
Abstract
Background Blood culture contamination (BCC) has been associated with prolonged antibiotic use (AU) and increased health care utilization; however, this has not been widely reevaluated in the era of increased attention to antibiotic stewardship. We evaluated the impact of BCC on AU, resource utilization, and length of stay in Dutch and US patients. Methods This retrospective observational study examined adults admitted to 2 hospitals in the Netherlands and 5 hospitals in the United States undergoing ≥2 blood culture (BC) sets. Exclusion criteria included neutropenia, no hospital admission, or death within 48 hours of hospitalization. The impact of BCC on clinical outcomes-overall inpatient days of antibiotic therapy, test utilization, length of stay, and mortality-was determined via a multivariable regression model. Results An overall 22 927 patient admissions were evaluated: 650 (4.1%) and 339 (4.8%) with BCC and 11 437 (71.8%) and 4648 (66.3%) with negative BC results from the Netherlands and the United States, respectively. Dutch and US patients with BCC had a mean ± SE 1.74 ± 0.27 (P < .001) and 1.58 ± 0.45 (P < .001) more days of antibiotic therapy than patients with negative BC results. They also had 0.6 ± 0.1 (P < .001) more BCs drawn. Dutch but not US patients with BCC had longer hospital stays (3.36 days; P < .001). There was no difference in mortality between groups in either cohort. AU remained higher in US but not Dutch patients with BCC in a subanalysis limited to BC obtained within the first 24 hours of admission. Conclusions BCC remains associated with higher inpatient AU and health care utilization as compared with patients with negative BC results, although the impact on these outcomes differs by country.
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Affiliation(s)
- Michiel Schinkel
- Center for Experimental and Molecular Medicine, Amsterdam UMC, Location Academic Medical Center, Amsterdam, the Netherlands
- Division of Acute Medicine, Department of Internal Medicine, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Anneroos Boerman
- Division of Acute Medicine, Department of Internal Medicine, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Karen Carroll
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sara E Cosgrove
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Yea-Jen Hsu
- Department of Health Policy and Management, Johns Hopkins Bloomberg of School of Public Health, Baltimore, Maryland, USA
| | - Eili Klein
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Center for Disease Dynamics, Economics & Policy, Washington, DC, USA
| | - Prabath Nanayakkara
- Division of Acute Medicine, Department of Internal Medicine, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Rogier Schade
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Amsterdam, the Netherlands
| | - W Joost Wiersinga
- Center for Experimental and Molecular Medicine, Amsterdam UMC, Location Academic Medical Center, Amsterdam, the Netherlands
- Division of Infectious Diseases, Department of Internal Medicine, Amsterdam UMC, Location Academic Medical Center, Amsterdam, the Netherlands
| | - Valeria Fabre
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Bae S, Kwon KT, Hwang S, Kim Y, Chang HH, Kim SW, Lee NY, Kim YK, Lee JC. Analysis of microbiological tests in patients withholding or withdrawing life-sustaining treatment at the end stage of life in 2 Korean hospitals. Infect Control Hosp Epidemiol 2024; 45:201-206. [PMID: 37694735 PMCID: PMC10877534 DOI: 10.1017/ice.2023.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 06/23/2023] [Accepted: 07/15/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE We evaluated the adequacy of microbiological tests in patients withholding or withdrawing life-sustaining treatment (WLST) at the end stage of life. SETTING The study was conducted at 2 tertiary-care referral hospitals in Daegu, Republic of Korea. DESIGN Retrospective cross-sectional study. METHODS Demographic findings, clinical and epidemiological characteristics, statistics of microbiological tests, and microbial species isolated from patients within 2 weeks before death were collected in 2 tertiary-care referral hospitals from January to December 2018. We also reviewed the antimicrobial treatment that was given within 3 days of microbiological testing in patients on WLST. RESULTS Of the 1,187 hospitalized patients included, 905 patients (76.2%) had WLST. The number of tests per 1,000 patient days was higher after WLST than before WLST (242.0 vs 202.4). Among the category of microbiological tests, blood cultures were performed most frequently, and their numbers per 1,000 patient days before and after WLST were 95.9 and 99.0, respectively. The positive rates of blood culture before and after WLST were 17.2% and 18.0%, respectively. Candida spp. were the most common microbiological species in sputum (17.4%) and urine (48.2%), and Acinetobacter spp. were the most common in blood culture (17.3%). After WLST determination, 70.5% of microbiological tests did not lead to a change in antibiotic use. CONCLUSIONS Many unnecessary microbiological tests are being performed in patients with WLST within 2 weeks of death. Microbiological testing should be performed carefully and in accordance with the patient's treatment goals.
