Skip to main content
Erschienen in: European Journal of Clinical Microbiology & Infectious Diseases 9/2018

30.06.2018 | Original Article

How small modifications in laboratory workflow of blood cultures can have a significant impact on time to results

verfasst von: B. Van den Poel, A. Klak, S. Desmet, J. Verhaegen

Erschienen in: European Journal of Clinical Microbiology & Infectious Diseases | Ausgabe 9/2018

Einloggen, um Zugang zu erhalten

Abstract

Rapid identification and antimicrobial susceptibility testing of micro-organisms causing bloodstream infections is crucial in the management of septic patients. In this study, we compared a period of twice-daily and a period of thrice-daily reading of subculture agar plates. In 2016, 10,644 positive blood cultures bottles (bioMérieux) from 2608 patients were analyzed at UZ Leuven. Identification and antimicrobial susceptibility testing were performed by MALDI-TOF MS (Bruker Daltonics) and Vitek 2 (bioMérieux) respectively. In period 1 (January to June), subculture plates were read at 8:30 a.m. and 2:00 p.m. during the weekdays. In period 2 (August until December), reading was performed at 8:30 a.m., 2:00 p.m., and 5:00 p.m. Time to identification and time to AST results after positivity were compared. In period 1, median time to identification of all organisms was 22.8 h compared to 20.2 h in period 2 (p < 0.01). Moreover, micro-organisms were identified before 12 h in 9% of samples in period 2, a significant increase compared to 2% in period 1 (p < 0.01). In period 2, AST results were known within 36 h in 39% of samples, compared to 31% in period 1 (p < 0.01). Optimization of the reading frequency of subcultures of blood cultures significantly decreases time to results. Further optimization can be done by introducing lab automation. We will use the data of this study as a baseline to analyze the impact of introducing WASPLab (Copan Diagnostics) automation on time to results.
Literatur
1.
Zurück zum Zitat Singer M (2016) The new sepsis consensus definitions (Sepsis-3): the good, the not-so-bad, and the actually-quite-pretty. Intensive Care Med 42(12):2027–2029CrossRefPubMed Singer M (2016) The new sepsis consensus definitions (Sepsis-3): the good, the not-so-bad, and the actually-quite-pretty. Intensive Care Med 42(12):2027–2029CrossRefPubMed
2.
Zurück zum Zitat Sherwin R, Winters ME, Vilke GM, Wardi G (2017) Does early and appropriate antibiotic administration improve mortality in emergency department patients with severe sepsis or septic shock? J Emerg Med 53(4):588–595CrossRefPubMed Sherwin R, Winters ME, Vilke GM, Wardi G (2017) Does early and appropriate antibiotic administration improve mortality in emergency department patients with severe sepsis or septic shock? J Emerg Med 53(4):588–595CrossRefPubMed
3.
Zurück zum Zitat Deresinski S (2007) Principles of antibiotic therapy in severe infections: optimizing the therapeutic approach by use of laboratory and clinical data. Clin Infect Dis 45(Suppl 3):S177–S183CrossRefPubMed Deresinski S (2007) Principles of antibiotic therapy in severe infections: optimizing the therapeutic approach by use of laboratory and clinical data. Clin Infect Dis 45(Suppl 3):S177–S183CrossRefPubMed
4.
Zurück zum Zitat Kerremans JJ, Verboom P, Stijnen T, Hakkaart-van Roijen L, Goessens W, Verbrugh HA, Vos MC (2008) Rapid identification and antimicrobial susceptibility testing reduce antibiotic use and accelerate pathogen-directed antibiotic use. J Antimicrob Chemother 61(2):428–435CrossRefPubMed Kerremans JJ, Verboom P, Stijnen T, Hakkaart-van Roijen L, Goessens W, Verbrugh HA, Vos MC (2008) Rapid identification and antimicrobial susceptibility testing reduce antibiotic use and accelerate pathogen-directed antibiotic use. J Antimicrob Chemother 61(2):428–435CrossRefPubMed
