- ABSTRACT.
- INTRODUCTION
- MATERIALS AND METHODS
- Selection of study sites.
- Quality assessment of blood culture systems.
- Assessment 1: Aggregated quality indicators.
- Assessment 2: Sampling and transportation indicators.
- Assessment 3: Clinical survey on missed opportunities for blood culture utilization.
- Survey content.
- Survey validation.
- Survey implementation.
- Assessment 4: Local guidelines and practices.
- DATA MANAGEMENT AND ANALYSIS
- ETHICAL CONSIDERATIONS
- RESULTS
- DISCUSSION
- CONCLUSION
- ACKNOWLEDGMENTS
- REFERENCES
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Underutilization and Quality Gaps in Blood Culture Processing in Public Hospitals of Peru
ABSTRACT.
Correct processing of blood cultures may impact individual patient management, antibiotic stewardship, and scaling up of antimicrobial resistance surveillance. To assess the quality of blood culture processing, we conducted four assessments at 16 public hospitals across different regions of Peru. We assessed the following standardized quality indicators: 1) positivity and contamination rates, 2) compliance with recommended number of bottles/sets and volume of blood sampled, 3) blood culture utilization, and 4) possible barriers for compliance with recommendations. Suboptimal performance was found, with a median contamination rate of 4.2% (range 0–15.1%), with only one third of the participating hospitals meeting the target value of < 3%; and a median positivity rate of 4.9% (range 1–8.1%), with only 6 out of the 15 surveilled hospitals meeting the target of 6–12%. None of the assessed hospitals met both targets. The median frequency of solitary blood cultures was 71.9% and only 8.9% (N = 59) of the surveyed adult bottles met the target blood volume of 8 – 12 mL, whereas 90.5% (N = 602) were underfilled. A high frequency of missed opportunities for ordering blood cultures was found (69.9%, 221/316) among patients with clinical indications for blood culture sampling. This multicenter study demonstrates important shortcomings in the quality of blood culture processing in public hospitals of Peru. It provides a national benchmark of blood culture utilization and quality indicators that can be used to monitor future quality improvement studies and diagnostic stewardship policies.
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Author Notes
Financial support: This work was funded by the Belgian Directorate of Development Cooperation (DGD) through the Framework Agreement between the Belgian DGD and the Institute of Tropical Medicine, Belgium. F. K. holds a PhD scholarship of the Belgian DGD.
Authors’ addresses: Fiorella Krapp and Claudia Rondon, Universidad Peruana Cayetano Heredia, Lima, Peru, E-mails: fiorella.krapp@upch.pe and claudia.rondon.p@upch.pe. Catherine Amaro, Hospital Cayetano Heredia, Lima, Peru, E-mail: catherineamaro2007@hotmail.com. Evelyn Barco-Yaipén, Hospital Regional II-2 José Alfredo Mendoza Olavarría, Tumbes, Peru, E-mail: evelynbarco@gmail.com. María Valera-Krumdieck and Rubén Vásquez, Hospital María Auxiliadora, Lima, Peru, E-mails: mvalerak@gmail.com and ruben_dariovb@yahoo.es. Alexander Briones and Martin Casapia, Hospital Regional de Loreto Felipe Santiago Arriola Iglesias Loreto, Peru, E-mails: alexander.brionesalejos@gmail.com and mcasapia@acsaperu.org. Antonio Burgos and Favio Sarmiento López, Hospital Regional de Pucallpa, Pucallpa, Peru, E-mails: segundo67lab@hotmail.com and faviosar@yahoo.com. Pierina Vilcapoma, Hospital Regional Daniel Alcides Carrión, Huancayo, Peru, E-mail: pierina222@hotmail.com. Roberto Díaz Sipión and Miguel Villegas-Chiroque, Hospital Regional Lambayeque, Chiclayo, Peru, E-mails: betosipion@hotmail.com and mivichi2003@hotmail.com. Kelly Castillo, Hospital Belén de Trujillo, La Libertad, Peru, E-mail: kmcastillod@yahoo.es. Jimena Pino-Dueñas, Hospita Antonio Lorena Cusco, Cusco, Peru, E-mail: jimenaedith@hotmail.com. Edwin Cuaresma Cuadros, Hospital III Daniel Alcides Carrión Essalud-Tacna, Tacna, Peru, E-mail: ecuaresma74@hotmail.com. Hugo Alpaca-Salvador, Hospital III Essalud-Chimbote, Ancash, Peru, E-mail: h_anibal24@hotmail.com. René Campana, Hospital Goyeneche, Arequipa, Peru, E-mail: reneefrain@yahoo.es. Teresa Peralta Córdova, Hospital Base Víctor Lazarte Echegaray de EsSalud La Libertad, La Libertad, Peru, E-mail: tdjpc@hotmail.com. Elizett Sierra Chavez, Hospital Nacional Hipólito Unanue, Lima Peru, E-mail: elicett_b@hotmail.com. Carla Aguado Ventura, Hospital Regional de Ica, Ica, Peru, E-mail: carlaguado@hotmail.com. Marjan Peeters, Institute of Tropical Medicine Antwerp, Belgium, E-mail: mpeeters@itg.be. Jan Jacobs, Institute of Tropical Medicine Antwerp, Belgium and Department of Microbiology, Immunology and Transplantation, KU Leuven, Belgium, E-mail: jjacobs@itg.be. Coralith Garcia, Universidad Peruana Cayetano Heredia, Lima, Peru and Hospital Cayetano Heredia, Lima, Peru, E-mail: coralith.garcia@upch.