Barriers and enablers to blood culture sampling: a systematic review and theoretical domains framework survey in Indonesia, Thailand and Vietnam

BackgroundBlood culture (BC) sampling is recommended for all suspected sepsis patients prior to antibiotic administration. Here, we aimed to identify barriers and enablers to BC sampling in three Southeast Asian countries. MethodsWe conducted a systematic review of studies evaluating barriers/enablers to BC sampling from 1900 to 2020 globally (PROSPERO, CRD42020206557). Using the findings of the systematic review, we developed and conducted a Theoretical Domains Framework (TDF)-based survey with a case scenario question among doctors and final-year medical students in Indonesia, Thailand and Vietnam. FindingsIn the systematic review, we identified 6,175 unique records from the databases, of which 25 met the eligibility criteria. Studies were conducted in 37 high-income countries (HICs) and 41 low-and middle-income countries (LMICs). Of 14 TDF domains, three and seven were not assessed in HICs and LMICs by the studies included in the systematic review, respectively. 1,070 medical doctors and 238 final-year medical students completed the survey. The proportion of respondents who would definitely take BC in the case scenario was 89.8% for Thai, 50.5% for Vietnamese and 31.3% for Indonesians (p<0.001). Eight TDF domains were considered key in influencing BC sampling, including no awareness of guideline [TDF-knowledge], low priority of BC [TDF-goals], no intention to follow guidelines [TDF-intention], level of doctors who can order or initiate an order for BC [TDF-social professional role and identity], no norms of BC sampling [TDF-social influence], perceived cost-effectiveness of BC [TDF-environmental context and resources], regulation on cost reimbursement [TDF-behavioural regulation] and consequences that discourage BC sampling [TDF-reinforcement]. However, there was substantial heterogeneity between the countries across most domains. ConclusionsEvidence on barriers and enablers to BC sampling is limited globally. We identified individual, socio-cultural and environmental barriers/enablers to BC sampling across different countries, which represent potential targets for interventions. Context-specific multifaceted interventions at both hospital and policy levels are required to improve diagnostic stewardship practices. FundingWellcome Trust, UK (220557/Z/20/Z).