5.
Zurück zum Zitat Willems E, Smismans A, Cartuyvels R, Coppens G, Van Vaerenbergh K, Van den Abeele AM, Frans J, Group BS (2012) The preanalytical optimization of blood cultures: a review and the clinical importance of benchmarking in 5 Belgian hospitals. Diagn Microbiol Infect Dis 73(1):1–8CrossRefPubMed Willems E, Smismans A, Cartuyvels R, Coppens G, Van Vaerenbergh K, Van den Abeele AM, Frans J, Group BS (2012) The preanalytical optimization of blood cultures: a review and the clinical importance of benchmarking in 5 Belgian hospitals. Diagn Microbiol Infect Dis 73(1):1–8CrossRefPubMed
6.
Zurück zum Zitat Saito T, Iinuma Y, Takakura S, Nagao M, Matsushima A, Shirano M, Ichiyama S (2009) Delayed insertion of blood culture bottles into automated continuously monitoring blood culture systems increases the time from blood sample collection to the detection of microorganisms in bacteremic patients. J Infect Chemother 15(1):49–53CrossRefPubMed Saito T, Iinuma Y, Takakura S, Nagao M, Matsushima A, Shirano M, Ichiyama S (2009) Delayed insertion of blood culture bottles into automated continuously monitoring blood culture systems increases the time from blood sample collection to the detection of microorganisms in bacteremic patients. J Infect Chemother 15(1):49–53CrossRefPubMed
7.
Zurück zum Zitat Clark AE, Kaleta EJ, Arora A, Wolk DM (2013) Matrix-assisted laser desorption ionization-time of flight mass spectrometry: a fundamental shift in the routine practice of clinical microbiology. Clin Microbiol Rev 26(3):547–603CrossRefPubMedPubMedCentral Clark AE, Kaleta EJ, Arora A, Wolk DM (2013) Matrix-assisted laser desorption ionization-time of flight mass spectrometry: a fundamental shift in the routine practice of clinical microbiology. Clin Microbiol Rev 26(3):547–603CrossRefPubMedPubMedCentral
8.
Zurück zum Zitat Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S, Suppes R, Feinstein D, Zanotti S, Taiberg L, Gurka D, Cheang M (2006) Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 34(6):1589–1596CrossRefPubMed Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S, Suppes R, Feinstein D, Zanotti S, Taiberg L, Gurka D, Cheang M (2006) Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 34(6):1589–1596CrossRefPubMed
9.
Zurück zum Zitat Maelegheer K, Nulens E (2017) Same-day identification and antibiotic susceptibility testing on positive blood cultures: a simple and inexpensive procedure. Eur J Clin Microbiol Infect Dis 36(4):681–687CrossRefPubMed Maelegheer K, Nulens E (2017) Same-day identification and antibiotic susceptibility testing on positive blood cultures: a simple and inexpensive procedure. Eur J Clin Microbiol Infect Dis 36(4):681–687CrossRefPubMed
10.
Zurück zum Zitat French K, Evans J, Tanner H, Gossain S, Hussain A (2016) The clinical impact of rapid, direct MALDI-ToF identification of bacteria from positive blood cultures. PLoS One 11(12):e0169332CrossRefPubMedPubMedCentral French K, Evans J, Tanner H, Gossain S, Hussain A (2016) The clinical impact of rapid, direct MALDI-ToF identification of bacteria from positive blood cultures. PLoS One 11(12):e0169332CrossRefPubMedPubMedCentral
11.
