{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T03:16:35Z","timestamp":1791083795414,"version":"4.1.0"},"reference-count":30,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Blood culturing is a critical diagnostic procedure affecting patient outcomes and antibiotic stewardship. Although there are standards for blood culturing, the process is not often measured.<\/jats:p><\/jats:sec>Objectives<\/jats:title>To evaluate processes related to the diagnosis of bloodstream infection and compare them with best practices.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>A quality improvement study using laboratory data from January 1 to June 30, 2019, was conducted in 28 (96.6%) Israeli acute care hospitals. All blood cultures (BCs) performed on samples from adults and children in a period of 147 hospital-months were analyzed. Data analysis was performed from April 12, 2021, to September 9, 2022.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>True pathogen detection rate, contamination rate, proportion of adults with blood cultures performed, proportion of adult culturing episodes with only 1 set or bottle used, and median time of steps from sample collection to pathogen identification.<\/jats:p><\/jats:sec>Results<\/jats:title>The data set consisted of 348\u202f987 BC bottles. Bloodstream infection was detected in a median of 6.7% (IQR, 5.8%-8.2%) of adult culturing episodes and 1.1% (IQR, 0.7%-1.9%) of pediatric episodes. Eleven of 27 hospitals (40.7%) with adult patients met the standard of a contamination rate of less than 3% and only 2 hospitals (7.4%) met the more stringent standard of less than or equal to 1% contamination rate. The percentage of adults with blood cultures ranged from 2.7% to 29.0% (mean [SD], 15.7% [6.0%]). There was an association between sampling rate and pathogen detection until BCs were performed in 17% of adult admissions. The percentage of solitary BCs ranged from 47.8% to 94.4%. An estimated 1745 of 7436 (23.5%) adult bloodstream infections went undetected because solitary BCs were performed, anaerobic bottles were not used, or BCs were not performed. Median processing time was 51.2 (IQR, 33.9-78.0) hours, 3 times the optimal time: 4.4 (IQR, 1.7-12.5) hours for the preanalytical stage, 15.9 (IQR, 10.2-23.6) hours from incubation to growth detection, 4.5 (IQR, 1.5-10.7) hours from detection to Gram stain, and 30.9 (IQR, 22.0-41.9) hours from detection to isolate identification. An 8.6-hour delay was related to off-hours operating of laboratories.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>The findings of this study suggest that the multistep process of blood culturing is not managed comprehensively in Israel, leading to poor clinical practices and delayed results.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2022.38309","type":"journal-article","created":{"date-parts":[[2022,10,25]],"date-time":"2022-10-25T15:05:04Z","timestamp":1666710304000},"page":"e2238309","source":"Crossref","is-referenced-by-count":19,"title":["Analysis of Blood Culture Collection and Laboratory Processing Practices in Israel"],"prefix":"10.1001","volume":"5","author":[{"given":"Elizabeth","family":"Temkin","sequence":"first","affiliation":[{"name":"National Institute for Antibiotic Resistance and Infection Control, Israel Ministry of Health, Tel Aviv, 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