Contingency Plan in Response to Blood Culture Bottle Shortages as a Diagnostic Stewardship Strategy in a Large Tertiary Hospital

In July 2024, an international alert reported a critical shortage of blood culture bottles (BCBs). In response, a phased contingency plan was implemented. The objective was to establish criteria to ensure safe diagnostic continuity, prevent stock depletion, and monitor potential impacts on patient care. A retrospective descriptive study conducted in a large tertiary hospital between April 2024 and March 2025, analyzing three periods: pre-plan (April–June), during the plan (July–December), and post-plan (January–March). The plan was phased into three progressively restrictive stages, based on strict clinical criteria and available stock, which was centrally monitored daily. Requests were evaluated by clinical pharmacists, with support from the Hospital Infection Control Service (SCIH) in cases of disagreement with established criteria. The following were assessed: BCB collection rates per 1,000 patient-days, positivity rates, bloodstream infection (BSI) rates, overall and intensive care unit (ICU) mortality, and antimicrobial consumption measured in Days of Therapy (DOT). Statistical comparison among the three periods was performed using the Kruskal–Wallis test for BSI, DOT, and mortality variables (p < 0.05). During the contingency plan, 984 BCB requests were evaluated by clinical pharmacy, with increasing adherence from 59.8% to 97.2%. Only 5% required discussion with the SCIH physician. The collection rate per 1,000 patient-days decreased from 159.4 (pre) to 100.1 (during) and 97.8 (post). Positivity increased from 7.8% to 11.4% and 11.7%. The BSI rate decreased from 0.157 to 0.142 and 0.107 (p > 0.05). ICU mortality ranged from 2.82% to 3.11% and 2.43%, and overall mortality from 1.00% to 1.23% and 1.28% (p > 0.05). DOT/month consumption was 1,026.4 (before), 1,043.1 (during), and 1,002.7 (after) (p > 0.05). Implementation of the structured contingency plan was effective in rationalizing the use of blood culture bottles while maintaining diagnostic safety. Reduced collections combined with increased positivity suggest greater appropriateness of indications, both metrics consistent with benchmarks of good practices described in the literature. The absence of statistical differences in mortality, BSI rates, and antimicrobial consumption reinforces that clinical outcomes were preserved throughout the analyzed period. Increasing adherence underscores the effectiveness of a multiprofessional approach with defined clinical criteria and shared decision-making.