Impact of Timing of Culture Collection in Relation to Antibiotic Administration Among Suspected Sepsis Patients: A Quality Improvement Study

Background: Timely microbiological culture collection before initiation of antibiotics is an essential component of sepsis management. Administration of antibiotics prior to specimen collection may reduce culture positivity and affect pathogen identification, while failure to send cultures can compromise diagnosis and antimicrobial stewardship. Objective: To evaluate the pattern and microbiological yield of culture samples collected before antibiotic administration, after antibiotic administration, and cases where samples were not sent in suspected sepsis patients. Methods: A retrospective quality improvement study was conducted using microbiology data from suspected sepsis patients admitted to a tertiary care hospital during 2024–2025. Culture samples from blood, urine, sputum, ET secretions, tissue, pus, wound swab, CSF, and ascitic fluid were analyzed. Cases were categorized into three groups: cultures collected before antibiotics, cultures collected after antibiotics, and cultures not sent before antibiotic administration. Results: A total of 144 cases were reviewed. Among them, 60 cultures were collected before antibiotic administration, 42 cultures were collected after antibiotics, and in 42 cases no cultures were sent before initiating antibiotics. Blood cultures were the most common samples in both groups. Higher organism isolation was observed in cultures collected before antibiotic administration compared to cultures collected after antibiotics. Common isolates included Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, CONS, MRCONS, Escherichia coli, and Candida albicans. Reduced microbiological yield was observed when cultures were obtained after antibiotic exposure. Conclusion: Collection of cultures prior to antibiotic administration improves microbiological yield and pathogen detection in suspected sepsis patients. Delayed or missed culture collection may reduce diagnostic accuracy and affect antimicrobial stewardship efforts. Continuous education and protocol reinforcement are necessary to improve compliance with sepsis sampling guidelines.