Diagnostic Stewardship for optimizing blood culture practices: A Systematic Review of clinical practice guidelines and evidence-based recommendations.

Authors

Maria López-Rodríguez, Ana Álvarez-Fernández, Alex Smithson, Asja Kunøe, Anne Kjerulf, Ulisa Jeyaratnam, Silvana Gastaldi, Fortunato D'Ancona, Miquel Pujol-Rojo, Enric Limón Cáceres

Published in

The Journal of hospital infection. Jul 03, 2026. Epub Jul 03, 2026.

Abstract

Blood cultures (BC) are fundamental for diagnosing bloodstream infections (BSI), yet pre-analytical errors and inappropriate use undermine their value. Within the EU-JAMRAI 2 framework, we conducted a systematic review to formulate evidence-based diagnostic stewardship (DS) recommendations for optimizing BC practices across the entire testing pathway, aiming to strengthen antimicrobial stewardship (AMS) programs.
Following a scoping review identifying existing documents through 2023, we systematically searched Medline, the Cochrane Library, and grey literature for 2023-2025. From 2,440 records, we included 14 clinical practice guidelines and 3 systematic reviews. Methodological quality was assessed using AGREE-II and AMSTAR-2, and key recommendations were synthesized across all BC phases.
Strong consensus emerged on several DS interventions: testing guided by clinical suspicion of sepsis, avoiding routine use in low-yield scenarios; single-site collections sufficient for most cases except endovascular infections; optimal blood volumes (8-10 mL per bottle in adults); and skin antisepsis with 2% chlorhexidine in 70% alcohol. Rapid molecular assays expedite pathogen identification but have limited sensitivity directly from blood. Quality improvement, including contamination monitoring and mandatory training, is essential for sustainability. A key limitation was heterogeneous guideline reporting formats complicating direct comparison.
Standardized, evidence-based DS protocols are crucial for accurate BSI diagnosis. This work provides harmonized recommendations applicable across Europe and underscores the urgent need for EU-wide guidelines ensuring consistent, high-quality BC practices that directly strengthen AMS efforts.

PMID:
42398632
Bibliographic data and abstract were imported from PubMed on 04 Jul 2026.

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