Abstract
BackgroundPrompt identification of bloodstream pathogens is essential for optimal management of patients. Significant changes in analytical methods have improved the turnaround time for laboratory diagnosis. Less attention has been paid to the time elapsing from blood collection to incubation and to its potential effect on recovery of pathogens. We evaluated the performance of blood cultures collected under typical hospital conditions in relation to the length of their pre-analytical time.MethodsWe carried out a large retrospective study including 50,955 blood cultures collected, over a 30-month period, from 7,035 adult septic patients. Cultures were accepted by the laboratory only during opening time (Mon-Fri: 8am–4pm; Sat: 8am–2pm). Samples collected outside laboratory hours were stored at room temperature at clinical wards. All cultures were processed by automated culture systems. Day and time of blood collection and of culture incubation were known for all samples.ResultsA maximum pre-analytical interval of 2 hours is recommended by guidelines. When the laboratory was open, 57% of cultures were processed within 2 h. When the laboratory was closed, 4.9% of cultures were processed within 2 h (P<0.001). Samples collected when the laboratory was closed showed pre-analytical times significantly longer than those collected when laboratory was open (median time: 13 h and 1 h, respectively, P<0.001). The prevalence of positive cultures was significantly lower for samples collected when the laboratory was closed compared to open (11% vs 13%, P<0.001). The probability of a positive result decreased of 16% when the laboratory was closed (OR:0.84; 95%CI:0.80–0.89, P<0.001). Further, each hour elapsed from blood collection to incubation resulted associated with a decrease of 0.3% (OR:0.997; 95%CI:0.994–0.999, P<0.001) in the probability of a positive result.DiscussionDelayed insertions of cultures into automated systems was associated with lower detection rates, with potentially important consequences for patients. In each hospital setting the logistic factors able to shorten pre-analytical time should be carefully investigated and specifically targeted.
Highlights
BackgroundPrompt identification of bloodstream pathogens is essential for optimal management of patients
Prompt identification of the infecting pathogen is essential for optimal management of patients with sepsis syndromes, and has been reported to significantly improve patient outcome, to reduce antibiotic resistance, to decrease healthcare costs, with active antimicrobial stewardship involvement [1,2,3,4,5,6].Collecting blood cultures prior to antimicrobial therapy remains the most important diagnostic tool for sepsis syndrome and it is recommended as a standard of care in all international guidelines for management of sepsis and septic shock [3, 6, 7]
We evaluated the performance of blood cultures collected under typical hospital conditions in relation to the length of their pre-analytical time
Summary
Prompt identification of bloodstream pathogens is essential for optimal management of patients. Significant changes in analytical methods have improved the turnaround time for laboratory diagnosis. Less attention has been paid to the time elapsing from blood collection to incubation and to its potential effect on recovery of pathogens. We evaluated the performance of blood cultures collected under typical hospital conditions in relation to the length of their pre-analytical time. Data Availability Statement: Due to ethical constraints and concerns for patient privacy, data are available on request. Study data will be made available to all interested researchers. Interested researchers may contact Dr Claudia Venturelli (venturelli.claudia@policlinico.mo.it) or Prof. Elena Righi (elena.righi@unimore.it) or Prof Massimo Girardis (girardis.massimo@unimo.it) to request data.
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