Enhancing the effectiveness of multidisciplinary interventions to improve blood culture efficiency and optimize antimicrobial utilization

Rana Hassan D. Almaghrabi, Deena S. S. Alharbi, Khulud Salem Mohammed Alqahtani, Muneerah Abdulrahman Y. Alzouman, Turki Saqer J. Almutairi, Abdullah Bandar T. Alotaibi, Mohamed Gafir Rajab, Maher Abdrabalredah Mohammed Al Kuwaiti, Amal Ibrahim Zamil Akresh, Noura S. Alaboudi, Nour M. AlThibani, Adel Saeed S. Alotaibi, N. Kaabia, Maaly Zayed Eid Alotaibi, Saad Saeed Tamam Alalyani, Wafa Ahmed Mohammed Alfahad, Fatimah Alzahra Abdulkarim A. Alnakhli, Asma Abdullah I. Alabdulsalam

Background 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. Methods 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. Results 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. Conclusion A multidisciplinary diagnostic stewardship approach significantly improved blood culture utilization, reduced contamination, and optimized antimicrobial prescriptions.