Immediate incubation of blood cultures outside routine laboratory hours of operation accelerates antibiotic switching

Abstract

The aim of this prospective randomized controlled clinical trial was to assess the impact of immediate incubation of blood cultures delivered to the laboratory outside its hours of operation on turnaround times, antibiotic prescription practices, and patient outcomes. A continuously monitoring blood culture incubator was placed outside the laboratory, which was switched on (intervention arm) and off (control arm) in a randomized manner. Included were new bacteremia episodes of patients older than 18 years. During the 30-week study period, the first positive blood culture specimen of an episode had to be brought to the laboratory outside its hours of operation. The median time from specimen collection until growth detection was reduced by 10.1 h in the intervention arm (P < 0.001). For 46 of 66 (70%) episodes in the intervention arm and for 51 of 85 (60%) episodes in the control arm, the antibiotic regimen was changed (not significant). The median time until the first change in the antibiotic regimen was 42.8 h in the intervention arm and 64.0 h in the control arm (P, 0.024). There was no difference in length of stay or hospital mortality. Immediate incubation of blood cultures outside laboratory hours reduces turnaround times and accelerates antibiotic switching.

FIG. 1.

Blood cultures brought to the laboratory outside its hours of operation from March to October 2005, and selection of positive episodes to be included in the study. *, a blood culture consists of two bottles: an aerobic and an anaerobic bottle.

FIG. 2.

Time from specimen collection to the first antibiotic regimen change after growth detection. Episodes were censored if patients left the hospital before the changes in therapy occurred. The differences between the arms are significant (P = 0.029).