HAEMATOLOGY
to diagnose bacteraemia, which has a significant morbidity and a mortality rate of up to 37%, any delay in treatment due to identifying more than one causative organism could be fatal for patients.8 The largest proportion of false-positive blood cultures (50–85%) result from contamination with coagulase-negative staphylococci which is primarily found on the skin.3
However, if found in the
bloodstream and not from contamination they are a significant cause of bacteraemia.9 Because of this, clinicians cannot ignore these results and a positive blood culture result of coagulase-negative staphylococci often requires immediate treatment of broad- spectrum antibiotics. Unnecessary antibiotics are prescribed in 40-50% of cases of BCC10
and needless
use of antibiotics for patients’ conflicts with the efforts to combat and improve global antimicrobial stewardship.
Studies confirm an association between contaminated blood culture samples and increased length of hospital stay (LOS) for patients.3,5,6
As can be shown in Table 1,
increased LOS is estimated to range from 2.5-8.0 additional days in hospital.5,6,11,12 This is important as unnecessary hospitalisation can lead to hospital-acquired infections (HAIs), including Clostridium Difficile,5
pneumonia and MRSA. Studies also show that 8% of hospitalised patients are exposed to HAIs, of which 20% can be multi-drug resistant13
and as patients’ LOS is
increased, the risk of exposure to HAIs grows exponentially.
Antimicrobial stewardship Antimicrobial resistance is a significant global threat to public health.13
Study
Increased LOS Cost per (in days)
Bates et al
(1991)11 Zwang et al
(2006)6 Gander
et al (2009)25 Alahamadi
et al (2011)12 Geisler et al5
5.4 2.35 8 - 12.5 Not reported 4-5
contamination
Estimated total BCC estimated total savings (with intervention)
cost to a hospital $8,731 - $13,116 not reported Not reported $8,720
(additional charges)
£5,001 $6,436 Not reported
Phlebotomist Team
$4.1 mil Not reported
Phlebotomist Team
$1.3 mil
Table 1: Increased LOS in days, cost per contamination, total savings with intervention, and estimated total cost to hospitals.
and, when faced with drugs that can kill them such as antibiotics, they mutate and form resistance, resulting in bacterial infections that cannot be treated.15 Resistant microorganisms and multi-drug resistant infections are exacerbated by poor practices within hospitals and in the community, such as over prescribing of broad-spectrum antibiotics and poor infection control practices, thus requiring the need for antimicrobial stewardship efforts. Antimicrobial stewardship is a set of coordinated measures to help tackle further creation and introduction of drug resistant microorganisms.16
Key elements Analysis
by Lord Jim O’Neill predicts that by 2050, 10 million deaths worldwide will be attributable to antibiotic resistant infections.14 A microbe’s primary function is to survive,
of antimicrobial stewardship include; correct antibiotic prescribing, correct dosing, only prescribing antibiotics for suspected bacterial infections and not prescribing for viral infections.16
This global initiative is endorsed
by the World Health Organization as well as the Health Service Executive (Ire) and the National Health Service NHS (UK). While antimicrobial stewardship is recognised by many clinicians as a key factor to the future of healthcare, false- positive blood culture results misguide clinicians and microbiologists. BCC is a leading cause of unnecessary prescription of broad-spectrum antibiotics4
which
subsequently undermines the antimicrobial stewardship effort.
As previously discussed, bacteraemia pose too high a risk to patients’ lives8
to
go untreated if tests show positive results. However, knowing how frequently these results are falsely positive highlights the strain BCC has on the global antimicrobial stewardship initiative.
£1,270,381 Not reported Not reported $1.4 mil - $1.8 mil Not reported
Serves as a flash chamber to provide visual confirmation of proper needle placement in the vein.
Contaminants residing in the initial ~0.15ml volume of blood are captured in the u-shaped Kurin Lock
44 l
WWW.CLINICALSERVICESJOURNAL.COM
Blood flows directly from the vein into the culture bottle through a separate channel.
NOVEMBER 2020
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