Capacity and Utilization of Blood Culture in Two Referral Hospitals in Indonesia and Thailand

Abstract

Abstract.It is generally recommended that sepsis patients should have at least two blood cultures obtained before antimicrobial therapy. From 1995 to 2015, the number of blood cultures taken each year in a 1,100-bed public referral hospital in Ubon Ratchathani northeast Thailand rose from 5,235 to 56,719, whereas the number received in an 840-bed referral public hospital in South Sulawesi, Indonesia, in 2015 was 2,779. The proportion of patients sampled for blood cultures out of all inpatients in South Sulawesi in 2015 (9%; 2,779/30,593) was lower than that in Ubon Ratchathani in 2003 (13%; 8,707/66,515), at a time when health expenditure per capita in the two countries was comparable. Under-use of bacterial cultures may lead to an underestimate and underreporting of the incidence of antimicrobial-resistant infections. Raising capacity and utilization of clinical microbiology laboratories in developing countries, at least at sentinel hospitals, to monitor the antimicrobial resistance situation should be prioritized.

Challenges in Implementing Antimicrobial Stewardship Programmes at Secondary Level Hospitals in India: An Exploratory Study

“…Other hospitals outsource the culture specimens to standalone labs, thereby increasing the turn-around time and costs. Traditionally, microbiology functions like blood cultures have been underutilized in LMIC contexts due to various reasons (20). The lack of facilities or inadequate number of specimens will make it extremely difficult to have a facility specific antibiogram and give recommendations about standard treatment guidelines.…”

Melioidosis in Thailand: Present and Future

“…An increase in the total number of culture-confirmed cases diagnosed in Northeast Thailand, from 964 cases in 1994 (assuming one isolate per case) [ 6 ] to 1865 in 2007 [ 7 ], could be due to an increase in incidence rates of melioidosis, an increase in usage of bacterial culture as shown by the rise of the number of blood culture bottles used per year [ 32 ], and/or improved access to healthcare [ 33 ]. A genuine increase in incidence rates of melioidosis could be due to the rise in the prevalence of diabetes mellitus (an important risk factor for melioidosis) [ 34 ], the rising age of farmers in rural areas [ 35 ], increased land use for irrigated agriculture and rice farming [ 8 ], and/or depletion of soil nutrients caused by crop residue burning and poor farming practices [ 30 ].…”

“…Microbiological facilities are largely available in all provincial hospitals [ 32 ]. Following international sepsis campaigns [ 56 ], it is usual practice that doctors collect blood specimens for bacterial culture from every patient who presents at a provincial hospital and is prescribed parenteral antibiotics.…”

Emergence of Melioidosis in Indonesia and Today’s Challenges

“…To improve diagnosis of melioidosis, not only does the capacity of clinical microbiology laboratories need to be expanded [ 13 ], but all healthcare workers should also be informed about the importance of bacterial culture in patients presenting with sepsis [ 38 ]. Recent evidence suggests that bacterial culture is under-utilized in Indonesia compared to the country’s health expenditure, and this could be related to the reimbursement system for bacterial culture, local customs and practice of clinicians, and a lack of support from related stakeholders and organizations [ 13 ].…”

“…Even good microbiological laboratories may initially miss the diagnosis and discard B. pseudomallei as a contaminant, especially in non-endemic areas [ 9 , 12 ]. Recent evidence suggests that, in Indonesia, where melioidosis is possibly highly endemic countrywide [ 9 ], capacity and utilization of bacterial cultures is limited [ 13 ], that misidentification of B. pseudomallei as another species or a contaminant is common, and that awareness of the disease among physicians and laboratory staff is very low [ 6 , 7 , 8 ].…”