Association Between Blood Culture Bottle Shortage and Ordering Restrictions and Clinical Outcomes for Patients With Staphylococcus aureus Bacteremia

Abstract Background A nationwide shortage of blood culture bottles led to significant restriction of blood culture utilization at our institution. Methods We evaluated the impact of 3 combined interventions: (1) guidance on appropriate blood culture utilization, (2) restriction of repeat cultures within a 48-hour period, and (3) restriction of initial assessment to a single blood culture set consisting of 1 aerobic and 1 anaerobic blood culture bottle, on the management of patients with Staphylococcus aureus bacteremia (SAB) using an interrupted time series analysis. Results Prior to the intervention, 90.1% of patients had 2 blood culture sets ordered for initial assessment, versus 5.7% during the intervention and 84.1% postintervention. The median number of cultures to document SAB clearance was 4 (range, 2–17) in the preintervention period, 2 (range, 2–9) during the intervention period, and 4 (range, 3–11) postintervention. The median number of days to SAB clearance was not significantly different across the study periods, nor were days to central venous catheter placement or days of intravenous S aureus therapy. Fewer patients had documented SAB clearance within 24 hours and median time to diagnosis for community-acquired cases was longer in the intervention period, suggesting the restrictions were not without potential clinical impact. Conclusions These data demonstrate that efforts to reduce blood culture utilization should be implemented with careful stewardship in order to minimize adverse effects for patients with SAB.