By Patrick R. Murray, PhD
Bloodstream infections are an increasingly serious medical problem. Sepsis, in particular, presents a challenge for physicians and hospitals as they work to improve patient outcomes and manage the significant costs associated with medical complications in hospitalized patients.
The ability of physicians to effectively treat sepsis is dependent on the laboratory’s ability to rapidly recover and identify the responsible organism, which is critical for the selection of targeted antimicrobial treatment. The challenges associated with achieving detection and identification, however, are influenced by a number of factors:
• Early initiation of antimicrobial treatment. Because of the seriousness and rapid progression of sepsis, patients require immediate treatment with antimicrobials once a bloodstream infection is suspected, often before blood cultures are drawn. This early initiation of antimicrobial treatment, though essential given the acute nature of the systemic response, can reduce the ability of the laboratory to recover the organism from the patient’s blood.
• Blood culture volume. For potentially septic patients, a minimum of two blood cultures with significant blood volume are recommended within 30 minutes of the presentation of symptoms of sepsis and before the initiation of treatment. Collection of the recommended amount of blood for each culture may not be accomplished unless attention is devoted to this factor.
• Delays in transport. Though seemingly simple steps in the process, transportation of the bottles to the laboratory and initiation of incubation in the appropriate instrument can often be significantly delayed.
• Prompt communication of results and leveraging diagnostic information. Once the causative organism has been detected and identified, and sepsis has been positively diagnosed, it is essential that the right clinician receives the results as soon as they are available. Then, the physician must be able to utilize the available information to select the most effective, least toxic antibiotic therapy for the patient.
When evaluating how to address these challenges, the priority in sepsis confirmation and management is rooted in reducing the time to actionable results. Improvements in both technology and process have been and continue to be essential in reducing the time to a positive culture, properly identifying the pathogen and informing treatment decisions based on reliable susceptibility results.
From a technological perspective, advances in blood culture media and integrated diagnostic systems are truly enabling better, faster and more accurate organism detection and identification. BD (Becton, Dickinson and Company) and other diagnostic companies are working to improve the efficiency of the diagnostic process through innovative product design, standardization and cutting-edge, sensitive technology. In particular, blood culture media with proprietary formulations of antibiotic-binding resin have allowed for more positive blood cultures and earlier pathogen recovery even in the presence of antimicrobials. In addition, even the location of blood culture instruments can impact outcomes, and newer systems have been designed for remote placement in high-volume areas of hospitals such as the emergency room or intensive care unit, to address and eliminate transportation delays once blood is drawn. Efforts to integrate organism identification and antimicrobial susceptibility results are also underway.
It is highly encouraging to note that many hospitals and healthcare systems are actively working to improve sepsis diagnosis and management through improved processes, as well. Even the most advanced blood culture systems are rendered ineffective if the information generated from these systems isn’t properly leveraged in real-time. To this end, the implementation of advanced diagnostics must be coupled with the evolution of procedures and processes for effective communication of actionable result to the appropriate healthcare provider, ensuring that faster, more accurate treatment decisions are possible.
While the challenges associated with sepsis are many, advancements in technology, refined processes and procedures and the commitment of all stakeholders across the sepsis diagnosis and care continuum are creating a new dynamic in the diagnosis and management of this serious condition.
Patrick R. Murray, PhD, is worldwide director of scientific affairs for BD Diagnostics - Diagnostic Systems.