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Affiliation(s)
- Sohyun Bae
- Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Ki Tae Kwon
- Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Soyoon Hwang
- Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Yoonjung Kim
- Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Hyun-Ha Chang
- Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Shin-Woo Kim
- Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Nan Young Lee
- Department of Clinical Pathology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Yu Kyoung Kim
- Department of Clinical Pathology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Je Chul Lee
- Department of Microbiology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
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8
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Yu J, Zhang L, Gao D, Wang J, Li Y, Sun N. Comparison of metagenomic next-generation sequencing and blood culture for diagnosis of bloodstream infections. Front Cell Infect Microbiol 2024; 14:1338861. [PMID: 38328669 PMCID: PMC10847245 DOI: 10.3389/fcimb.2024.1338861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/08/2024] [Indexed: 02/09/2024] Open
Abstract
Objectives This study aimed to evaluate the clinical performance of plasma cell-free DNA (cfDNA) next-generation sequencing (NGS) for pathogen detection in patients with sepsis. Methods A total of 43 pairs of blood and plasma samples form 33 blood culture-positive patients were used as testing samples in metagenomic NGS (mNGS) and NGS of 16S ribosomal RNA gene amplicons (16S rRNA NGS). The results of routine tests, including microbial culture, complete blood count, and biochemical tests, were collected from electronic medical records. Results Using blood as an mNGS testing sample, the proportion of host DNA was 99.9%, with only three bacteria and no fungi detected. When using plasma in mNGS, the proportion of host DNA was approximately 97%, with 84 bacteria and two fungi detected. Notably, 16S rRNA NGS detected 15 and 16 bacteria in 43 pairs of blood and plasma samples, respectively. Blood culture detected 49 bacteria (23 gram-negative bacilli and 26 gram-positive cocci) and four fungi, with 14 bacteria considered contaminants by clinical microbiologists. For all blood cultures, plasma cfDNA mNGS detected 78.26% (19/23) gram-negative rods, 17% (2/12) gram-positive cocci, and no fungi. Compared to blood cultures, the sensitivity and specificity of plasma cfDNA mNGS for detecting bacteria and fungi were 62.07% and 57.14%, respectively. Conclusion Compared to blood, plasma is more suitable for the detection of bloodstream infections using mNGS and is less affected by host DNA. The positive detection rate of plasma cfDNA mNGS for bloodstream infections caused by gram-negative bacteria was higher than that caused by gram-positive cocci.
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Affiliation(s)
- Juan Yu
- Department of Clinical Laboratory, Nanjing Lishui People’s Hospital, Nanjing, China
- Department of Clinical Laboratory Science, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Li Zhang
- Department of Clinical Laboratory, Nanjing Lishui People’s Hospital, Nanjing, China
| | - Deyu Gao
- Department of Clinical Laboratory Science, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Jie Wang
- Clinical Medicine Research Center, The Affiliated Suqian First People’s Hospital of Nanjing Medical University, Suqian, China
| | - Yi Li
- Department of Clinical Laboratory Science, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Ning Sun
- Department of Clinical Laboratory Science, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
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Hawes AM, Greene MT, Ratz D, Fowler KE, Kendall RE, Patel PK. Antimicrobial Stewardship Teams in Veterans Affairs and Nonfederal Hospitals in the United States: A National Survey of Antimicrobial Stewardship Practices. Open Forum Infect Dis 2024; 11:ofad620. [PMID: 38213633 PMCID: PMC10783152 DOI: 10.1093/ofid/ofad620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/16/2023] [Indexed: 01/13/2024] Open
Abstract
In a cross-sectional survey of US acute care hospitals, antimicrobial stewardship programs were present in most Veterans Affairs and nonfederal hospitals but varied in team composition, scope, and impact. Diagnostic stewardship was common across hospitals. Veterans Affairs hospitals had increased reach in outpatient settings. Telestewardship remains an opportunity in all hospital systems.
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Affiliation(s)
- Armani M Hawes
- Department of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - M Todd Greene
- Department of Internal Medicine, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Department of Internal Medicine, VA/UM Patient Safety Enhancement Program, Ann Arbor, Michigan, USA
| | - David Ratz
- Department of Internal Medicine, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Internal Medicine, VA/UM Patient Safety Enhancement Program, Ann Arbor, Michigan, USA
| | - Karen E Fowler
- Department of Internal Medicine, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Internal Medicine, VA/UM Patient Safety Enhancement Program, Ann Arbor, Michigan, USA
| | - Ronald E Kendall
- Department of Internal Medicine, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Payal K Patel
- Department of Internal Medicine, VA/UM Patient Safety Enhancement Program, Ann Arbor, Michigan, USA
- Division of Infectious Diseases, Department of Internal Medicine, Intermountain Health, Salt Lake City, Utah, USA
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10
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Liu W, Liao K, Wu J, Liu S, Zheng X, Wen W, Fu L, Fan X, Yang X, Hu X, Jiang Y, Wu K, Guo Z, Li Y, Liu W, Cai M, Guo Z, Guo X, Lu J, Chen E, Zhou H, Chen D. Blood culture quality and turnaround time of clinical microbiology laboratories in Chinese Teaching Hospitals: A multicenter study. J Clin Lab Anal 2024; 38:e25008. [PMID: 38235610 PMCID: PMC10829685 DOI: 10.1002/jcla.25008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/10/2023] [Accepted: 01/06/2024] [Indexed: 01/19/2024] Open
Abstract
PURPOSE Blood culture (BC) remains the gold standard for the diagnosis of bloodstream infections. Improving the quality of clinical BC samples, optimizing BC performance, and accelerating antimicrobial susceptibility test (AST) results are essential for the early detection of bloodstream infections and specific treatments. METHODS We conducted a retrospective multicenter study using 450,845 BC specimens from clinical laboratories obtained from 19 teaching hospitals between 1 January 2021 and 31 December 2021. We evaluated key performance indicators (KPIs), turnaround times (TATs), and frequency distributions of processing in BC specimens. We also evaluated the AST results of clinically significant isolates for four different laboratory workflow styles. RESULTS Across the 10 common bacterial isolates (n = 16,865) and yeast isolates (n = 1011), the overall median (interquartile range) TATs of AST results were 2.67 (2.05-3.31) and 3.73 (2.98-4.64) days, respectively. The specimen collections mainly occurred between 06:00 and 24:00, and specimen reception and loadings mainly between 08:00 and 24:00. Based on the laboratory workflows of the BCs, 16 of the 19 hospitals were divided into four groups. Time to results (TTRs) from specimen collection to the AST reports were 2.35 (1.95-3.06), 2.61 (1.98-3.32), 2.99 (2.60-3.87), and 3.25 (2.80-3.98) days for groups I, II, III, and IV, respectively. CONCLUSION This study shows the related BC KPIs and workflows in different Chinese hospitals, suggesting that laboratory workflow optimization can play important roles in shortening time to AST reports and initiation of appropriate timely treatment.
