HPR volume 17 issue 2: news (27 February 2023)

Updated 28 December 2023

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New UKHSA recommendations for microbiological investigation of sepsis

UK Standards for Microbiology Investigations (UK SMI), a provider of services to microbiology laboratories under the auspices of the UK Health Security Agency, has published a new set of recommendations for the microbiological investigation of sepsis and systemic or otherwise disseminated infections.

The latest in the UK SMI NICE-accredited syndromic standards series (SMI S12: Sepsis and systemic disseminated infections) brings together the bacteriology, virology, mycology and parasitology disciplines, under a syndromic approach, and takes account of changes in available testing methods, having consideration for the whole ‘specimen pathway’ from bedside to receipt of the final test result. UK SMI S12 was developed in parallel with, and is aligned with, the NHS England Blood Culture Implementation Task and Finish Group’s update of the national standards for collecting and processing blood cultures.

The document highlights significant changes needed in both clinical and laboratory practice to improve the sensitivity and utility of the blood cultures which are critical for the effective monitoring of antimicrobial resistance and further control of inappropriate use of antimicrobials.

Among its recommendations are that, although certain clinical conditions may require antimicrobials to be given prior to blood culture collection (for example, unstable septic patients, patients with suspected meningococcal disease), blood cultures should ideally be taken before starting antimicrobial therapy; also that blood cultures should continue to be taken when a clinical condition requires a patient to receive ongoing antimicrobials.

Other provisions of SMI S12 are that:

collection of adequate volumes of blood for culture should be ensured, as every millilitre (mL) of blood increases the sensitivity of blood culture by 3%
a minimum of 2 blood culture sets (2x2 bottles, 40mL) are recommended to detect bacteriaemia in adults, which can be collected in one draw
collection of a third set (total of 3x2 bottles, 60mL) is recommended if candidaemia is suspected; all 3 sets can be collected in one draw
if endocarditis is suspected, 3 blood culture sets (3x2 bottles, 60mL) should be collected as separate draws over a 24 hour period
blood culture bottles should be transported to the laboratory and loaded into a blood culture analyser without delay, ideally within 4 hours of collection, subject to local constraints and agreements
a list of auditable outcomes is provided in the standard

The new document is endorsed by the 24 professional colleges and societies who are the partner organisations in the development of UK SMIs, including the Royal College of Pathologists (RCPath) and Institute of Biomedical Science (IBMS).