Hennepin County Medical Center
BD BACTEC™ Blood culture system case study
Sepsis guidelines recommend prompt and broad spectrum antimicrobial therapy be started within 1 hour of recognition of septic shock, followed by daily reassessment and antibiotic deescalation1. De-escalation requires reliable diagnostic data on which to base clinical decisions.
Previous studies involving Staphylococcus aureus infections have demonstrated that rapid Gramstain reporting and use of rapid identification molecular testing can affect changes in antimicrobialprescribing 2,3.
We have previously shown that differences among contemporary blood culture media can lead to differences in the microbiological recovery of bacteria involved in suspected cases of sepsis. These differences become pronounced when antimicrobial therapy is given prior to obtaining laboratory blood cultures.
The BACTEC Plus (Becton Dickinson) blood culture media is more likely to identify blood stream infections if previous antibiotics have been administered. This finding is of particular importance in the critical care setting where over 80% of cultures were exposed to antimicrobials prior to blood culture collection (4). Whether the use of sensitive blood culture media would lead to changes in antibiotic prescribing has not been described.
1. Dellinger, R. P., et al. "Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012." Crit Care Med. 41.2 (2013): 580-637.
2. Davies, J., et al. "Impact of results of a rapid Staphylococcus aureus diagnostic test on prescribing of antibiotics for patients with clustered gram-positive cocci in blood cultures." J.Clin.Microbiol. 50.6 (2012): 2056-58.
3. Kerremans, J. J., H. A. Verbrugh, and M. C. Vos. "Frequency of microbiologically correct antibiotic therapy increased by infectious disease consultations and microbiological results." J.Clin.Microbiol. 50.6 (2012): 2066-68.
4. Zadroga, R., et al. "Comparison of 2 blood culture media shows significant differences in bacterial recovery for patients on antimicrobial therapy." Clin.Infect.Dis. 56.6 (2013): 790-97.