Zurück zum Zitat Barnini S, Brucculeri V, Morici P, Ghelardi E, Florio W, Lupetti A (2016) A new rapid method for direct antimicrobial susceptibility testing of bacteria from positive blood cultures. BMC Microbiol 16(1):185CrossRefPubMedPubMedCentral Barnini S, Brucculeri V, Morici P, Ghelardi E, Florio W, Lupetti A (2016) A new rapid method for direct antimicrobial susceptibility testing of bacteria from positive blood cultures. BMC Microbiol 16(1):185CrossRefPubMedPubMedCentral
12.
Zurück zum Zitat Verroken A, Defourny L, Lechgar L, Magnette A, Delmée M, Glupczynski Y (2015) Reducing time to identification of positive blood cultures with MALDI-TOF MS analysis after a 5-h subculture. Eur J Clin Microbiol Infect Dis 34(2):405–413CrossRefPubMed Verroken A, Defourny L, Lechgar L, Magnette A, Delmée M, Glupczynski Y (2015) Reducing time to identification of positive blood cultures with MALDI-TOF MS analysis after a 5-h subculture. Eur J Clin Microbiol Infect Dis 34(2):405–413CrossRefPubMed
13.
Zurück zum Zitat Köck R, Wüllenweber J, Horn D, Lanckohr C, Becker K, Idelevich EA (2017) Implementation of short incubation MALDI-TOF MS identification from positive blood cultures in routine diagnostics and effects on empiric antimicrobial therapy. Antimicrob Resist Infect Control 6:12CrossRefPubMedPubMedCentral Köck R, Wüllenweber J, Horn D, Lanckohr C, Becker K, Idelevich EA (2017) Implementation of short incubation MALDI-TOF MS identification from positive blood cultures in routine diagnostics and effects on empiric antimicrobial therapy. Antimicrob Resist Infect Control 6:12CrossRefPubMedPubMedCentral
14.
Zurück zum Zitat Zabbe JB, Zanardo L, Mégraud F, Bessède E (2015) MALDI-TOF mass spectrometry for early identification of bacteria grown in blood culture bottles. J Microbiol Methods 115:45–46CrossRefPubMed Zabbe JB, Zanardo L, Mégraud F, Bessède E (2015) MALDI-TOF mass spectrometry for early identification of bacteria grown in blood culture bottles. J Microbiol Methods 115:45–46CrossRefPubMed
15.
Zurück zum Zitat Idelevich EA, Schüle I, Grünastel B, Wüllenweber J, Peters G, Becker K (2014) Rapid identification of microorganisms from positive blood cultures by MALDI-TOF mass spectrometry subsequent to very short-term incubation on solid medium. Clin Microbiol Infect 20(10):1001–1006CrossRefPubMed Idelevich EA, Schüle I, Grünastel B, Wüllenweber J, Peters G, Becker K (2014) Rapid identification of microorganisms from positive blood cultures by MALDI-TOF mass spectrometry subsequent to very short-term incubation on solid medium. Clin Microbiol Infect 20(10):1001–1006CrossRefPubMed
16.
Zurück zum Zitat Fitzgerald C, Stapleton P, Phelan E, Mulhare P, Carey B, Hickey M, Lynch B, Doyle M (2016) Rapid identification and antimicrobial susceptibility testing of positive blood cultures using MALDI-TOF MS and a modification of the standardised disc diffusion test: a pilot study. J Clin Pathol Fitzgerald C, Stapleton P, Phelan E, Mulhare P, Carey B, Hickey M, Lynch B, Doyle M (2016) Rapid identification and antimicrobial susceptibility testing of positive blood cultures using MALDI-TOF MS and a modification of the standardised disc diffusion test: a pilot study. J Clin Pathol
17.
Zurück zum Zitat Idelevich EA, Schüle I, Grünastel B, Wüllenweber J, Peters G, Becker K (2014) Acceleration of antimicrobial susceptibility testing of positive blood cultures by inoculation of Vitek 2 cards with briefly incubated solid medium cultures. J Clin Microbiol 52(11):4058–4062CrossRefPubMedPubMedCentral Idelevich EA, Schüle I, Grünastel B, Wüllenweber J, Peters G, Becker K (2014) Acceleration of antimicrobial susceptibility testing of positive blood cultures by inoculation of Vitek 2 cards with briefly incubated solid medium cultures. J Clin Microbiol 52(11):4058–4062CrossRefPubMedPubMedCentral
