tetano
Editor, Senior Moderator
J Clin Microbiol. 2020 May 13. pii: JCM.00875-20. doi: 10.1128/JCM.00875-20. [Epub ahead of print]
Bacteremia and Blood Culture Utilization During COVID-19 Surge in New York City.
Sepulveda J[SUP]1[/SUP], Westblade LF[SUP]2,[/SUP][SUP]3[/SUP], Whittier S[SUP]1[/SUP], Satlin MJ[SUP]3[/SUP], Greendyke WG[SUP]4[/SUP], Aaron JG[SUP]4[/SUP], Zucker J[SUP]4[/SUP], Dietz D[SUP]4[/SUP], Sobieszczyk M[SUP]4[/SUP], Choi JJ[SUP]3[/SUP], Liu D[SUP]5[/SUP], Russell S[SUP]5[/SUP], Connelly C[SUP]5[/SUP], Green DA[SUP]6[/SUP].
Author information
Abstract
A surge of patients with coronavirus disease 2019 (COVID-19) presenting to New York City hospitals in March 2020 led to a sharp increase blood culture utilization, which overwhelmed the capacity of automated blood culture instruments. We sought to evaluate the utilization and diagnostic yield of blood cultures during the COVID-19 pandemic to determine prevalence and common etiologies of bacteremia, and to inform a diagnostic approach to relieve blood culture overutilization. We performed a retrospective cohort analysis of 88,201 blood cultures from 28,011 patients at a multicenter network of hospitals within New York City to evaluate order volume, positivity rate, time to positivity, and etiologies of positive cultures in COVID-19. Ordering volume increased by 34.8% in the second half of March 2020 compared to the first half of the month. The rate of bacteremia was significantly lower among COVID-19 patients (3.8%) than COVID-19 negative patients (8.0%) and those not tested (7.1%), p < 0.001. COVID-19 patients had a high proportion of organisms reflective of commensal skin microbiota, reducing the bacteremia rate to 1.6% when excluded. More than 98% of all positive cultures were detected within 4 days of incubation. Bloodstream infections are very rare for COVID-19 patients, which supports the judicious use of blood cultures in the absence of compelling evidence for bacterial co-infection. Clear communication with ordering providers is necessary to prevent overutilization of blood cultures during patient surges, and laboratories should consider shortening the incubation period from 5 days to 4 days, if necessary, to free additional capacity.
Copyright ? 2020 American Society for Microbiology.
PMID:32404482DOI:10.1128/JCM.00875-20
Bacteremia and Blood Culture Utilization During COVID-19 Surge in New York City.
Sepulveda J[SUP]1[/SUP], Westblade LF[SUP]2,[/SUP][SUP]3[/SUP], Whittier S[SUP]1[/SUP], Satlin MJ[SUP]3[/SUP], Greendyke WG[SUP]4[/SUP], Aaron JG[SUP]4[/SUP], Zucker J[SUP]4[/SUP], Dietz D[SUP]4[/SUP], Sobieszczyk M[SUP]4[/SUP], Choi JJ[SUP]3[/SUP], Liu D[SUP]5[/SUP], Russell S[SUP]5[/SUP], Connelly C[SUP]5[/SUP], Green DA[SUP]6[/SUP].
Author information
Abstract
A surge of patients with coronavirus disease 2019 (COVID-19) presenting to New York City hospitals in March 2020 led to a sharp increase blood culture utilization, which overwhelmed the capacity of automated blood culture instruments. We sought to evaluate the utilization and diagnostic yield of blood cultures during the COVID-19 pandemic to determine prevalence and common etiologies of bacteremia, and to inform a diagnostic approach to relieve blood culture overutilization. We performed a retrospective cohort analysis of 88,201 blood cultures from 28,011 patients at a multicenter network of hospitals within New York City to evaluate order volume, positivity rate, time to positivity, and etiologies of positive cultures in COVID-19. Ordering volume increased by 34.8% in the second half of March 2020 compared to the first half of the month. The rate of bacteremia was significantly lower among COVID-19 patients (3.8%) than COVID-19 negative patients (8.0%) and those not tested (7.1%), p < 0.001. COVID-19 patients had a high proportion of organisms reflective of commensal skin microbiota, reducing the bacteremia rate to 1.6% when excluded. More than 98% of all positive cultures were detected within 4 days of incubation. Bloodstream infections are very rare for COVID-19 patients, which supports the judicious use of blood cultures in the absence of compelling evidence for bacterial co-infection. Clear communication with ordering providers is necessary to prevent overutilization of blood cultures during patient surges, and laboratories should consider shortening the incubation period from 5 days to 4 days, if necessary, to free additional capacity.
Copyright ? 2020 American Society for Microbiology.
PMID:32404482DOI:10.1128/JCM.00875-20