BD BACTEC Blood Culture Media Shortage

Authored by: Kristina Bryant, MD, Larry K. Kociolek, MD, MSCI, Andi L. Shane, MD, MPH, MSc, and Danielle M. Zerr, MD, MPH

This communication is to inform pediatric clinicians about a critical supply shortage of blood culture media bottles (both aerobic and anaerobic bottles) for the Becton Dickinson (BD) BACTEC blood culture system. According to the US Centers for Disease Control and Prevention (CDC), “this shortage has the potential to disrupt patient care by leading to delays in diagnosis, misdiagnosis, or other challenges in the clinical management of patients with certain infectious diseases.” This shortage has an unclear timeline for resolution at this time, although it is expected to continue at least into September 2024.

Current blood culture supply is limited nationally, and alternative blood culture media are unavailable for this BD BACTEC blood culture system. For this reason, clinicians must be judicious and avoid unnecessary blood culture utilization. This can be done safely by following best practices. Below are some recommendations for optimizing blood culture use in children.

General Guidance

Inform local stakeholders: Work with your local clinical microbiology laboratory on situational awareness, developing and implementing a strategy for educating local pediatric clinicians, and process for monitoring blood culture usage, media availability, and opportunities for improvements in utilization. Your clinical microbiology laboratory may be able to additionally validate recently expired blood culture media to extend shelf life during the shortage.

Guidance may vary by clinical condition and/or specialty: Clinicians should familiarize themselves with local clinical care guidelines and/or published guidelines for their specialty, when available, to avoid inappropriate blood culture utilization. A sample clinical care guideline from Johns Hopkins Medicine is available.

Familiarize yourself with literature and resources: See references at the end for additional information. Pay considerable attention to the safe, evidence-based, and pediatric-focused principles proposed by the BrighT STAR research group. Although this guidance was developed for children receiving care in the PICU, many of the presented principles are broadly applicable to pediatric care.

Evaluate patients for clinical likelihood of bloodstream infection: Before reflexively ordering a blood culture for a non-specific symptom (e.g., fever), review patient’s history/risk factors, clinical signs/symptoms, and lab and imaging results, and perform a physical examination, to determine if there is a clinical indication for a blood culture.

Eliminate blood culture “draw and hold” by nursing staff: Blood cultures should not be collected and held (just in case one is needed later) prior to a clinician evaluating the patient and ordering a blood culture.

Avoid blood culture contamination: Educate on CDC best practices to prevent blood culture contamination.

Limit repeat blood cultures: Repeat blood cultures should be based on clinical suspicion of true bloodstream infection (vs contamination) and a planned intervention based on the result (e.g., escalation or de-escalation of antimicrobial therapy). Confirming bloodstream infection clearance for true bloodstream infection is necessary in specific situations (more specific information below).

Limit number of blood cultures collected: A single blood culture collected aseptically with appropriate weight-based volume is sufficient to detect bacteremia in most clinical situations. More than one blood culture may be indicated for some conditions such as endocarditis or those where more than one blood culture result is needed to support a suspected diagnosis. In general, a single appropriate weight-based volume blood culture from a vascular access device collected simultaneously with an appropriate weight-based volume peripheral blood culture, should be adequate to guide management of patients with a vascular access device. Follow local practice for collection of cultures from multi-lumen vascular access devices if local practice differs from this guidance.

Utilize pediatric infectious diseases consultants: Please consult the local pediatric infectious diseases team, if available, when guidance is needed regarding blood culture utility.

Leverage your electronic medical record: Consider eliminating the option to order blood cultures more frequently than a one-time order and incorporation of clinical decision support tools for optimal blood culture utilization.

Optimize blood culture yield: To optimize the yield of pathogen recovery by blood culture, manufacturer-recommended blood culture volumes* should be collected.