Blood culture contamination in a tertiary care hospital of Saudi Arabia. A one-year study

Bacterial bloodstream infections in a pediatric population: A 7-year experience at a tertiary care center in Saudi Arabia

OBJECTIVES

This study explored the epidemiological trends and antimicrobial susceptibility patterns of bloodstream pathogens among pediatric patients over a 7-year period at a tertiary care facility in Saudi Arabia.

METHODS

This retrospective single-center longitudinal descriptive study was conducted from 2015 to 2021. Blood culture and susceptibility data of pathogens isolated from patients aged <15 years were extracted from the hospital's laboratory information system. The trends observed over the 7-year period were graphically illustrated.

RESULTS

Among the 83,605 pediatric blood cultures analyzed, 2945 (3.5 %) tested positive. Approximately 65 % of the positive cultures were confirmed as true bloodstream infections (BSIs), with an average BSI rate of 3 per 1000 inpatient days. Gram-negative bacterial infections accounted for 61 % of BSIs, with Klebsiella spp. being the most prevalent. Susceptibility testing revealed reduced sensitivity to meropenem, imipenem, ciprofloxacin, and levofloxacin among gram-negative bacteria. Gram-positive pathogens represented 39 % of infections, with the most common being Staphylococcus spp. (21 %) and Streptococcus spp. (7 %). Methicillin-resistant Staphylococcus aureus exhibited 100 % sensitivity to vancomycin, quinupristin/dalfopristin, tigecycline, and linezolid. However, Streptococcus pneumoniae showed decreasing sensitivity to penicillin and ceftriaxone for meningitis (33 % and 55 % susceptibility, respectively). Furthermore, Enterococcus spp. were less susceptible against ampicillin, linezolid, levofloxacin, and vancomycin.

CONCLUSIONS

The findings of this study offer crucial insights into the incidence of pediatric bacteremia and trends in antibiotic susceptibility, which can inform treatment strategies, guide antibiotic stewardship programs, and enhance infection control measures in healthcare settings.

Integrating Lean Six Sigma into Microbiology Laboratories: Insights from a Literature Review

BACKGROUND/OBJECTIVES

Clinical laboratories are fundamental to healthcare systems, contributing to over 70% of clinical decisions while accounting for only 2-3% of hospital budgets. Among them, microbiology laboratories provide critical information that directly influences patient outcomes and satisfaction. This study presents a structured review of the current state of Lean Six Sigma (LSS) implementation in microbiology and comparable laboratory environments. The objective is to identify relevant contributions within the state of the art to highlight potential benefits applicable to microbiology laboratories and to detect persistent gaps and unresolved needs.

METHODS

A systematic literature review was performed across six databases (Web of Science, ScienceDirect, Scopus, ProQuest, PubMed, and Google Scholar) to identify studies published between 2012 and September 2024. After screening, 33 studies were selected for full-text analysis.

RESULTS

The selected literature was analyzed to assess the extent to which LSS methodologies have been applied in microbiology laboratories. Particular attention was given to the definition and use of key performance indicators (KPIs). While industry-adapted metrics such as cost reduction and turnaround time are commonly employed, clinical indicators, such as patient impact, satisfaction, and diagnostic accuracy, are underutilized. Additionally, the analysis revealed a frequent omission of the control phase in LSS projects, limiting long-term process monitoring. The review also identifies the most suitable LSS tools and evaluates how laboratories manage interruptions in routine workflows.

CONCLUSIONS

Future research should prioritize the integration of clinical KPIs into LSS frameworks, establish robust control phases for sustained monitoring, and systematically address the impact of process interruptions on optimization efforts.

Contamination rate of rare bacterial species detected by MALDI-TOFMS: a retrospective cohort study

When rare bacterial species are identified in blood cultures, determining the clinical significance is sometimes difficult. This study aimed to analyze the clinical significance of rare bacterial species detected in blood cultures using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOFMS) by comparing their contamination rates with those of common species. We retrospectively analyzed medical records of adult patients with positive blood cultures at Kyoto City Hospital from 2014 to 2022. Rare species were defined by low detection rates and few PubMed reports. Of 4880 microorganisms identified from 3441 individuals, 1150 (23.6%) were classified as contamination. Meanwhile, 24 rare microorganisms were identified, of which 14 (58.3%) were classified as contamination, which was significantly higher than common species (odds ratio 4.56, 95% confidence Interval 1.88-11.50, P < 0.001). These findings may help in determining the clinical significance of rare bacterial species in blood cultures with few reported cases.

Outbreak investigation of NDM-producing Burkholderia cepacia causing neonatal sepsis in Pakistan

Aim: To investigate the outbreak of Burkholderia cepacia complex (BCC), mortality, antimicrobial resistance and associated risk factors in the neonatal intensive care unit. Method: Eighteen blood culture samples from neonates and twenty swab samples from different neonatal intensive care unit surfaces were collected. The VITEK 2 was used to confirm the isolates and generate the antibiogram. PCR was used to identify blaNDM. Results: Eighteen samples tested positive for BCC, and 10/18 (55.5%) of the neonates died. 13/18 (72%) of the neonates had late-onset neonatal sepsis, and 10/18 (55%) had low birth weight. Resistance to minocycline and chloramphenicol was 100%, 72.2% to meropenem; 72.2% NDM gene was found in neonates and was 20% from the environment. Conclusion: Outbreak of NDM-producing BCC resulting in high neonatal mortality in NICU.

Blood culture contamination in a tertiary care hospital: a retrospective three-year study

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.

Blood Culture Contamination Rate as a Quality Indicator - a Prospective Observational Study

Introduction: Blood culture test is the gold standard test to diagnose bloodstream infections, but contamination is the main problem in this valuable test. False positive results in blood cultures are mainly due to contamination that occurs mostly during pre-analytical procedures like sample collection and sometimes during sample processing. Materials and method:Our prospective observational study was undertaken at St. Theresa Hospital, Hyderabad, India, during January 2020-June 2020. Blood cultures received from inpatient departments (IPD) and outpatient departments (OPD) are included. Sample size: The contamination rate was calculated by dividing the total number of contaminated blood cultures by the total number of cultures multiplied by 100. Results:Blood culture contamination rate is 2.4%, which is within the limit as per the standard guideline. Conclusion:Contamination occurred mainly due to improper disinfection of the skin and environmental contamination.

Blood Culture Contamination: A Single General Hospital Experience of 2-Year Retrospective Study

In the event of blood culture contamination (BCC), blood culture (BC) needs to be repeated. This may delay appropriate treatment, prolong hospitalization and, consequently, increase its costs. The aim of the study was to assess the frequency of BCC and associated factors in a general hospital in Poland based on reports of BC in samples submitted for laboratory testing in 2019−2020. BCC is recognized when bacteria (especially those belonging to natural human microbiota) are isolated from a single sample and no clinical signs indicated infection. True positive BC is confirmed by the growth of bacteria in more than one set of blood samples with the corresponding clinical signs present. The structure of BC sets, microorganisms, and laboratory costs of BCC were analyzed. Out of 2274 total BC cases, 11.5% were true positive BC and 9.5% were BCC. Of all the BCC identified in the entire hospital, 72% was from Internal Medicine (IM) and Intensive Care Unit (ICU) combined. When single sets for BC were used in IM in 2020, the use increased to 85% compared with 2019 (p < 0.05). The predominant isolates were coagulase-negative staphylococci (84%). The estimated extra laboratory costs of BCC exceeded EUR 268,000. The BCC was a more serious problem than expected, including non-recommended using of single BC sets. Compliance with the BC collection procedure should be increased in order to reduce BCC and thus extra hospital costs.