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Affiliation(s)
- Wanting Liu
- Microbiome Medicine Center, Department of Laboratory Medicine, Zhujiang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
| | - Kang Liao
- Department of Laboratory MedicineThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouGuangdongChina
| | - Jinsong Wu
- Department of Laboratory MedicineShenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology)ShenzhenGuangdongChina
| | - Suling Liu
- Department of Clinical Laboratory, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhouGuangdongChina
| | - Xin Zheng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer CenterGuangzhouGuangdongChina
| | - Weihong Wen
- Department of Laboratory MedicineThe Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's HospitalQingyuanGuangdongChina
| | - Liang Fu
- Department of Laboratory MedicineThe Fifth Affiliated Hospital, Southern Medical UniversityGuangzhouGuangdongChina
| | - Xiaoyi Fan
- The Clinical Microbiological LaboratoryThe First Affiliated Hospital of Jinan UniversityGuangzhouGuangdongChina
| | - Xiao Yang
- Department of Laboratory MedicineGuangzhou First People's HospitalGuangzhouGuangdongChina
| | - Xiumei Hu
- Department of Laboratory MedicineNanfang Hospital, Southern Medical UniversityGuangzhouGuangdongChina
| | - Yueting Jiang
- Department of Laboratory MedicineThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouGuangdongChina
| | - Kuihai Wu
- Department of Laboratory MedicineThe First People's Hospital of FoshanFoshanGuangdongChina
| | - Zhusheng Guo
- Clinical Microbiology LaboratoryDepartment of Dongguan Tungwah HospitalDongguanGuangdongChina
| | - Yang Li
- Department of Laboratory MedicineZhongshan City People's HospitalZhongshanGuangdongChina
| | - Weiyang Liu
- Clinical LaboratoryThe Third People's Hospital of HuizhouHuizhouGuangdongChina
| | - Mufa Cai
- The Center for Laboratory MedicineAffiliated Hospital of Guangdong Medical UniversityZhanjiangGuangdongChina
| | - Zhaowang Guo
- Clinical LaboratoryThe Fifth Affiliated Hospital of Sun Yat‐sen UniversityZhuhaiGuangdongChina
| | - Xuguang Guo
- Department of Clinical Laboratory MedicineThe Third Affiliated Hospital of Guangzhou Medical UniversityGuangzhouGuangdongChina
| | - Jinghui Lu
- Laboratory Medicine DepartmentThe First Affiliated Hospital (School of Clinical Medicine), Guangdong Pharmaceutical UniversityGuangzhouGuangdongChina
| | - Enzhong Chen
- Microbiome Medicine Center, Department of Laboratory Medicine, Zhujiang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
| | - Hongwei Zhou
- Microbiome Medicine Center, Department of Laboratory Medicine, Zhujiang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
| | - Dingqiang Chen
- Microbiome Medicine Center, Department of Laboratory Medicine, Zhujiang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
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11
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Moehring R, Vaughn VM. Development of Inpatient Stewardship Metrics: Is It Time for Public Reporting? Infect Dis Clin North Am 2023; 37:853-871. [PMID: 37661471 DOI: 10.1016/j.idc.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Given the complexity and nuance needed to make antimicrobial prescribing decisions, metrics aiming to assess these decisions can be complex in method, require resource investment for measurement, and demand thoughtfulness in how to use data for program implementation and messaging to key partners. Antimicrobial stewardship programs today use several metrics of antimicrobial use in parallel with other clinical data for a multitude of purposes and audiences. Here, we discuss goals for inpatient stewardship metrics, current metrics used by stewardship programs locally and nationally, and future directions for antimicrobial use metric development.
