Underutilization and Quality Gaps in Blood Culture Processing in Public Hospitals of Peru

Abstract

Correct processing of blood cultures may impact individual patient management, antibiotic stewardship, and scaling up of antimicrobial resistance surveillance. To assess the quality of blood culture processing, we conducted four assessments at 16 public hospitals across different regions of Peru. We assessed the following standardized quality indicators: 1) positivity and contamination rates, 2) compliance with recommended number of bottles/sets and volume of blood sampled, 3) blood culture utilization, and 4) possible barriers for compliance with recommendations. Suboptimal performance was found, with a median contamination rate of 4.2% (range 0-15.1%), with only one third of the participating hospitals meeting the target value of < 3%; and a median positivity rate of 4.9% (range 1-8.1%), with only 6 out of the 15 surveilled hospitals meeting the target of 6-12%. None of the assessed hospitals met both targets. The median frequency of solitary blood cultures was 71.9% and only 8.9% (N = 59) of the surveyed adult bottles met the target blood volume of 8 - 12 mL, whereas 90.5% (N = 602) were underfilled. A high frequency of missed opportunities for ordering blood cultures was found (69.9%, 221/316) among patients with clinical indications for blood culture sampling. This multicenter study demonstrates important shortcomings in the quality of blood culture processing in public hospitals of Peru. It provides a national benchmark of blood culture utilization and quality indicators that can be used to monitor future quality improvement studies and diagnostic stewardship policies.

Figure 1.

Box-plot distribution of the blood volume inoculated to surveyed bottles in eight participating hospitals. The boxes represent the interquartile range, with the lower and upper ends representing the first and third quartiles, respectively. The horizontal line within the boxes represent the median, and the lower and upper whiskers represent the minimum and maximum, whereas the dots above and below the whiskers represent the outliers. Dotted lines represent the target volume from 8 to 12 mL.

Figure 2.

Distribution of the needle-to-incubator time assessed in five hospitals in Peru. The boxes represent the interquartile range, with the lower and upper ends representing the first and third quartiles, respectively. The horizontal line within the boxes represent the median, and the lower and upper whiskers represent the minimum and maximum, whereas the dots above and below the whiskers represent the outliers. Dotted line represents the target of 2 hours or less for transport time.