MICROBIOLOGY
Blood culture pre-analytical KPIs – The next challenge in microbiology?
The blood culture pathway is often thought of as a relatively straightforward one; sample to laboratory and result to clinician but, in reality, is a complex network of multidisciplinary stakeholders that is dependent on timely interventions and limited by availability of services and diagnostic tools, says Kate Donnachie.
Blood cultures remain the standard for the investigation of blood stream infections (BSIs) and are recommended as one of the earliest actions for patients who present with signs of sepsis or septic shock.1,2
The results gathered from
blood culture investigations allow for the identification and appropriate therapy of the causative agent of these infections.
Collection of samples ahead of empiric antimicrobial administration is advised and the results can lead to more targeted therapy. Therefore, prompt and accurate investigation of blood cultures positively impacts antimicrobial stewardship and reduces unnecessary exposure of patients to inappropriate drugs and their associated side effects. Ideally this
A nationwide survey of blood culture pathway practices conducted in 2018 and 2019 showed that 42% of respondents had never audited their blood culture pathway.
process should operate 24/7 with all services; clinical, support and laboratory operating at an appropriate capacity to ensure no differentiation between a sample taken during ‘office hours’ and one taken at 3am. The reality of the situation is, unfortunately only around 42% of European hospitals are loading blood cultures on a 24/7 basis with only 13% processing positive blood cultures around the clock.3 The pre-analytical steps, laboratory
processing and clinical action based on results are all instrumental in ensuring the optimisation of the pathway, and any delay in results can lead to inappropriate therapy, prolonged patient stay, increased risk of antimicrobial resistance, and ultimately negatively impact patient care in general.4,5
Guidelines and recommendations
In June of 2022, NHS England published an executive summary entitled Improving the blood culture pathway – A national review of blood culture pathway processes to support better antimicrobial stewardship and improved patient safety. The publication was based on the findings of a nationwide survey of blood culture pathway practices conducted in 2018 and 2019 and included querying the hospital’s adherence to the standards set out in the current Standards for Microbiology Investigations (SMI) at the time, B37, Investigation of blood cultures (for organisms other than Mycobacterium species).6
The results, which were
understandably delayed by a global pandemic, made for concerning reading. Notable results of the survey were: n 42% of respondents had never audited their blood culture pathway
n Only 17/158 collected the recommended two blood culture sets
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