Bacteremia and Blood Culture Utilization during COVID-19 Surge in New York City.

TitleBacteremia and Blood Culture Utilization during COVID-19 Surge in New York City.
Publication TypeJournal Article
Year of Publication2020
AuthorsSepulveda J, Westblade LF, Whittier S, Satlin MJ, Greendyke WG, Aaron JG, Zucker J, Dietz D, Sobieszczyk M, Choi JJ, Liu D, Russell S, Connelly C, Green DA
JournalJ Clin Microbiol
Date Published2020 Jul 23
KeywordsBacteremia, Betacoronavirus, Blood Culture, Coinfection, Coronavirus Infections, COVID-19, Hospitals, Humans, New York City, Pandemics, Pneumonia, Viral, Prevalence, Retrospective Studies, SARS-CoV-2

A surge of patients with coronavirus disease 2019 (COVID-19) presenting to New York City hospitals in March 2020 led to a sharp increase in 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 level in the first half of the month. The rate of bacteremia was significantly lower among COVID-19 patients (3.8%) than among COVID-19-negative patients (8.0%) and those not tested (7.1%) ( < 0.001). COVID-19 patients had a high proportion of organisms reflective of commensal skin microbiota, which, when excluded, reduced the bacteremia rate to 1.6%. 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 coinfection. 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.

Alternate JournalJ Clin Microbiol
PubMed ID32404482
PubMed Central IDPMC7383550
Grant ListL30 AI133789 / AI / NIAID NIH HHS / United States
T32 AI007531 / AI / NIAID NIH HHS / United States
Related Faculty: 
Lars Westblade, Ph.D.


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