Criteria & Principles
The shortage BD BACTEC Blood Culture Media Bottles announced by the FDA on July 10, 2024 has now largely resolved. DUHS supply is adequate as of November 1, 2024.
Educational information is provided in the attached slide deck for use by clinical teams implementing blood culture stewardship initiatives.
Diagnosis-Specific Information
References
1BCx required by U.S. Centers for Medicare and Medicaid Services (CMS) severe sepsis criteria of the Severe Sepsis and Septic Shock Early Management Bundle
- Severe sepsis- two SIRS criteria plus suspected infection (i.e. sepsis) plus at least one end-organ dysfunction
- Septic shock- severe sepsis with hypoperfusion despite adequate fluid resuscitation or lactate > 4
2 i.e., septic thrombophlebitis, infected endovascular thrombi, implantable ICD/pacemaker lead infections, intravascular catheter infection and vascular graft infections.
3Patients at risk of endovascular infection: ICD/pacemaker, vascular graft, prosthetic valves and prosthetic material used for cardiac valve repair, history of IE, valvulopathy in heart transplant recipient, unrepaired congenital heart disease.
4Before ordering a BCx, assess the patient’s clinical history and perform a physical exam to identify infectious and non-infectious sources for the isolated fever episode and review the potential benefit added by BCx.
5Routine additional follow-up BCx for a single BCx with skin flora (e.g., Coagulase negative Staphylococcus) in an immunocompetent patient are not necessary unless bacteremia is suspected or a prosthesis is present. If continued questions regarding clinical status and BCx, consider ID consult.
- Symptomatic, for example, is isolated fever, hypotension, tachycardia with no other explainable cause
6Complicated Gram-negative bacteremia includes patients with difficult to control or uncontrolled source (including CNS, bone or joint infection, endocarditis/endovascular infection, implanted material, liver abscess), inadequate clinical response (defervescence or hemodynamic stability not achieved at 72h), or pathogens with limited treatment options (e.g. drug resistance). See CustomID GN BSI Guideline.
7i.e., change antibiotic choice or duration, lead to further imaging or procedures
8If there is disagreement about the utility of blood culture for a patient, consider an ID consult to discuss.
9Devices include intravascular catheters (e.g. PICC line, vascath for HD) or permanent implants (including VP shunt, prosthetic joint, cardiac implant). Blood cultures interpreted as skin contaminants (e.g. 1 of 2 sets with coagulase negative Staphylococcus) are NOT considered confirmed bacteremia.