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. 2024 Dec 30;4(1):e226.
doi: 10.1017/ash.2024.463. eCollection 2024.

Cultures for acid-fast bacilli: are we being good stewards?

Jennifer Hanrahan  1 , Julie D Sill  1 , Patricia Ver Schneider  2 , Jessica F Copeland  2 , Elsie Frimpongmaa Amoako-Kissi  1 , Ogochukwu O Ilobi  1 , Angela J Toepp  1   2
Affiliations

Cultures for acid-fast bacilli: are we being good stewards?

Jennifer Hanrahan et al. Antimicrob Steward Healthc Epidemiol. .

Abstract

Objective: To describe the use of cultures for acid-fast bacilli (AFB) and situations in which AFB cultures are unlikely to be of clinical benefit.

Design: Retrospective descriptive study of AFB cultures submitted to Sentara Health microbiology laboratory from December 1, 2021, to December 1, 2023. Data were collected from the electronic medical record and included patient demographics, the service line that ordered the culture, specimen source, and culture results.

Setting: Sentara Healthcare System.

Patients: All patients who had specimens submitted to the microbiology laboratory during the study period were included.

Results: A total of 13,944 AFB cultures from 8,243 patients were collected during the study period. Of these, 4.72% (n = 389) patients had a positive result, and 40 of 680 positive cultures were likely contaminants or non-mycobacterial. The average number of days between culture collection and positive results was 84.32 days (SD = 49.64) and 56.25 days (SD = 8.32) for negative results. Most cultures were ordered by medical subspecialties (44.06%, n = 6,144), followed by orthopedic providers (23.34%, n = 3,254) and surgical subspecialty providers (16.11%, n = 2,246). Most specimens were pulmonary (n = 6,620) with 619 (9.35%) positive cultures. Of 3,561 AFB cultures ordered from bone specimens, only 17 were positive (0.48%). The number of specimens processed by the microbiology laboratory required 2 full-time microbiology technicians to process specimens.

Conclusions: Many AFB cultures were sent from patients who did not have clinical scenarios consistent with mycobacterial disease and cultures were not clinically indicated. Implementation of testing criteria could decrease AFB cultures and healthcare costs.

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Conflict of interest statement

None.

Figures

Figure 1.
Figure 1.
Acid-fast bacilli species by average number of days to identification.
Figure 2.
Figure 2.
Acid-fast bacilli specimens sent by specialty group. N/A group is a contaminant or non-mycobacterial organism.
Figure 3.
Figure 3.
Number of specimens by specimen source. N/A are specimens that were either contaminants or non-mycobacterial organisms.
See this image and copyright information in PMC

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