{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T07:02:01Z","timestamp":1784876521267,"version":"3.55.0"},"reference-count":11,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:00:00Z","timestamp":1784851200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Blood cultures are essential for diagnosing bloodstream infections and for guiding antimicrobial therapy. Excessive blood culture utilization in non-ICU settings can lead to false-positive results, antibiotic exposure, increased healthcare costs, and harm to patients. Diagnostic stewardship (DS) aims to improve the appropriateness of diagnostic testing and optimize antimicrobial use; however, its implementation remains inconsistent across healthcare systems.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective quasi-experimental study evaluated a multidisciplinary stewardship program in adult and pediatric emergency departments. From May to August 2025, with baseline data from January to April 2025 used for comparison. Improving specimen collection practices to reduce contamination, implementing clinical guidance to optimize blood culture ordering, and strengthening antimicrobial stewardship by monitoring Days of Therapy (DOT). Data were extracted from electronic health records and analyzed using descriptive statistics. Blood Culture Event Rate (BCER), contamination rates, antimicrobial utilization, and 30-day emergency department readmissions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The Blood Culture Event Rate (BCER), decreased from 12 to 4% in adults and from 4 to 1% in pediatric patients. Blood culture contamination declined by approximately 87%, decreasing from approximately 35 to fewer than five cases per month. Antimicrobial utilization improved, with a 100% reduction in ceftazidime\/avibactam use and 40.39% reduction in Meropenem DOT, which is the aggregate number of days on which a patient received at least one dose of a specific antimicrobial agent. Additional reductions were observed for ceftazidime (61%), ciprofloxacin (29.49%), and vancomycin (19.83%). Compliance with blood culture ordering guidelines has improved from 70 to 97%, and no blood culture-related 30-day readmissions have been reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A multidisciplinary diagnostic stewardship approach significantly improved blood culture utilization, reduced contamination, and optimized antimicrobial prescriptions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1903984","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T06:23:55Z","timestamp":1784874235000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Enhancing the effectiveness of multidisciplinary interventions to improve blood culture efficiency and optimize antimicrobial utilization"],"prefix":"10.3389","volume":"14","author":[{"given":"Rana Hassan D.","family":"Almaghrabi","sequence":"first","affiliation":[{"name":"Antimicrobial Stewardship Center of Excellence, Prince Sultan Military Medical City (PSMMC)","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deena S. S.","family":"Alharbi","sequence":"additional","affiliation":[{"name":"Central Military Laboratory and Blood Blank, PSMMC","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khulud Salem Mohammed","family":"Alqahtani","sequence":"additional","affiliation":[{"name":"Antimicrobial Stewardship Center of Excellence, Prince Sultan Military Medical City (PSMMC)","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muneerah Abdulrahman Y.","family":"Alzouman","sequence":"additional","affiliation":[{"name":"Central Military Laboratory and Blood Blank, PSMMC","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Turki Saqer J.","family":"Almutairi","sequence":"additional","affiliation":[{"name":"Executive Nursing affairs, PSMMC","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah Bandar T.","family":"Alotaibi","sequence":"additional","affiliation":[{"name":"Central Military Laboratory and Blood Blank, PSMMC","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Gafir","family":"Rajab","sequence":"additional","affiliation":[{"name":"Department of Emergency, PSMMC","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maher Abdrabalredah Mohammed","family":"Al Kuwaiti","sequence":"additional","affiliation":[{"name":"Department of Pharmceutical Services, PSMMC","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amal Ibrahim Zamil","family":"Akresh","sequence":"additional","affiliation":[{"name":"Antimicrobial Stewardship Center of Excellence, Prince Sultan Military Medical City (PSMMC)","place":["Riyadh, Saudi Arabia"]},{"name":"Department of Pharmceutical Services, PSMMC","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noura S.","family":"Alaboudi","sequence":"additional","affiliation":[{"name":"Central Military Laboratory and Blood Blank, PSMMC","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nour