5.1 Reporting results immediately and appropriately
Rapid notification of even preliminary blood culture results, such as growth and Gram stain results, can impact rational antibiotic prescriptions, length of hospitalisation and even patient survival significantly.
Such immediate blood culture results are important in infection prevention and control, and in the early detection of outbreaks (Ombelet et al., 2019). The laboratory should have a system to immediately notify clinicians of significant and urgent results.
Good communication and mutual respect between the clinicians and the laboratory is the foundation stone for building good diagnostic stewardship, as the following activity illustrates.
Before you attempt the activity, note that
Activity 4: CREs and advising clinicians
a.
A highly pathogenic organism is present, so must be treated.
b.
Results are correlated with clinical presentation and a decision is made on treatment.
c.
Bacteraemia is significant, so treatment with meropenem and colistin is necessary.
d.
There is the possibility of poor blood-taking techniques, particularly in neonates.
e.
Infection control measures must be implemented.
The correct answers are b, d and e.
Discussion
Why are these the correct answers?
- Results are correlated with clinical presentation and a decision is made on treatment: We must always treat the patient and use the result in context of clinical assessment and history. This patient is well, so there is no need to treat.
- There is the possibility of poor blood-taking techniques, particularly in neonates: Blood samples obtained from a device can be contaminated, and the volume of blood can also be insufficient. In this case, the patient is well, so it is likely that the CRE was a contaminant. Clinical assessment is the defining factor in the decision to treat: if there is any doubt, a repeat culture should be taken using an optimal technique.
- Infection control measures must be implemented: The presence of a CRE should alert the ICU and the infection control team, because this highly resistant organism is present in the ward and can potentially cause severe infections because it is transmitted horizontally (such as by the hands of ICU staff). Strict infection prevention and control measures should be followed, and regular audits should be in place.
5 The post-analytical stage
