A Prospective Study to Improve Automated Blood Culture Diagnostics in Gram Negative Sepsis by Implementing a "Diagnostic Stewardship Care-Bundle"

ObjectivesWe implemented a diagnostic stewardship care-bundle (DSB): "Sepsis-48" with the aim of evaluating its impact on changes in duration of key steps in automated blood culture diagnostics (aBCD), compliance to care-bundle and turnaround time (TAT). MethodsIn this prospective study, a care-bundle checklist for automated blood culture bottles (BCBs) received from adult intensive care units (AICUs) was implemented between July 2020-June 2021 (intervention period, P2) and compared with a retrospective, pre-intervention period (P1) between March-June 2020. Microbial identification in positive BCBs with gram-negatives (+nBCBs) was enabled by inoculating conventional biochemical tests directly (dID) and direct antimicrobial susceptibility testing (dAST) was done as per EUCAST RAST standard. Clinical reports were issued only if a RAST reportable gram-negative was identified in dID. ResultsWe observed significant reductions in the Loading time (LT) [63.5 (104.5-24.5) vs 32 (55-14) minutes, P<0.001] & time to dID+dAST performance (TTD) [186 (288.25-202.25) vs 115 (180-68) minutes, P=0.0018] in +nBCBs received from AICUs during P2. There was a significant increase in compliance to the bundle targets [LT[&le;]45: 44% vs 66%, P=.006 and TTD[&le;]120: 34% vs 51.7%, P=.03] during P2 (Table 2). Using dID+dAST method, provisional results could be read [~]13 hours earlier than those generated by VITEK(R). Similar improvements were also noted for +nBCBs received from other locations. O_TBL View this table: org.highwire.dtl.DTLVardef@1da2dceorg.highwire.dtl.DTLVardef@f5367corg.highwire.dtl.DTLVardef@cc3fcdorg.highwire.dtl.DTLVardef@170be9aorg.highwire.dtl.DTLVardef@f1a063_HPS_FORMAT_FIGEXP M_TBL O_FLOATNOTable 2:C_FLOATNO O_TABLECAPTIONPerformance and interpretation of direct microbial identification (dID) method by directly inoculating conventional biochemical tests C_TABLECAPTION C_TBL ConclusionsThe "diagnostic stewardship care-bundle" strategy to improve aBCD was successfully implemented leading to significant reductions in duration of targeted steps. Laboratories should implement "diagnostic stewardship care-bundles" as per their needs to improve microbiological diagnostics.