M.","family":"AlThibani","sequence":"additional","affiliation":[{"name":"Antimicrobial Stewardship Center of Excellence, Prince Sultan Military Medical City (PSMMC)","place":["Riyadh, Saudi Arabia"]},{"name":"Executive Nursing affairs, PSMMC","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adel Saeed S.","family":"Alotaibi","sequence":"additional","affiliation":[{"name":"Executive Nursing affairs, PSMMC","place":["Riyadh, Saudi Arabia"]},{"name":"Department of Emergency, PSMMC","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoufel M.","family":"Kaabia","sequence":"additional","affiliation":[{"name":"Antimicrobial Stewardship Center of Excellence, Prince Sultan Military Medical City (PSMMC)","place":["Riyadh, Saudi Arabia"]},{"name":"Infection Prevention and Control Center of Excellence, PSMMC","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maaly Zayed Eid","family":"Alotaibi","sequence":"additional","affiliation":[{"name":"Central Military Laboratory and Blood Blank, PSMMC","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saad Saeed Tamam","family":"Alalyani","sequence":"additional","affiliation":[{"name":"Central Military Laboratory and Blood Blank, PSMMC","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wafa Ahmed Mohammed","family":"Alfahad","sequence":"additional","affiliation":[{"name":"Department of Pharmceutical Services, PSMMC","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatimah Alzahra Abdulkarim A.","family":"Alnakhli","sequence":"additional","affiliation":[{"name":"Antimicrobial Stewardship Center of Excellence, Prince Sultan Military Medical City (PSMMC)","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asma Abdullah I.","family":"Alabdulsalam","sequence":"additional","affiliation":[{"name":"Department of Continuous Quality Improvement and Patient Safety, PSMMC","place":["Riyadh, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,24]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"985","DOI":"10.1016\/j.ajic.2024.04.198","article-title":"Blood culture algorithm implementation in emergency department patients as a diagnostic stewardship intervention","volume":"52","author":"Theophanous","year":"2024","journal-title":"Am J Infect Control"},{"key":"ref2","doi-asserted-by":"crossref","DOI":"10.1128\/JCM.01053-20","article-title":"A diagnostic stewardship intervention to improve blood culture use among adult nonneutropenic inpatients: the DISTRIBUTE study","volume":"58","author":"Fabre","year":"2020","journal-title":"J Clin Microbiol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"452","DOI":"10.1017\/ice.2023.249","article-title":"Implementation of a diagnostic stewardship intervention to improve blood-culture utilization in 2 surgical ICUs: time for a blood-culture change","volume":"45","author":"Seidelman","year":"2024","journal-title":"Infect Control Hosp Epidemiol"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.7573\/dic.2022-9-5","article-title":"Leveraging diagnostic stewardship within antimicrobial stewardship programmes","volume":"12","author":"Claeys","year":"2023","journal-title":"Drugs 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Pediatr"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/s13613-023-01107-y","article-title":"Impact of a strategy based on unique blood culture sampling on contamination rate and detection of bloodstream infections in critically ill patients","volume":"13","author":"Mahieu","year":"2023","journal-title":"Ann Intensive Care"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1432433","DOI":"10.3389\/fpubh.2024.1432433","article-title":"Effectiveness of multidisciplinary interventions to improve blood culture efficiency and optimize antimicrobial utilization","volume":"12","author":"Li","year":"2024","journal-title":"Front Public Health"},{"key":"ref10","article-title":"77 it's a BIG deal! Reduction on unsatisfactory blood sample, a strategy to reduce blood culture contaminations","volume":"14","author":"Dimatatac","year":"2025","journal-title":"BMJ Open Qual"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"e0008724","DOI":"10.1128\/cmr.00087-24","article-title":"American Society for Microbiology evidence-based laboratory medicine practice guidelines to reduce blood culture contamination rates: a systematic review and meta-analysis","volume":"37","author":"Sautter","year":"2024","journal-title":"Clin Microbiol Rev"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1903984\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T06:23:56Z","timestamp":1784874236000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1903984\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,24]]},"references-count":11,"alternative-id":["10.3389\/fpubh.2026.1903984"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1903984","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,24]]},"article-number":"1903984"}}