Survey of blood cultures methods in Italy in 2010

Sepsis is a serious clinical condition, associated with high mortality despite advanced modern medical treatment. Traditionally, the detection and identification of bacteria and fungi circulating in the blood-stream is based on blood cultures. A number of factors influence the yield of blood culture, most of them concerning the microbiologist skill and the laboratory organization. In order to collect information about the practices and procedures used for the detection of microrganisms in blood cultures in the italian laboratory (lab), an e-mail with the invitation to participate in the survey was sent to 2000 members of the Italian Association of Clinical Microbiology. Responses were received from 100 lab, located from all over the country (in 18/20 italian regions). The results presented hereby concern specimen collection, culture techniques, rapid identification and susceptibility testing, laboratory organization, relationships with physicians. In summary, most lab use automated systems (96%), the bottles are incubated immediately during public holidays in 72/96 lab (75%) and in 49/97 lab at night (50.5%), the lenght of incubation was 5 or 7 days in 93% of the lab, although it is common to extend the incubation period when brucellosis (74 lab), endocarditis (49 lab), systemic mycosis (33 lab) is suspected. A wide variety of media are employed for subcultures. All lab process the positive bottles at least once a day, while only in 42 of 81 (51.9%) lab the positive blood are processed on holiday. Communication between clinicians and microbiologist include: distribution of specimen collection guidelines (96/100 lab), availability to microbiologist of patients’ clinical situation (77/96 lab, 80.2%), and adding to report the microbiologist’ suggestion (75/98 lab, 76.5%). The results, compared with those collected with a similar questionnaire in 2001, show a greater adherence to guidelines: the number of bottles examined by lab yearly is almost doubled, the length of incubation is shortened to 5 days in 42% (vs 9.2% in 2001), direct susceptibility tests seem to be performed more frequently (in 29% of lab vs18.6% in 2001, mostly in larger hospitals), more lab process positive bottles on Sunday, cooperation with clinicians is improved.