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Affiliation(s)
| | - Valerie M Vaughn
- Division of General Internal Medicine, University of Utah, 30 Mario Capecchi Drive, 3S149, Salt Lake City, UT 84112, USA
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12
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Ohta R, Sano C. Factors Associated With Blood Culture Contamination in Rural Hospitals in Japan: A Cross-Sectional Study. Cureus 2023; 15:e47987. [PMID: 38034244 PMCID: PMC10685058 DOI: 10.7759/cureus.47987] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Background Blood culture, a cornerstone diagnostic test, is paramount for identifying bacteremia due to serious infections. However, its accuracy is jeopardized by contamination, often due to inappropriate collection procedures. Resource constraints and a limitation in specialized staff can heighten contamination risks in rural hospitals, underscoring the need to understand the associated demographics and conditions. This study aimed to elucidate the demographics and conditions associated with heightened blood culture contamination risk in rural hospitals to optimize testing practices and improve patient care. Methods A single-center, cross-sectional study was conducted in Unnan City Hospital, Unnan, Japan with participants suspected of having bacteremia. Data from the electronic medical records of 455 patients were analyzed using multivariate logistic regression with contamination as the dependent variable. Results Of the 455 patients who underwent blood culture testing, 321 and 134 tests were negative and positive for contamination, respectively. Older age and blood obtained from arteries were associated with a reduced risk of contamination (odds ratio (OR)=0.97; p=0.012, and OR=0.17; p=0.00069, respectively). Patients with dependencies exhibited an increase in contamination risk (OR=1.81; p=0.044). Patients admitted for infection demonstrated a reduced likelihood of sample contamination (OR=0.44; p=0.0034). The predominant organisms identified varied, with Escherichia coli being more frequent in uncontaminated blood samples and Staphylococcus epidermidis in the contaminated samples. Conclusion This study reveals a complex relationship between patient demographics, clinical practices, and the risk of contamination. Factors such as age, dependency status, and reason for admission were associated with sample contamination. Enhanced procedural stringency, microbial surveillance, and continuous training could mitigate these risks, particularly in resource-constrained settings. Identifying and understanding the factors influencing blood culture contamination can significantly bolster clinical practice in rural settings. While this study provides foundational insights, future research can deepen our understanding, ensuring the refinement of patient care protocols in similar environments.
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Affiliation(s)
| | - Chiaki Sano
- Community Medicine Management, Shimane University Faculty of Medicine, Izumo, JPN
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13
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Huttner BD, Sharland M, Huttner A. On culture and blood cultures. Clin Microbiol Infect 2023; 29:1100-1102. [PMID: 37263416 DOI: 10.1016/j.cmi.2023.05.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 06/03/2023]
Affiliation(s)
- Benedikt D Huttner
- Secretariat of the Model List of Essential Medicines, Department of Health Product Policy and Standards, World Health Organization, Geneva, Switzerland.
| | - Mike Sharland
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's University London, London, UK
| | - Angela Huttner
- Geneva University Hospitals and University of Geneva Faculty of Medicine, Geneva, Switzerland
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14
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McFadden BR, Inglis TJJ, Reynolds M. Machine learning pipeline for blood culture outcome prediction using Sysmex XN-2000 blood sample results in Western Australia. BMC Infect Dis 2023; 23:552. [PMID: 37620774 PMCID: PMC10463910 DOI: 10.1186/s12879-023-08535-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 08/11/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Bloodstream infections (BSIs) are a significant burden on the global population and represent a key area of focus in the hospital environment. Blood culture (BC) testing is the standard diagnostic test utilised to confirm the presence of a BSI. However, current BC testing practices result in low positive yields and overuse of the diagnostic test. Diagnostic stewardship research regarding BC testing is increasing, and becoming more important to reduce unnecessary resource expenditure and antimicrobial use, especially as antimicrobial resistance continues to rise. This study aims to establish a machine learning (ML) pipeline for BC outcome prediction using data obtained from routinely analysed blood samples, including complete blood count (CBC), white blood cell differential (DIFF), and cell population data (CPD) produced by Sysmex XN-2000 analysers. METHODS ML models were trained using retrospective data produced between 2018 and 2019, from patients at Sir Charles Gairdner hospital, Nedlands, Western Australia, and processed at Pathwest Laboratory Medicine, Nedlands. Trained ML models were evaluated using stratified 10-fold cross validation. RESULTS Two ML models, an XGBoost model using CBC/DIFF/CPD features with boruta feature selection (BFS) , and a random forest model trained using CBC/DIFF features with BFS were selected for further validation after obtaining AUC scores of [Formula: see text] and [Formula: see text] respectively using stratified 10-fold cross validation. The XGBoost model obtained an AUC score of 0.76 on a internal validation set. The random forest model obtained AUC scores of 0.82 and 0.76 on internal and external validation datasets respectively. CONCLUSIONS We have demonstrated the utility of using an ML pipeline combined with CBC/DIFF, and CBC/DIFF/CPD feature spaces for BC outcome prediction. This builds on the growing body of research in the area of BC outcome prediction, and provides opportunity for further research.
