- Habib G.
- Lancellotti P.
- Antunes M.J.
- Bongiorni M.G.
- Casalta J.P.
- Del Z.F.
- et al.
Materials and methods
Design and sampling strategy
Questionnaire and analysis
Recruited laboratories and response rates
|Data||Blood culture positivity rates|
|As proportion of positive BC sets||As proportion of positive BC bottles|
|Mean BC positivity rate||14.1%||13.8%|
|Number (%) of laboratories which provided data for that particular analysis||162/209 (77.5%)||159/209 (76.1%)|
|Day of the week||Starting incubation of BC bottles||Processing of positive BCs||Validation of ID and AST results|
|n||Percentage of laboratories with||Coverage of time-restricted service||N||Percentage of laboratories with||Coverage of time-restricted service||n||Percentage of laboratories with||Coverage of time-restricted service|
|24-h service||Time-restricted service||No service||24-h service||Time-restricted service||No service||24-h service||Time-restricted service||No service|
|Monday–Friday||185||42.2%||57.8%||0.0%||10.5 h||192||13.0%||87.0%||0.0%||10.3 h||190||4.7%||95.3%||0.0%||9.3 h|
|Saturday||184||41.3%||58.7%||0.0%||8.1 h||191||12.6%||85.9%||1.6%||7.8 h||190||4.2%||91.6%||4.2%||7.2 h|
|Sunday/holiday||183||41.5%||49.2%||9.3%||7.4 h||191||12.6%||72.3%||15.2%||7.1 h||190||4.2%||74.2%||21.6%||6.3 h|
- Habib G.
- Lancellotti P.
- Antunes M.J.
- Bongiorni M.G.
- Casalta J.P.
- Del Z.F.
- et al.
Appendix A. Supplementary data
- Multimedia component 1
Fig. S1. The annual numbers of blood cultures received by laboratories. A: blood culture sets received per 100 patient hospitalisations; B: blood culture sets received per 100 beds; C: blood culture bottles received per 100 patient hospitalisations; D: blood culture bottles received per 100 beds. In the analysis for all countries (left column on each figure) all laboratories are considered which provided response to that particular question (A, n=162; B, n=169; C, n=154; D, n=154). In the analysis for individual countries only countries are included for which at least 7 laboratories per country provided response to that particular question. Median values are presented.
- Multimedia component 2
Fig. S2. Estimated time to arrival of the majority of blood cultures (>80%) in laboratory after blood culture draw, % of respondents (A) and estimated percentage of blood cultures received and processed during off-hours for laboratories with 24/7 service for both starting incubation in the automated systems and for processing of positive BCs (n=23), % of respondents (B).
- Multimedia component 3
Fig. S3. Coverage of blood culture diagnostics in laboratories of different countries. A. Hours during which the laboratory can start incubation of blood culture bottles in a semi-automated blood culture system. B. Hours during which the laboratory can start processing blood culture bottles that have flagged positive in a semi-automated blood culture system. C. Hours during which the laboratory can validate and transmit the results of identification and susceptibility testing of blood culture isolates to the clinicians. In the analysis for all countries (left column on each graph) all laboratories are considered which provided response to that particular question (A, during the week: n=185; A, on Saturdays: n=184; A, on Sundays and holidays: n=183; B, during the week: n=192; B, on Saturdays: n=191; B, on Sundays and holidays: n=191; C, during the week: n=190; C, on Saturdays: n=190; C, on Sundays and holidays: n=190). For the analysis of individual countries only countries are included for which at least 7 laboratories per country provided response to that particular question. The analysis includes all laboratories independent of whether they provide 24 h-, part-time or no (0 h) respective service on respective days. Mean values of time coverage per 24 hours are presented.
- Multimedia component 4
Fig. S4. Proportion of multidrug-resistant organisms among blood culture isolates. A: methicillin-resistant S. aureus (MRSA) among all S. aureus blood culture isolates; B: ESBL-producing or third-generation cephalosporin-resistant E. coli among all E. coli blood cultures isolates; C: carbapenem-resistant Klebsiella spp. among all Klebsiella spp. blood cultures isolates; D: carbapenem-resistant P. aeruginosa among all P. aeruginosa blood cultures isolates; E: vancomycin-resistant E. faecium (VRE) among all E. faecium blood cultures isolates. In the analysis for all countries (left column on each figure) all laboratories are considered which provided response to that particular question (A, n=188; B, n=191; C, n=188; D, n=186; E, n=192). In the analysis for individual countries only countries are included for which at least 7 laboratories per country provided response to that particular question. Mean values are presented.
- Multimedia component 5
Fig. S5. Consultations by microbiology laboratory staff and infectious diseases department. A. Is advice for antimicrobial treatment provided by the laboratory staff for patients with detected bacteremia? B. Are blood culture results communicated to the infectious diseases department staff or consultation service? C. Reasons for selecting cases for presentation to infectious diseases department staff or consultation service (among laboratories which communicate only selected positive results to the infectious diseases department; multiple responses were allowed). * The following multidrug-resistant organisms were most commonly specified: methicillin-resistant S. aureus (MRSA) (8 laboratories), carbapenem-resistant bacteria (8 laboratories), vancomycin-resistant enterococci (VRE) (7 laboratories), ESBL-producing bacteria (4 laboratories). ** The following wards were most commonly specified: intensive care unit (5 laboratories), oncology/haematology (3 laboratories), paediatrics (1 laboratory).
