Importance: The 2024 national blood culture bottle shortage led some hospitals to adopt single-set blood culture restrictions, conflicting with professional society guidance for 2-3 sets and risking underdiagnosis. Patient outcomes are not well studied. Objective: To evaluate the impact of single-set blood culture restriction on patient outcomes, culture use, and antimicrobial therapy. Design, Setting, and Participants: Interrupted time series analysis of 147,214 hospitalizations (36,909 with ≥1 blood culture) across 3 tertiary hospitals in an urban academic center, June 26, 2023-June 25, 2025. Periods were categorized as pre-restriction, restriction, and post-restriction. Analyses were conducted overall, among hospitalizations with ≥1 blood culture set (≥1-BC hospitalizations), and by hospital. Exposure: Strict electronic health record order restriction limiting to 1 blood culture set per patient every 24 hours (June 26-December 23, 2024). Main Outcomes and Measures: Primary outcomes included in-hospital mortality or hospice discharge, 30-day revisits, and length of stay (LOS). Secondary outcomes included blood culture metrics (positivity, number, timing, proportion with ≥1 culture) and receipt and days of antimicrobials. Odds or incidence rate ratios were reported. Results: Among all hospitalizations, in-hospital mortality/hospice discharge declined pre-restriction (-1.3%/week, P<.001), plateaued during restriction (+0.6%/week, P=.33), and resumed decline post-restriction (-2.8%/week, P<.001). Among ≥1-BC hospitalizations, trends were similar, with additional 37.6% increase upon restriction onset (P=.005); LOS increased 14.9% upon restriction onset (P<.001) then decreased post-restriction (-0.9%/week, P<.001). 30-day revisits were unchanged. Overall culture positivity increased 37.8% upon restriction onset (P<.001) and decreased 27.1% upon restriction withdrawal (P<.001). The proportion of hospitalizations with ≥1 culture decreased 37.7% among all hospitalizations (P<.001) and mean number of cultures per hospitalization decreased 49.2% among ≥1-BC hospitalizations (P<.001) upon restriction onset, both partially rebounding afterward. Among ≥1-BC hospitalizations, time from admission to first culture collection and antimicrobial administration increased 72.2% (P<.001) and 21.5% (P=.001), respectively, upon restriction onset; antimicrobial use increased 24.9% upon restriction onset (P=.02) and decreased 14.7% upon post-restriction onset (P=.19). Conclusions and Relevance: Single-set blood culture restriction was associated with decreased and delayed testing, delayed antimicrobial start, and increased in-hospital mortality/hospice discharge. Findings underscore the need for optimal diagnostic stewardship practices and supply-chain resiliency for critical diagnostic supplies.
Ladines-Lim et al. (Thu,) studied this question.
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