Abstract
We investigated the impact of a multimodal intervention to improve the compliance of BC collections as a composite outcome, taking into account both blood volume collected and absence of solitary BC. We performed a quasi-experimental study using a before-after design (5 months for pre- and post-intervention evaluation) in an adult emergency department at a tertiary care hospital that showed that a multimodal intervention was associated with a dramatic increase in the proportion of blood cultures that were collected as recommended per national guidelines, from 17.3% (328/1896) to 68.9% (744/1080), P < 0.0001. The implementation of such intervention in other settings could improve the diagnosis of bloodstream infections and reduce irrelevant costs.
This is a preview of subscription content, log in via an institution to check access.
Data availability
Due to the French ethical legislation regarding the privacy of individuals who participated in the study, the data underlying this article cannot be shared.
Code availability
Not available.
References
Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR et al (2020) Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the global burden of disease study. Lancet 395:200–211. https://doi.org/10.1016/S0140-6736(19)32989-7
Lamy B, Dargère S, Arendrup MC, Parienti J-J, Tattevin P (2016) How to optimize the use of blood cultures for the diagnosis of bloodstream infections? A state-of-the art. Front Microbiol 7:697. https://doi.org/10.3389/fmicb.2016.00697
Zasowski EJ, Claeys KC, Lagnf AM, Davis SL, Rybak MJ (2016) Time is of the essence: the impact of delayed antibiotic therapy on patient outcomes in hospital-onset enterococcal bloodstream infections. Clin Infect Dis 15(62):1242–1250. https://doi.org/10.1093/cid/ciw110
Phua J, Ngerng W, See K, Tay C, Kiong T, Lim H et al (2013) Characteristics and outcomes of culture-negative versus culture-positive severe sepsis. Crit Care 17:R202. https://doi.org/10.1186/cc12896
Baron EJ, Miller JM, Weinstein MP, Richter SS, Gilligan PH, Thomson RB et al (2013) A guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2013 Recommendations by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM)a. Clin Infect Dis 15(57):e22-121. https://doi.org/10.1093/cid/cit278
Towns ML, Jarvis WR, Hsueh P-R (2010) Guidelines on blood cultures. J Microbiol Immunol Infect 43:347–349. https://doi.org/10.1016/S1684-1182(10)60054-0
Schifman RB, Strand CL, Braun E, Louis-Charles A, Spark RP, Fried ML (1991) Solitary blood cultures as a quality assurance indicator. Qual Assur Util Rev 6:132–137. https://doi.org/10.1177/0885713x9100600406
Libertin CR, Sacco KA, Peterson JH (2018) Education and coaching to optimise blood culture volumes: continuous quality improvement in microbiology. BMJ Open Qual 7:e000228. https://doi.org/10.1136/bmjoq-2017-000228
Khare R, Kothari T, Castagnaro J, Hemmings B, Tso M, Juretschko S (2020) Active monitoring and feedback to improve blood culture fill volumes and positivity across a large integrated health system. Clin Infect Dis 2(70):262–268. https://doi.org/10.1093/cid/ciz198
van Ingen J, Hilt N, Bosboom R (2013) Education of phlebotomy teams improves blood volume in blood culture bottles. J Clin Microbiol 51:1020–1021. https://doi.org/10.1128/JCM.03068-12
Shaji R, Madigubba H, Priyadarshi K, Anandh P, Nathan B, Vivekanandan M et al (2022) Effectiveness of multimodal intervention to improve blood culture collection in the emergency department. J Global Infect Dis 14:10. https://doi.org/10.4103/jgid.jgid_138_21
Fabre V, Sharara SL, Salinas AB, Carroll KC, Desai S, Cosgrove SE (2020) Does this patient need blood cultures? A scoping review of indications for blood cultures in adult nonneutropenic inpatients. Clin Infect Dis 22(71):1339–1347. https://doi.org/10.1093/cid/ciaa039
Fabre V, Klein E, Salinas AB, Jones G, Carroll KC, Milstone AM et al (2020) A Diagnostic stewardship intervention to improve blood culture use among adult nonneutropenic inpatients: the DISTRIBUTE study. J Clin Microbiol 22(58):e01053-e1120. https://doi.org/10.1128/JCM.01053-20
Husabø G, Nilsen RM, Flaatten H, Solligård E, Frich JC, Bondevik GT et al (2020) Early diagnosis of sepsis in emergency departments, time to treatment, and association with mortality: an observational study. PLoS ONE 22(15):e0227652. https://doi.org/10.1371/journal.pone.0227652
Acknowledgements
The authors are grateful to the participants, to all emergency staff, and to microbiology laboratory staff.
Author information
Authors and Affiliations
Contributions
RG and YM designed the study. YM, PT, CP, VC, and AB were in charge of the implementation of the local protocol. AM, DB, and LS were in charge of the staff training and of data collection. CP and VC were in charge of microbiological data collection. RG analyzed the data. AB, AM, DB, RG, PT, and YM wrote the initial manuscript. All authors contributed to the revision of the manuscript and approved the final version.
Corresponding author
Ethics declarations
Ethics approval
Validated by the local ethical committee.
Consent to participate
All participants provided informed consent for the reutilization of the hospital data.
Consent for publication
Each author has read and approved the final version of the manuscript.
Conflict of interest
The authors declare no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Merien, A., Bacle, A., Tattevin, P. et al. Effectiveness of a multimodal intervention to improve blood culture collection in an adult emergency department. Eur J Clin Microbiol Infect Dis 42, 1519–1522 (2023). https://doi.org/10.1007/s10096-023-04680-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10096-023-04680-z