Blood culture pathways in UK hospitals
Abstract:
Background: Timely blood culture (BC) processing is key for optimising antimicrobial therapy in bloodstream infections. However, variability in pre-analytical, analytical, and post-analytical workflows may limit the clinical benefits of rapid diagnostics.
Methods: We conducted a nationwide survey (1 February 2024-6 February 2025) of microbiology laboratories across England and Scotland to assess BC pathways, turnaround times for organism identification and antimicrobial susceptibility testing (AST), availability of rapid methods, operational hours, and result communication. Associations between workflow factors and turnaround times were evaluated using univariate analysis.
Results: Thirty-one sites participated, including teaching 20/31 (64%) and district general hospitals 11/31 (35%). BCs were incubated and analysed on-site in 20/31 (65%) sites, incubated on-site but analysed off-site in 5/31 (16%), and processed entirely off-site in 6/31 (19%). Ward-based incubators were rare (3/31, 10%). Incubation within four hours was reported in 16/31 (52%) sites and was strongly associated with 24 hour a day laboratory services (OR 10.0, 95% CI 0.99-100, p=0.050). Rapid identification technique was available in 30/31 (97%), via MALDI-TOF, and achieved results within 8h of a blood culture flagging positive in 11/30 (37%) sites. Sites performing both incubation and analysis off-site were more likely to provide identification within 8 h of positive blood culture (OR 26.7, 95% CI 2.24-317.1, p=0.009). Rapid AST was available in 8/31 (26%), but only 1 site achieved results within 8h; no factors were significantly associated with AST results ≤24 h. Only 10/31 (32%) sites operated 24 hours a day, and 2/31 (6%) routinely communicated identification results and 1/31 (3%) AST results at all hours.
Conclusion: Blood culture pathways across England and Scotland show significant variability, with most of the laboratories using rapid identification methods but limited access to rapid AST and operating hours under 12 h a day. Faster pre-analytical processing is linked to 24-hour a day working laboratories, and rapid identification to centralisation, but rapid AST capacity remains limited. Extending operational hours, optimising transport, and adopting rapid AST may improve BC workflows, shorten turnaround times, and support timely antimicrobial optimisation.
Reference:
Drury K, Anton-Vazquez V, Sellers P, Lant S, Kirby A, Walsh C, de Sario V, Lambourne J, Khan D, Holmes C, Dall’Antonia M, Bamford KB, Twagira MFN, Barton E, Nageshwaran V, Jeffery K, Parker A, Subbaraj KP, Sabtu N, Patel T, Deas G, Pichierri G, Palmer R, McKerr E, Hamson C, White L, Senior E, Prescott D, Gupta I, Planche T. Blood Culture Pathways in UK Hospitals: An Exploratory Survey. J Hosp Infect. 2026 Apr 8:S0195-6701(26)00117-9. doi: 10.1016/j.jhin.2026.03.027. Epub ahead of print. PMID: 41962848.