Decreased Mortality Associated With Prompt Gram Staining of Blood Cultures

Abstract

Gram stains of positive blood cultures are the most important factor influencing appropriate therapy. The sooner appropriate therapy is initiated, the better. Therefore, it is reasonable to expect that the sooner Gram stains are performed, the better. To determine the value of timely Gram stains and whether improvement in Gram stain turnaround time (TAT) is feasible, we compared data for matched pairs of patients with cultures processed promptly (<1 hour TAT) with data for patients with cultures not processed promptly (> or =1 hour TAT) and then monitored TAT by control charting.In 99 matched pairs, average difference in time to detection of positive blood cultures within a pair of patients was less than 0.1 hour. For the less than 1 hour TAT group, the average TAT and crude mortality were 0.1 hour and 10.1%, respectively; for the 1 hour or longer TAT group, they were 3.3 hours and 19.2%, respectively (P < .0001 and P = .0389, respectively). After multifaceted efforts, we achieved significant improvement in the TAT for Gram stains.

Timeliness and Accuracy of Reporting Preliminary Blood Culture Results: A College of American Pathologists Q-Probes Study of 65 Institutions

“…Previous studies have shown that timeliness of detecting bloodstream pathogens improves antimicrobial therapy, reduces costs, and decreases length of stay and patient mortality. [3][4][5][6][7][9][10][11] Timeliness and accuracy of preliminary blood culture results represent 2 important, evidence-based quality indicators that are closely linked to clinical outcomes.…”

“…Faster results reporting has been shown to be associated with lower mortality, 3 especially when combined with clinical consultation. 4,5 Other benefits of rapid reporting include improved selection of antimicrobial therapy, [6][7][8][9] lower overall health care costs, 10 and reduced length of stay.…”

Effect of Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry (MALDI-TOF MS) Alone versus MALDI-TOF MS Combined with Real-Time Antimicrobial Stewardship Interventions on Time to Optimal Antimicrobial Therapy in Patients with Positive Blood Cultures

“…These infection rates continue to uptrend, posing a substantial public health risk by driving providers to utilize broad-spectrum antimicrobials and potentiating the cycle that creates MDROs (1)(2)(3). To minimize these threats, early administration of appropriate antimicrobial therapy is critical, as are antimicrobial streamlining to optimal therapy and discontinuation of inappropriate therapy, particularly in the setting of contaminated cultures (4)(5)(6)(7). Utilizing time-consuming conventional methods of organism identification can delay the time to optimal therapy (TTOT) and increase patient exposure to unnecessary antimicrobials.…”

Análisis de la monitorización de cinco indicadores de calidad del hemocultivo en un hospital universitario en Chile 2009-2011

“…En nuestro hospital, siguiendo las recomendaciones del Clinical and Laboratory Standards Institute, el tiempo fi jado para avisar la tinción de Gram de un hemocultivo identifi cado como positivo es de 1 hora. Trabajos recientes han demostrado que el aviso dentro de este lapso está asociado a una disminución de la mortalidad de los pacientes 18 . En el año 2011, a diferencia de los años anteriores, nuestro laboratorio logró estar por sobre la meta, con la implementación de un cronómetro para el tecnólogo médico, que comienza a medir el tiempo desde que el equipo de hemocultivos avisa la positividad del frasco.…”