Antimicrobial stewardship & healthcare epidemiology : ASHE · 2025
Implementation of blood culture stewardship during a blood culture bottle shortage: a multicenter assessment.
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Sevilla Kristen, Konyk Orest, Rittenberger Jon C, Williams Karen S
Аннотация
OBJECTIVE: Assess clinical outcomes, knowledge, and attitudes about shortage mitigation interventions during a nationwide blood culture bottle shortage. We hypothesized that efforts to target ordering of blood cultures would not change patient-oriented outcomes.
DESIGN: Retrospective, noninferiority, multicenter study.
SETTING: Tertiary, rural healthcare system.
PATIENTS: Eligible patients had any culture ordered before and after mitigation strategies.
INTERVENTIONS: Mitigation strategies were rapidly implemented to preserve the availability of blood culture bottles for high-risk patients. Interventions included best practice advisories, algorithms, cascade questions, hard stops, education, and communication.
RESULTS: The primary composite outcome (death during hospitalization, death within 14 d after discharge, return to the emergency department (ED) or readmission within 14 d after discharge) occurred in 603 of 3,174 patients (19.0%) in the pregroup and 1,496 of 8,232 patients (18.2%) in the postgroup (P = 0.321), meeting noninferiority in inverse probability treatment weight (IPTW) analysis. The groups were similar in secondary outcomes and in the subgroup with severe sepsis or septic shock. 69% of 41 survey respondents answered the case questions correctly. Regulatory pressure and patient status were the strongest drivers of blood culture ordering. Clinicians favored in-person communication, algorithms, and cascade over emails, daily huddles, and hard stops/second signatures.
CONCLUSIONS: Implementation of mitigation strategies during the shortage was not associated with differences in outcomes including mortality, return to the ED, readmission, or length of stay. Preliminary evidence suggests that outcomes may not be affected by the absence of blood cultures in high-risk sepsis patients. If proven in future studies, sepsis recommendations could be rewritten to accommodate pretest probability for bacteremia.
DESIGN: Retrospective, noninferiority, multicenter study.
SETTING: Tertiary, rural healthcare system.
PATIENTS: Eligible patients had any culture ordered before and after mitigation strategies.
INTERVENTIONS: Mitigation strategies were rapidly implemented to preserve the availability of blood culture bottles for high-risk patients. Interventions included best practice advisories, algorithms, cascade questions, hard stops, education, and communication.
RESULTS: The primary composite outcome (death during hospitalization, death within 14 d after discharge, return to the emergency department (ED) or readmission within 14 d after discharge) occurred in 603 of 3,174 patients (19.0%) in the pregroup and 1,496 of 8,232 patients (18.2%) in the postgroup (P = 0.321), meeting noninferiority in inverse probability treatment weight (IPTW) analysis. The groups were similar in secondary outcomes and in the subgroup with severe sepsis or septic shock. 69% of 41 survey respondents answered the case questions correctly. Regulatory pressure and patient status were the strongest drivers of blood culture ordering. Clinicians favored in-person communication, algorithms, and cascade over emails, daily huddles, and hard stops/second signatures.
CONCLUSIONS: Implementation of mitigation strategies during the shortage was not associated with differences in outcomes including mortality, return to the ED, readmission, or length of stay. Preliminary evidence suggests that outcomes may not be affected by the absence of blood cultures in high-risk sepsis patients. If proven in future studies, sepsis recommendations could be rewritten to accommodate pretest probability for bacteremia.