18.
Zurück zum Zitat Unit S (2014) UK Standards for Microbiology Investigations. In: England PH (ed) Investigation of Blood Cultures (for Organisms other than Mycobacterium species). Public Health England, London, p 51 Unit S (2014) UK Standards for Microbiology Investigations. In: England PH (ed) Investigation of Blood Cultures (for Organisms other than Mycobacterium species). Public Health England, London, p 51
19.
Zurück zum Zitat Meda M, Clayton J, Varghese R, Rangaiah J, Grundy C, Dashti F, Garner D, Groves K, Fitzmaurice K, Hutley E (2017) What are the critical steps in processing blood cultures? A prospective audit evaluating current practice of reporting blood cultures in a centralised laboratory serving secondary care hospitals. J Clin Pathol 70(4):361–366CrossRefPubMed Meda M, Clayton J, Varghese R, Rangaiah J, Grundy C, Dashti F, Garner D, Groves K, Fitzmaurice K, Hutley E (2017) What are the critical steps in processing blood cultures? A prospective audit evaluating current practice of reporting blood cultures in a centralised laboratory serving secondary care hospitals. J Clin Pathol 70(4):361–366CrossRefPubMed
20.
Zurück zum Zitat She RC, Alrabaa S, Lee SH, Norvell M, Wilson A, Petti CA (2015) Survey of physicians' perspectives and knowledge about diagnostic tests for bloodstream infections. PLoS One 10(3):e0121493CrossRefPubMedPubMedCentral She RC, Alrabaa S, Lee SH, Norvell M, Wilson A, Petti CA (2015) Survey of physicians' perspectives and knowledge about diagnostic tests for bloodstream infections. PLoS One 10(3):e0121493CrossRefPubMedPubMedCentral
21.
Zurück zum Zitat Verroken A, Defourny L, le Polain de Waroux O, Belkhir L, Laterre PF, Delmée M, Glupczynski Y (2016) Clinical impact of MALDI-TOF MS identification and rapid susceptibility testing on adequate antimicrobial treatment in sepsis with positive blood cultures. PLoS One 11(5):e0156299CrossRefPubMedPubMedCentral Verroken A, Defourny L, le Polain de Waroux O, Belkhir L, Laterre PF, Delmée M, Glupczynski Y (2016) Clinical impact of MALDI-TOF MS identification and rapid susceptibility testing on adequate antimicrobial treatment in sepsis with positive blood cultures. PLoS One 11(5):e0156299CrossRefPubMedPubMedCentral
22.
Zurück zum Zitat Mitchell SL, Alby K (2017) Performance of microbial identification by MALDI-TOF MS and susceptibility testing by VITEK 2 from positive blood cultures after minimal incubation on solid media. Eur J Clin Microbiol Infect Dis 36(11):2201–2206CrossRefPubMed Mitchell SL, Alby K (2017) Performance of microbial identification by MALDI-TOF MS and susceptibility testing by VITEK 2 from positive blood cultures after minimal incubation on solid media. Eur J Clin Microbiol Infect Dis 36(11):2201–2206CrossRefPubMed
23.
Zurück zum Zitat Sekercioglu AO, Cekin Y, Ogunc D, Ongut G, Baysan BO, Colak D, Gunseren F, Donmez L (2017) Matrix-assisted laser desorption-ionization time-of-flight mass spectrometry (MALDI- TOF MS) for early identification of septic patients. Clin Lab 63(4):839–844PubMed Sekercioglu AO, Cekin Y, Ogunc D, Ongut G, Baysan BO, Colak D, Gunseren F, Donmez L (2017) Matrix-assisted laser desorption-ionization time-of-flight mass spectrometry (MALDI- TOF MS) for early identification of septic patients. Clin Lab 63(4):839–844PubMed
24.
