On-site blood culture incubation shortens the time to knowledge of positivity and microbiological results in septic patients

Introduction To determine whether on-site incubation of blood cultures at the intensive care unit (ICU) improves not only the time to incubation but also time to positivity, time to knowledge of positivity and time to results (identification and antibiotic susceptibility testing). Methods This observational single-centre study in ICU patients with severe sepsis and septic shock investigated the impact of blood culture incubation immediately on-site at the ICU (ICU group) by comparison with traditional processing in a remote laboratory (LAB group) on different time intervals of blood culture diagnostics from obtaining blood to clinician notification of final result. The effect of on-site incubation was evaluated in Kaplan-Meier estimates for the time to positivity, time to knowledge of positivity and time to microbiological results and a linear mixed model was built. Results A total of 3,549 blood culture sets from 657 ICU patients were analysed: 2,381 in the LAB group and 1,168 in the ICU group. Overall, 660 (18.6%) blood culture sets were positive and 2,889 (81.4%) sets remained negative. On-site incubation was associated with reduced time to knowledge of positivity (46.9 h [CI 43.4–50.8 h] vs. 28.0 h [CI 23.6–32.2 h], p < 0.001) and reduced time to result (61.4 h [CI 58.4–64.8 h] vs. 42.1 h [CI 39.1–47.5 h], p < 0.001). In blood cultures processed instantaneously at the ICU compared to incubation in the remote laboratory within 4 h, the time to microbiological result was significantly reduced by 8.5 h (p < 0.001). Pre-existing anti-infective therapy had no significant impact on diagnostic time intervals. Conclusions Instantaneous incubation of blood cultures in the ICU compared to incubation in a remote laboratory significantly improves time to knowledge to positivity and time to result. These effects are even more pronounced during off-hours of the microbiological laboratory. The results underline the importance of 24/7 diagnostics to provide round-the-clock processing of blood culture samples in patients with sepsis and septic shock and an immediate to communication of the results to the clinicians.

[1]  J. Schrenzel,et al.  Microbiological diagnostics of bloodstream infections in Europe-an ESGBIES survey. , 2019, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[2]  B. Lamy Reprint of: Blood culture time-to-positivity: making use of the hidden information. , 2019, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[3]  A. Hoerauf,et al.  A prospective study on the effect of time-shifted telephone reporting of blood culture microscopy , 2019, European Journal of Clinical Microbiology & Infectious Diseases.

[4]  M. Vollmer,et al.  Impact of antibiotic administration on blood culture positivity at the beginning of sepsis: a prospective clinical cohort study. , 2019, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[5]  E. Peters,et al.  The impact of laboratory closing times on delay of adequate therapy in blood stream infections. , 2018, The Netherlands journal of medicine.

[6]  György J. Simon,et al.  Delay Within the 3-Hour Surviving Sepsis Campaign Guideline on Mortality for Patients With Severe Sepsis and Septic Shock* , 2018, Critical care medicine.

[7]  C. Ainger,et al.  Optimization of the blood culture pathway: a template for improved sepsis management and diagnostic antimicrobial stewardship. , 2018, The Journal of hospital infection.

[8]  Alexa Camarena-Michel Increased Time to Initial Antimicrobial Administration is Associated with Progression to Septic Shock in Severe Sepsis Patients: Whiles BB, Deis AS, Simpson SQ. Crit Care Med 2017;45(4):623-629 , 2017 .

[9]  Steven Q Simpson,et al.  Increased Time to Initial Antimicrobial Administration Is Associated With Progression to Septic Shock in Severe Sepsis Patients , 2017, Critical care medicine.

[10]  Sangeeta Mehta,et al.  Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016 , 2017, Intensive Care Medicine.

[11]  M. Vollmer,et al.  Quality Improvement Initiative for Severe Sepsis and Septic Shock Reduces 90-Day Mortality: A 7.5-Year Observational Study* , 2017, Critical care medicine.

[12]  M. Girardis,et al.  Impact of Pre-Analytical Time on the Recovery of Pathogens from Blood Cultures: Results from a Large Retrospective Survey , 2017, PloS one.

[13]  E. Hutley,et al.  What are the critical steps in processing blood cultures? A prospective audit evaluating current practice of reporting blood cultures in a centralised laboratory serving secondary care hospitals , 2016, Journal of Clinical Pathology.

[14]  D. Ecker,et al.  Rapid Diagnosis of Infection in the Critically Ill, a Multicenter Study of Molecular Detection in Bloodstream Infections, Pneumonia, and Sterile Site Infections* , 2015, Critical care medicine.

