Association Between Blood Culture Bottle Shortage and Ordering Restrictions and Clinical Outcomes for Patients With Staphylococcus aureus Bacteremia.

Abstract

Background: A nationwide shortage of blood culture bottles led to significant restriction of blood culture utilization at our institution.

Methods: We evaluated the impact of 3 combined interventions: (1) guidance on appropriate blood culture utilization, (2) restriction of repeat cultures within a 48-hour period, and (3) restriction of initial assessment to a single blood culture set consisting of 1 aerobic and 1 anaerobic blood culture bottle, on the management of patients with Staphylococcus aureus bacteremia (SAB) using an interrupted time series analysis.

Results: Prior to the intervention, 90.1% of patients had 2 blood culture sets ordered for initial assessment, versus 5.7% during the intervention and 84.1% postintervention. The median number of cultures to document SAB clearance was 4 (range, 2-17) in the preintervention period, 2 (range, 2-9) during the intervention period, and 4 (range, 3-11) postintervention. The median number of days to SAB clearance was not significantly different across the study periods, nor were days to central venous catheter placement or days of intravenous S aureus therapy. Fewer patients had documented SAB clearance within 24 hours and median time to diagnosis for community-acquired cases was longer in the intervention period, suggesting the restrictions were not without potential clinical impact.

Conclusions: These data demonstrate that efforts to reduce blood culture utilization should be implemented with careful stewardship in order to minimize adverse effects for patients with SAB.