- Multimedia component 6
Text S1. Questionnaire.
- Rapid phenotypic methods to improve the diagnosis of bacterial bloodstream infections: meeting the challenge to reduce the time to result.Clin Microbiol Infect. 2018; 24: 935-943
- Blood culture-based diagnosis of bacteraemia: state of the art.Clin Microbiol Infect. 2015; 21: 313-322
- Surviving Sepsis campaign: international guidelines for management of sepsis and septic shock: 2016.Intensive Care Med. 2017; 43: 304-377
- New microbiological techniques in the diagnosis of bloodstream infections.Dtsch Arztebl Int. 2018; 115: 822-832
- 2015 ESC guidelines for the management of infective endocarditis: the task force for the management of infective endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM).Eur Heart J. 2015; 36: 3075-3128
- How to: accreditation of blood cultures' proceedings. A clinical microbiology approach for adding value to patient care.Clin Microbiol Infect. 2018; 24: 956-963
- Impact of multiplex PCR on antimicrobial treatment in febrile neutropenia: a randomized controlled study.Med Microbiol Immunol. 2015; 204: 585-592
- Rapid identification and antimicrobial susceptibility testing reduce antibiotic use and accelerate pathogen-directed antibiotic use.J Antimicrob Chemother. 2008; 61: 428-435
- Implementation of short incubation MALDI-TOF MS identification from positive blood cultures in routine diagnostics and effects on empiric antimicrobial therapy.Antimicrob Resist Infect Control. 2017; 6: 12
- Effects of rapid detection of bloodstream infections on length of hospitalization and hospital charges.J Clin Microbiol. 2003; 41: 3119-3125
- Developmental roadmap for antimicrobial susceptibility testing systems.Nat Rev Microbiol. 2019; 17: 51-62
- Blood culture turnaround time in US acute care hospitals and implications for laboratory process optimization.J Clin Microbiol. 2018; 56: e00500-e00518
- Rapid identification of microorganisms from positive blood cultures by MALDI-TOF mass spectrometry subsequent to very short-term incubation on solid medium.Clin Microbiol Infect. 2014; 20: 1001-1006
- Real life turnaround time of blood cultures in the clinical microbiology laboratory: results of the first Italian survey, May 2015.Microbiol Med. 2016; 31 (6127:6185–88)
- Quality of blood culture testing—a survey in intensive care units and microbiological laboratories across four European countries.Crit Care. 2013; 17: R248
- The 24-h clinical microbiology service is essential for patient management.Future Microbiol. 2018; 13: 1625-1628
- A retrospective evaluation of critical care blood culture yield—do support services contribute to the "Weekend Effect"?.PLoS One. 2015; 10e0141361
- Transport time for blood culture bottles: underlying factors and its consequences.Diagn Microbiol Infect Dis. 2013; 76: 286-290
- Work flow analysis of around-the-clock processing of blood culture samples and integrated MALDI-TOF mass spectrometry analysis for the diagnosis of bloodstream infections.Clin Chem. 2013; 59: 1649-1656
- CMI guidance for authors of surveys.Clin Microbiol Infect. 2016; 22: 901-902
- Utilization of blood cultures in Danish hospitals: a population-based descriptive analysis.Clin Microbiol Infect. 2015; 21: 344.e13-344.e21
- Proposing an empirically justified reference threshold for blood culture sampling rates in intensive care units.J Clin Microbiol. 2015; 53: 648-652
- Culturing rate and the surveillance of bloodstream infections: a population-based assessment.Clin Microbiol Infect. 2018; 24: 910
- Surveillance of antimicrobial resistance in Europe 2016.in: Annual report of the European Antimicrobial Resistance Surveillance Network (EARS-Net). ECDC, Stockholm2017
- Comparison of BacT/Alert and BACTEC NR 860 blood culture systems in a laboratory not continuously staffed.Clin Microbiol Infect. 1997; 3: 345-351
- Analysis of the comparative workflow and performance characteristics of the VITEK 2 and Phoenix systems.J Clin Microbiol. 2005; 43: 3829-3834
- What happens when automated blood culture instrument detect growth but there are no technologists in the microbiology laboratory?.Diagn Microbiol Infect Dis. 2004; 48: 173-174
- Timeliness and accuracy of reporting preliminary blood culture results: a College of American Pathologists Q-probes study of 65 institutions.Arch Pathol Lab Med. 2015; 139: 621-626
- Identification and susceptibility testing from shortly incubated cultures accelerate blood culture diagnostics at no cost.Clin Infect Dis. 2016; 62: 268-269
- EUCAST rapid AST directly from positive blood culture bottles. Version 1.0.2018 (Available at:)
- Identification and antimicrobial susceptibility testing of positive blood culture isolates from briefly incubated solid medium cultures.Enferm Infecc Microbiol Clin. 2017; 35: 582-585
- Acceleration of antimicrobial susceptibility testing of positive blood cultures by inoculation of Vitek 2 cards with briefly incubated solid medium cultures.J Clin Microbiol. 2014; 52: 4058-4062
- How small modifications in laboratory workflow of blood cultures can have a significant impact on time to results.Eur J Clin Microbiol Infect Dis. 2018; 37: 1753-1760
☆Part of this work was presented at the 27th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), 22–25 April 2017, Vienna, Austria (OS0743).
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