Survey on the Use of Antibiotics with Restricted Availability of the Blood Culture Set in the Emergency Room

Abstract

Owing to a global shortage of blood culture bottles, the standard practice of collecting two blood culture sets was temporarily reduced to one set; however, the impact of this change on the use of antibiotics has not been previously reported. Therefore, a retrospective study from the perspective of antimicrobial stewardship was performed to evaluate the use of antibiotics before and after the implementation of this restriction.

The study period was divided into two phases: Period A (May-June 2024) and Period B (July-August 2024). A total of 701 patients, admitted to the hospital after presenting at the emergency department, were included. During Period B, the rate of two-set blood culture collections decreased significantly, with most patients having only one set collected.

There were no statistically significant differences between the two periods in the proportion of patients who received broad-spectrum antibiotics as initial therapy, the de-escalation rate, or the duration of receiving broad-spectrum antibiotics. However, among patients with a positive blood culture, the de-escalation rate was lower, and the median duration of broad-spectrum therapy was longer in Period B. In contrast, no significant changes were observed in the use of antibiotics among patients with a negative blood culture.

Although restriction to a single blood culture set may have made de-escalation more challenging, particularly in patients who had a positive blood culture, and they tended to have prolonged use of broad-spectrum antibiotics, this short-term limitation had minimal overall impact on antibiotic prescribing practices.