Implementation of diagnostic stewardship in blood culture laboratory: a large-scale interventional study in a tertiary care hospital, South India

Abstract

Background: Laboratories with well-established diagnostic stewardship program for culture and antimicrobial susceptibility test (C-AST) play a key role in guiding the clinicians to institute specific targeted therapy. Methods: The study period was divided into three phases; pre-intervention phase, intervention phase and post- intervention phase. During the pre-intervention phase, the blood culture was performed by conventional methods. During the intervention phase, immense efforts were made for full-fledged implementation of all the components of intervention-educational intervention for microbiology and clinical team and automations for culture, workflow modifications for performing preliminary tests in parallel with reporting, enhanced reporting frequency and stage-wise communication of reports to the clinicians. Results: There was a significant improvement in the isolation rate in the post-intervention phase (from 10.3% to 15.5%). There has been a steady decrease in mean turnaround time (TAT) of positive culture reports (from 85 to 45 h), which was in turn due to faster blood culture positivity, identification time and AST time. There was also significant improvement in clinical team performance on various parameters such as % of samples sent in pair, % of specimens with appropriate blood volume collected and % culture drawn before the antibiotic start. Conclusions: Our observation shows significant improvement in the pathogen isolation rate as well as performance of both microbiology and the clinical team. Most patients with sepsis are critically ill, therefore, it is the responsibility of every clinical microbiologist to implement the highest standard of diagnostic stewardship in blood culture laboratory.