Zurück zum Zitat Florio W, Morici P, Ghelardi E, Barnini S, Lupetti A (2017) Recent advances in the microbiological diagnosis of bloodstream infections. Crit Rev Microbiol:1–20 Florio W, Morici P, Ghelardi E, Barnini S, Lupetti A (2017) Recent advances in the microbiological diagnosis of bloodstream infections. Crit Rev Microbiol:1–20
25.
Zurück zum Zitat Croxatto A, Prod'hom G, Durussel C, Greub G (2014) Preparation of a blood culture pellet for rapid bacterial identification and antibiotic susceptibility testing. J Vis Exp 92:e51985 Croxatto A, Prod'hom G, Durussel C, Greub G (2014) Preparation of a blood culture pellet for rapid bacterial identification and antibiotic susceptibility testing. J Vis Exp 92:e51985
26.
Zurück zum Zitat Randazzo A, Simon M, Goffinet P, Classen JF, Hougardy N, Pierre P, Kinzinger P, Mauel E, Goffinet JS (2016) Optimal turnaround time for direct identification of microorganisms by mass spectrometry in blood culture. J Microbiol Methods 130:1–5CrossRefPubMed Randazzo A, Simon M, Goffinet P, Classen JF, Hougardy N, Pierre P, Kinzinger P, Mauel E, Goffinet JS (2016) Optimal turnaround time for direct identification of microorganisms by mass spectrometry in blood culture. J Microbiol Methods 130:1–5CrossRefPubMed
27.
Zurück zum Zitat Nieman AE, Savelkoul PHM, Beishuizen A, Henrich B, Lamik B, MacKenzie CR, Kindgen-Milles D, Helmers A, Diaz C, Sakka SG, Schade RP (2016) A prospective multicenter evaluation of direct molecular detection of blood stream infection from a clinical perspective. BMC Infect Dis 16:314CrossRefPubMedPubMedCentral Nieman AE, Savelkoul PHM, Beishuizen A, Henrich B, Lamik B, MacKenzie CR, Kindgen-Milles D, Helmers A, Diaz C, Sakka SG, Schade RP (2016) A prospective multicenter evaluation of direct molecular detection of blood stream infection from a clinical perspective. BMC Infect Dis 16:314CrossRefPubMedPubMedCentral
28.
Zurück zum Zitat Jordana-Lluch E, Giménez M, Quesada MD, Rivaya B, Marcó C, Domínguez MJ, Arméstar F, Martró E, Ausina V (2015) Evaluation of the broad-range PCR/ESI-MS technology in blood specimens for the molecular diagnosis of bloodstream infections. PLoS One 10(10):e0140865CrossRefPubMedPubMedCentral Jordana-Lluch E, Giménez M, Quesada MD, Rivaya B, Marcó C, Domínguez MJ, Arméstar F, Martró E, Ausina V (2015) Evaluation of the broad-range PCR/ESI-MS technology in blood specimens for the molecular diagnosis of bloodstream infections. PLoS One 10(10):e0140865CrossRefPubMedPubMedCentral
30.
Zurück zum Zitat Dauwalder O, Landrieve L, Laurent F, de Montclos M, Vandenesch F, Lina G (2016) Does bacteriology laboratory automation reduce time to results and increase quality management? Clin Microbiol Infect 22(3):236–243CrossRefPubMed Dauwalder O, Landrieve L, Laurent F, de Montclos M, Vandenesch F, Lina G (2016) Does bacteriology laboratory automation reduce time to results and increase quality management? Clin Microbiol Infect 22(3):236–243CrossRefPubMed
Metadaten
Titel
How small modifications in laboratory workflow of blood cultures can have a significant impact on time to results
verfasst von
B. Van den Poel
A. Klak
S. Desmet
J. Verhaegen
Publikationsdatum
30.06.2018
Verlag
Springer Berlin Heidelberg
Erschienen in
European Journal of Clinical Microbiology & Infectious Diseases / Ausgabe 9/2018
Print ISSN: 0934-9723
Elektronische ISSN: 1435-4373
DOI
https://doi.org/10.1007/s10096-018-3309-4

Weitere Artikel der Ausgabe 9/2018

European Journal of Clinical Microbiology & Infectious Diseases 9/2018 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.