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Affiliation(s)
- Benjamin R McFadden
- School of Physics, Mathematics and Computing, University of Western Australia, Perth, Australia.
| | - Timothy J J Inglis
- Western Australian Country Health Service, Perth, Australia
- School of Medicine, University of Western Australia, Perth, Australia
- Department of Microbiology, Pathwest Laboratory Medicine, Perth, Australia
| | - Mark Reynolds
- School of Physics, Mathematics and Computing, University of Western Australia, Perth, Australia
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15
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Samuel L. Direct-from-Blood Detection of Pathogens: a Review of Technology and Challenges. J Clin Microbiol 2023; 61:e0023121. [PMID: 37222587 PMCID: PMC10358183 DOI: 10.1128/jcm.00231-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Blood cultures have been the staple of clinical microbiology laboratories for well over half a century, but gaps remain in our ability to identify the causative agent in patients presenting with signs and symptoms of sepsis. Molecular technologies have revolutionized the clinical microbiology laboratory in many areas but have yet to present a viable alternative to blood cultures. There has been a recent surge of interest in utilizing novel approaches to address this challenge. In this minireview, I discuss whether molecular tools will finally give us the answers we need and the practical challenges of incorporating them into the diagnostic algorithm.
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Affiliation(s)
- Linoj Samuel
- Division of Clinical Microbiology, Department of Pathology and Laboratory Medicine, Henry Ford Health, Detroit, Michigan, USA
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16
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Aiesh BM, Daraghmeh D, Abu-Shamleh N, Joudallah A, Sabateen A, Al Ramahi R. Blood culture contamination in a tertiary care hospital: a retrospective three-year study. BMC Infect Dis 2023; 23:448. [PMID: 37403044 DOI: 10.1186/s12879-023-08428-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 06/26/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Bloodstream infections (BSI) are a leading cause of morbidity and mortality in hospitalized patients worldwide. A blood culture is the primary tool for determining whether a patient has BSI and requires antimicrobial therapy, but it can result in an inappropriate outcome if the isolated microorganisms are deemed contaminants from the skin. Despite the development of medical equipment and technology, there is still a percentage of blood culture contamination. The aims of this study were to detect the blood culture contamination (BCC) rate in a tertiary care hospital in Palestine and to identify the departments with the highest rates along with the microorganisms isolated from the contaminated blood samples. METHOD Blood cultures that were taken at An-Najah National University Hospital between January 2019 and December 2021 were evaluated retrospectively. Positive blood cultures were classified as either true positives or false positives based on laboratory results and clinical pictures. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) version 21. A p-value of less than 0.05 was considered statistically significant for all analyses. RESULTS Out of 10,930 blood cultures performed in the microbiology laboratory from 2019 to 2021, 1479 (13.6%) were identified as positive blood cultures that showed microbial growth. Of these, 453 were blood culture contaminations, representing 4.17% of total blood cultures and 30.63% of the positive blood culture samples. The highest rate of contamination was in the hemodialysis unit (26.49%), followed by the emergency department (15.89%). Staphylococcus epidermidis was the most prevalent (49.2%), followed by Staphylococcus hominis (20.8%) and Staphylococcus haemolyticus (13.2%). The highest annual contamination rate was observed in 2019 (4.78%) followed by 2020 (3.95%) and the lowest was in 2021 (3.79%). The rate of BCC was decreasing, although it did not reach statistically significant levels (P value = 0.085). CONCLUSION The rate of BCC is higher than recommended. The rates of BCC are different in different wards and over time. Continuous monitoring and performance improvement projects are needed to minimize blood culture contamination and unnecessary antibiotic use.
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Affiliation(s)
- Banan M Aiesh
- Infection Control Department, An-Najah National University Hospital, Nablus, Palestine
| | - Duha Daraghmeh
- Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Nasreen Abu-Shamleh
- Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Abdalmenem Joudallah
- Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Ali Sabateen
- Infection Control Department, An-Najah National University Hospital, Nablus, Palestine
| | - Rowa' Al Ramahi
- Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
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17
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Kiyosuke M, Morishita S, Nakaie K, Kondo S, Sonobe K, Goto M, Ohashi K, Kashiyama S. Verification of quality assurance for blood culture surveillance using 6 years of data from the Japan Infection Prevention and Control Conference for National and Public University Hospitals. J Infect Chemother 2023; 29:565-570. [PMID: 36898502 DOI: 10.1016/j.jiac.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 02/08/2023] [Accepted: 02/26/2023] [Indexed: 03/12/2023]
Abstract
The importance of blood culture has been widely recognized, and there is a need for monitoring to evaluate the accuracy of blood culture that reflects domestic healthcare systems. In this study, we assessed 6-year trends in blood culture quality assurance data. The Japan Infection Prevention and Control Conference for National and Public University Hospitals conducted yearly blood culture surveillance at 52 national public university hospitals from 2015 to 2020. Statistical analysis showed that comparison with the previous year showed significant differences in the number of blood cultures per 1000 patient-days in all years. The number of blood cultures per 1000 admissions was not significantly different in 2017 and 2018, but significant differences were shown in all other years. The multiple blood culture set rate was significantly different between non-pediatric inpatients and outpatients but not between pediatric inpatients and outpatients. The contamination rate did not differ significantly. For all parameters, significant differences were found when comparing 2015 and 2020. Our survey showed that although the sample number improved over time, even the most recent values for 2020 were lower than Cumitech's targets. It is difficult to assess whether these sample numbers are appropriate because target values have not been set for the various types of hospitals in Japan. Surveillance is a useful tool for monitoring quality assurance for blood culture. All parameters improved over the 6-year period, but it is necessary to establish a benchmark for evaluating optimization. We will continue to monitor quality assurance and work on setting benchmarks.