[15]  B. Morton,et al.  A Retrospective Evaluation of Critical Care Blood Culture Yield – Do Support Services Contribute to the “Weekend Effect”? , 2015, PloS one.

[16]  D. Ecker,et al.  Improved Sensitivity for Molecular Detection of Bacterial and Candida Infections in Blood , 2014, Journal of Clinical Microbiology.

[17]  R. Ramphal,et al.  Time to Positivity of Blood Cultures Supports Antibiotic De-escalation at 48 Hours , 2014, The Annals of pharmacotherapy.

[18]  Mathias W Pletz,et al.  Quality of blood culture testing - a survey in intensive care units and microbiological laboratories across four European countries , 2013, Critical Care.

[19]  V. Özenci,et al.  Transport time for blood culture bottles: underlying factors and its consequences. , 2013, Diagnostic microbiology and infectious disease.

[20]  A. Dreyer Blood Culture Systems: From Patient to Result , 2012 .

[21]  M. Bauer,et al.  Evaluation of a Polymerase Chain Reaction Assay for Pathogen Detection in Septic Patients under Routine Condition: An Observational Study , 2012, PloS one.

[22]  E. Melander,et al.  Reducing Blood Culture Contamination by a Simple Informational Intervention , 2010, Journal of Clinical Microbiology.

[23]  P. Hsueh,et al.  Guidelines on blood cultures. , 2010, Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi.

[24]  J. Wu,et al.  Effect of overnight storage of blood culture bottles on bacterial detection time in the BACTEC 9240 blood culture system. , 2010, Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi.

[25]  M. Clementi,et al.  The Era of Molecular and Other Non-Culture-Based Methods in Diagnosis of Sepsis , 2010, Clinical Microbiology Reviews.

[26]  L. Lehmann,et al.  Potential clinical utility of polymerase chain reaction in microbiological testing for sepsis , 2009, Critical care medicine.

[27]  M. Vos,et al.  Immediate Incubation of Blood Cultures Outside Routine Laboratory Hours of Operation Accelerates Antibiotic Switching , 2009, Journal of Clinical Microbiology.

[28]  S. Ichiyama,et al.  Delayed insertion of blood culture bottles into automated continuously monitoring blood culture systems increases the time from blood sample collection to the detection of microorganisms in bacteremic patients , 2009, Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy.

[29]  M. Vos,et al.  Needle-to-Incubator Transport Time: Logistic Factors Influencing Transport Time for Blood Culture Specimens , 2009, Journal of Clinical Microbiology.

[30]  E. Reisinger,et al.  Delayed Processing of Blood Samples Influences Time to Positivity of Blood Cultures and Results of Gram Stain-Acridine Orange Leukocyte Cytospin Test , 2007, Journal of Clinical Microbiology.

[31]  K. Wood,et al.  Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock* , 2006, Critical care medicine.

[32]  O. Akan,et al.  Comparison of the effect of delayed entry into 2 different blood culture systems (BACTEC 9240 and BacT/ALERT 3D) on culture positivity. , 2006, Diagnostic microbiology and infectious disease.

[33]  Patricia Muñoz,et al.  Bloodstream infections: a trial of the impact of different methods of reporting positive blood culture results. , 2004, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[34]  R. Platt,et al.  Predicting Bacteremia in Patients with Sepsis Syndrome , 1997 .

[35]  D. Pittet,et al.  The natural history of the systemic inflammatory response syndrome (SIRS). A prospective study. , 1995, JAMA.

[36]  W. Knaus,et al.  Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. , 1992, Chest.

[37]  E. Cook,et al.  Predicting bacteremia in hospitalized patients. A prospectively validated model. , 1990, Annals of internal medicine.

[38]  SepNet Critical Care Trials Group Incidence of severe sepsis and septic shock in German intensive care units: the prospective, multicentre INSEP study , 2016, Intensive Care Medicine.

[39]  J. Garnacho-Montero,et al.  De-escalation of empirical therapy is associated with lower mortality in patients with severe sepsis and septic shock , 2013, Intensive Care Medicine.

[40]  L. Garcia Clinical Microbiology Procedures Handbook, 3rd Edition , 2010 .

[41]  H. Schønheyder,et al.  The impact of the first notification of positive blood cultures on antibiotic therapy. A one-year survey. , 1995, APMIS : acta pathologica, microbiologica, et immunologica Scandinavica.

[42]  M. Weinstein,et al.  The clinical significance of positive blood cultures: a comprehensive analysis of 500 episodes of bacteremia and fungemia in adults. I. Laboratory and epidemiologic observations. , 1983, Reviews of infectious diseases.