Clinical and economic evaluation of blood culture whole process optimization in critically ill adult patients with positive blood cultures

Optimizing blood culture processing is important to ensure bloodstream infections are accurately diagnosed while minimizing adverse events caused by antibiotic abuse. We evaluated the impact of optimized blood culture processes on antibiotic use, clinical outcomes and economics in intensive care unit (ICU) patients with positive blood cultures. From March 2020 to October 2021, our microbiology laboratory implemented a series of improvement measures, including the clinical utility of Fastidious Antimicrobial Neutralization (FAN® PLUS) bottles for the BacT/Alert Virtuo blood culture system, optimization of bottles reception, graded reports and an upgraded Laboratory Information System. A total of 122 ICU patients were included in the pre-optimization group from March 2019 to February 2020, while 179 ICU patients were included in the post-optimization group from November 2021 to October 2022. Compared with the pre-optimization group, the average reporting time of identification and antimicrobial sensitivity was reduced by 16.72h in the optimized group. The time from admission to targeted antibiotic therapy within 24 h after receiving both the Gram-stain report and the final report were both significantly less in the post-optimization group compared to the pre-optimization group. The average hospitalization time was reduced by 6.49 days, the average antimicrobial drug cost lowered by $1,720.85 and the average hospitalization cost by $9,514.17 in the post-optimization group. Optimizing blood culture processing was associated with a significantly increased positive detection rate, a remarkable reduction in the hospital length of stay and in hospital costs for patients in the ICU with bloodstream infections.