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Affiliation(s)
- Makiko Kiyosuke
- Department of Clinical Chemistry and Laboratory Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Shota Morishita
- Division of Clinical Laboratory, Tottori University Hospital, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan.
| | - Kiyotaka Nakaie
- Department of Infection Control and Prevention, Osaka Metropolitan University Hospital, 1-5-7 Asahimachi, Abeno-ku, Osaka City, 545-8586, Japan.
| | - Shuhei Kondo
- Clinical Laboratory, Clinical Technology Department, Nagoya City University Hospital, Nagoya City University, 1 Kawasumi Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8602, Japan.
| | - Kazunari Sonobe
- Clinical Laboratory, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
| | - Miki Goto
- Department of Laboratory Medicine, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan.
| | - Kazutaka Ohashi
- Department of Clinical Laboratory, Fukushima Medical University Hospital, 1 Hikariga-oka, Fukushima City, 960-1295, Japan.
| | - Seiya Kashiyama
- Section of Clinical Laboratory, Division of Clinical Support, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
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18
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Claeys KC, Johnson MD. Leveraging diagnostic stewardship within antimicrobial stewardship programmes. Drugs Context 2023; 12:dic-2022-9-5. [PMID: 36843619 PMCID: PMC9949764 DOI: 10.7573/dic.2022-9-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/16/2022] [Indexed: 02/17/2023] Open
Abstract
Novel diagnostic stewardship in infectious disease consists of interventions that modify ordering, processing, and reporting of diagnostic tests to provide the right test for the right patient, prompting the right action. The interventions work upstream and synergistically with traditional antimicrobial stewardship efforts. As diagnostic stewardship continues to gain public attention, it is critical that antimicrobial stewardship programmes not only learn how to effectively leverage diagnostic testing to improve antimicrobial use but also ensure that they are stakeholders and leaders in developing new diagnostic stewardship interventions within their institutions. This review will discuss the need for diagnostic and antimicrobial stewardship, the interplay of diagnostic and antimicrobial stewardship, evidence of benefit to antimicrobial stewardship programmes, and considerations for successfully engaging in diagnostic stewardship interventions. This article is part of the Antibiotic stewardship Special Issue: https://www.drugsincontext.com/special_issues/antimicrobial-stewardship-a-focus-on-the-need-for-moderation.
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Affiliation(s)
- Kimberly C Claeys
- University of Maryland School of Pharmacy, Department of Practice Science and Health Outcomes Research, Baltimore, MD, USA
| | - Melissa D Johnson
- Division of Infectious Diseases & International Health, Duke University School of Medicine, Durham, NC, USA,Duke Antimicrobial Stewardship Outreach Network (DASON), Duke University Medical Center Durham, NC, USA
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19
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Evaluation of hospital blood culture utilization rates to identify opportunities for diagnostic stewardship. Infect Control Hosp Epidemiol 2023; 44:200-205. [PMID: 35938213 DOI: 10.1017/ice.2022.191] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To evaluate the pattern of blood-culture utilization among a cohort of 6 hospitals to identify potential opportunities for diagnostic stewardship. METHODS We completed a retrospective analysis of blood-culture utilization during adult inpatient or emergency department (ED) encounters in 6 hospitals from May 2019 to April 2020. We investigated 2 measures of blood-culture utilization rates (BCURs): the total number of blood cultures, defined as a unique accession number per 1,000 patient days (BCX) and a new metric of blood-culture events per 1,000 patient days to account for paired culture practices. We defined a blood-culture event as an initial blood culture and all subsequent samples for culture drawn within 12 hours for patients with an inpatient or ED encounter. Cultures were evaluated by unit type, positivity and contamination rates, and other markers evaluating the quality of blood-culture collection. RESULTS In total, 111,520 blood cultures, 52,550 blood culture events, 165,456 inpatient admissions, and 568,928 patient days were analyzed. Overall, the mean BCUR was 196 blood cultures per 1,000 patient days, with 92 blood culture events per 1,000 patient days (range, 64-155 among hospitals). Furthermore, 7% of blood-culture events were single culture events, 55% began in the ED, and 77% occurred in the first 3 hospital days. Among all blood cultures, 7.7% grew a likely pathogen, 2.1% were contaminated, and 5.9% of first blood cultures were collected after the initiation of antibiotics. CONCLUSIONS Blood-culture utilization varied by hospital and was heavily influenced by ED culture volumes. Hospital comparisons of blood-culture metrics can assist in identifying opportunities to optimize blood-culture collection practices.
