[Source: Journal of Clinical Microbiology, full page: (LINK). Abstract, edited.]
Bacteremia and Blood Culture Utilization During COVID-19 Surge in New York City
Jorge Sepulveda [MD, PhD], Lars F. Westblade [PhD], Susan Whittier [PhD], Michael J. Satlin [MD], William G. Greendyke [MD], Justin G. Aaron [MD], Jason Zucker [MD], Donald Dietz [MD], Magdalena Sobieszczyk [MD], Justin J. Choi [MD], Dakai Liu [PhD], Sarah Russell [BA], Charles Connelly [BS], Daniel A. Green [MD]
A surge of patients with coronavirus disease 2019 (COVID-19) presenting to New York City hospitals in March 2020 led to a sharp increase blood culture utilization, which overwhelmed the capacity of automated blood culture instruments. We sought to evaluate the utilization and diagnostic yield of blood cultures during the COVID-19 pandemic to determine prevalence and common etiologies of bacteremia, and to inform a diagnostic approach to relieve blood culture overutilization. We performed a retrospective cohort analysis of 88,201 blood cultures from 28,011 patients at a multicenter network of hospitals within New York City to evaluate order volume, positivity rate, time to positivity, and etiologies of positive cultures in COVID-19. Ordering volume increased by 34.8% in the second half of March 2020 compared to the first half of the month. The rate of bacteremia was significantly lower among COVID-19 patients (3.8%) than COVID-19 negative patients (8.0%) and those not tested (7.1%), p < 0.001. COVID-19 patients had a high proportion of organisms reflective of commensal skin microbiota, reducing the bacteremia rate to 1.6% when excluded. More than 98% of all positive cultures were detected within 4 days of incubation. Bloodstream infections are very rare for COVID-19 patients, which supports the judicious use of blood cultures in the absence of compelling evidence for bacterial co-infection. Clear communication with ordering providers is necessary to prevent overutilization of blood cultures during patient surges, and laboratories should consider shortening the incubation period from 5 days to 4 days, if necessary, to free additional capacity.
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Keywords: SARS-CoV-2; COVID-19; Bacteremia; USA; NYC.