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20
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Giancola S, Hart KA. Equine blood cultures: Can we do better? Equine Vet J 2022. [PMID: 36210694 DOI: 10.1111/evj.13891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 10/02/2022] [Indexed: 11/30/2022]
Abstract
Blood culture is considered the gold standard test for documenting bacteraemia in patients with suspected bacterial sepsis in veterinary and human medicine. However, blood culture often fails to yield bacterial growth even though the clinical picture is strongly suggestive of bacterial sepsis, or contaminating organisms can overgrow the true pathogen, making accurate diagnosis and appropriate management of this life-threatening condition very challenging. Methodology for collecting blood cultures in equine medicine, and even in human hospitals, is not standardised, and many variables can affect the yield and type of microorganisms cultured. Microbiological culture techniques used in the laboratory and specific sample collection techniques, including volume of blood collected, aseptic technique utilised, and the site, timing and frequency of sample collection, all have substantial impact on the accuracy of blood culture results. In addition, patient-specific factors such as husbandry factors, the anatomical site of the primary infection, and changing microflora in different geographic locations, also can impact blood cultures. Thus, blood cultures obtained in practice may not always accurately define the presence or absence of, or specific organisms causing, bacteraemia in horses and foals with suspected sepsis. Erroneous blood culture results can lead to inappropriate antimicrobial use, which can result in poor outcomes for individual patients and contribute to the development of antimicrobial resistance in the patient's microflora and the environmental microcosm. This review summarises current indications and methodology, and specific factors that may be optimised, for equine blood culture, with particular focus on available literature from neonatal foals with suspected bacterial sepsis. To standardise and optimise blood culture techniques in horses and foals, future research in this area should be aimed at determining the optimal volume of blood that should be collected for culture, and the ideal site, timing, and frequency of sample collection.
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Affiliation(s)
- Shyla Giancola
- Department of Large Animal Medicine, University of Georgia College of Veterinary Medicine, Athens, Georgia, USA
| | - Kelsey A Hart
- Department of Large Animal Medicine, University of Georgia College of Veterinary Medicine, Athens, Georgia, USA
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21
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Temkin E, Biran D, Braun T, Schwartz D, Carmeli Y. Analysis of Blood Culture Collection and Laboratory Processing Practices in Israel. JAMA Netw Open 2022; 5:e2238309. [PMID: 36282502 PMCID: PMC9597385 DOI: 10.1001/jamanetworkopen.2022.38309] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Blood culturing is a critical diagnostic procedure affecting patient outcomes and antibiotic stewardship. Although there are standards for blood culturing, the process is not often measured. OBJECTIVES To evaluate processes related to the diagnosis of bloodstream infection and compare them with best practices. DESIGN, SETTING, AND PARTICIPANTS A quality improvement study using laboratory data from January 1 to June 30, 2019, was conducted in 28 (96.6%) Israeli acute care hospitals. All blood cultures (BCs) performed on samples from adults and children in a period of 147 hospital-months were analyzed. Data analysis was performed from April 12, 2021, to September 9, 2022. MAIN OUTCOMES AND MEASURES True pathogen detection rate, contamination rate, proportion of adults with blood cultures performed, proportion of adult culturing episodes with only 1 set or bottle used, and median time of steps from sample collection to pathogen identification. RESULTS The data set consisted of 348 987 BC bottles. Bloodstream infection was detected in a median of 6.7% (IQR, 5.8%-8.2%) of adult culturing episodes and 1.1% (IQR, 0.7%-1.9%) of pediatric episodes. Eleven of 27 hospitals (40.7%) with adult patients met the standard of a contamination rate of less than 3% and only 2 hospitals (7.4%) met the more stringent standard of less than or equal to 1% contamination rate. The percentage of adults with blood cultures ranged from 2.7% to 29.0% (mean [SD], 15.7% [6.0%]). There was an association between sampling rate and pathogen detection until BCs were performed in 17% of adult admissions. The percentage of solitary BCs ranged from 47.8% to 94.4%. An estimated 1745 of 7436 (23.5%) adult bloodstream infections went undetected because solitary BCs were performed, anaerobic bottles were not used, or BCs were not performed. Median processing time was 51.2 (IQR, 33.9-78.0) hours, 3 times the optimal time: 4.4 (IQR, 1.7-12.5) hours for the preanalytical stage, 15.9 (IQR, 10.2-23.6) hours from incubation to growth detection, 4.5 (IQR, 1.5-10.7) hours from detection to Gram stain, and 30.9 (IQR, 22.0-41.9) hours from detection to isolate identification. An 8.6-hour delay was related to off-hours operating of laboratories. CONCLUSIONS AND RELEVANCE The findings of this study suggest that the multistep process of blood culturing is not managed comprehensively in Israel, leading to poor clinical practices and delayed results.
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Affiliation(s)
- Elizabeth Temkin
- National Institute for Antibiotic Resistance and Infection Control, Israel Ministry of Health, Tel Aviv, Israel
| | - Dikla Biran
- National Institute for Antibiotic Resistance and Infection Control, Israel Ministry of Health, Tel Aviv, Israel
| | - Tali Braun
- National Institute for Antibiotic Resistance and Infection Control, Israel Ministry of Health, Tel Aviv, Israel
| | - David Schwartz
- National Institute for Antibiotic Resistance and Infection Control, Israel Ministry of Health, Tel Aviv, Israel
| | - Yehuda Carmeli
- National Institute for Antibiotic Resistance and Infection Control, Israel Ministry of Health and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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22
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García-Rivera C, Parra-Grande M, Merino E, Boix V, Rodríguez JC. Concordance of the Filmarray Blood Culture Identification Panel 2 and classical microbiological methods in a bacteriemia diagnostic unit. Diagn Microbiol Infect Dis 2022; 104:115787. [DOI: 10.1016/j.diagmicrobio.2022.115787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/20/2022] [Accepted: 08/06/2022] [Indexed: 11/24/2022]
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23
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Buzzalino LG, Mease J, Bernhardi CL, Bork JT, Johnson JK, Claeys K. Follow-Up Blood Culture Practices for Gram-Negative Bloodstream Infections in Immunocompromised Hosts at a Large Academic Medical Center. Open Forum Infect Dis 2022; 9:ofac173. [PMID: 35531383 PMCID: PMC9070332 DOI: 10.1093/ofid/ofac173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 04/13/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
The role of follow-up blood cultures (FUBC) in gram-negative (GN) bloodstream infections (BSI) to improve clinical outcomes remains controversial, especially among immunocompromised patients. Among 139 patients, FUBCs were common (117, 84.2%); however, positive FUBCs were rare (3, 2.6%). Only presence of fever was associated with positive FUBC.
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Affiliation(s)
| | - James Mease
- Food and Drug Administration; Silver Spring, MD, USA
| | | | | | | | - Kimberly Claeys
- University of Maryland School of Pharmacy; Baltimore, MD, USA
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24
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Fabre V, Jones GF, Hsu YJ, Carroll KC, Cosgrove SE. To wait or not to wait: Optimal time interval between the first and second blood-culture sets to maximize blood-culture yield. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e51. [PMID: 36310816 PMCID: PMC9614788 DOI: 10.1017/ash.2022.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 06/16/2023]
Abstract
The optimal timing of blood culture (BCx) sets collection has not been evaluated with continuous BCx detection systems. The yield of BCx was similar between short intervals (median, 3 minutes) and longer intervals (median, 16 or 43 minutes) among 5,856 BCx, except for improved polymicrobial bacteremia detection with long-interval BCx.
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Affiliation(s)
- Valeria Fabre
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - George F. Jones
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yea-Jen Hsu
- Department of Health Policy and Management, Johns Hopkins Bloomberg of School of Public Health, Baltimore, Maryland
| | - Karen C. Carroll
- Division of Clinical Microbiology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sara E. Cosgrove
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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25
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Wang L, Lin X, Liu T, Zhang Z, Kong J, Yu H, Yan J, Luan D, Zhao Y, Bian X. Reusable and universal impedimetric sensing platform for the rapid and sensitive detection of pathogenic bacteria based on bacteria-imprinted polythiophene film. Analyst 2022; 147:4433-4441. [DOI: 10.1039/d2an01122k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A bacteria-imprinted polythiophene film (BIF)-based impedimetric sensor was proposed for the rapid and sensitive detection of S. aureus. A significant improvement is the reduced time for both BIF fabrication (15 min) and bacterial capturing (10 min).
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Affiliation(s)
- Lingling Wang
- College of Food Science and Technology, Shanghai Ocean University, Shanghai 201306, China
| | - Xiaohui Lin
- College of Food Science and Technology, Shanghai Ocean University, Shanghai 201306, China
| | - Ting Liu
- College of Food Science and Technology, Shanghai Ocean University, Shanghai 201306, China
| | - Zhaohuan Zhang
- College of Food Science and Technology, Shanghai Ocean University, Shanghai 201306, China
| | - Jie Kong
- College of Food Science and Technology, Shanghai Ocean University, Shanghai 201306, China
| | - Hai Yu
- College of Food Science and Technology, Shanghai Ocean University, Shanghai 201306, China
| | - Juan Yan
- College of Food Science and Technology, Shanghai Ocean University, Shanghai 201306, China
| | - Donglei Luan
- College of Food Science and Technology, Shanghai Ocean University, Shanghai 201306, China
| | - Yong Zhao
- College of Food Science and Technology, Shanghai Ocean University, Shanghai 201306, China
| | - Xiaojun Bian
- College of Food Science and Technology, Shanghai Ocean University, Shanghai 201306, China
- Laboratory of Quality and Safety Risk Assessment for Aquatic Product on Storage and Preservation (Shanghai), Ministry of Agriculture, Shanghai 201306, China
- Shanghai Engineering Research Center of Aquatic-Product Processing & Preservation, Shanghai 201306, China
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