Key Findings: This cross-sectional analysis of the European Sepsis Care Survey (2021–2022) evaluated blood culture practices and microbiological diagnostic capacity across hospitals in multiple European countries.1 Major findings were:
1. Blood culture utilization was highly variable across hospitals, indicating that procedural compliance remains inconsistent despite widespread guideline availability.
- Many hospitals reported lower-than-recommended blood culture utilization rates, particularly regarding the recommended number of blood culture sets collected per suspected sepsis episode.
- In several facilities, blood culture collection prior to antibiotic administration was inconsistently achieved, limiting microbiological yield and diagnostic value.
- Inadequate blood culture volume collection remained a frequently reported challenge, reducing detection sensitivity for bloodstream infections.
2. Limited 24/7 microbiology laboratory availability was repeatedly identified and represented a significant barrier to timely sepsis diagnosis.
- A substantial proportion of hospitals lacked 24-hour microbiology laboratory services, requiring reliance on off-site or delayed specimen processing.
- Delays in specimen transport and processing were reported in hospitals without on-site microbiology facilities.
- Limited laboratory operating hours were associated with slower turnaround times for culture incubation and organism identification.
3. Staffing constraints affected laboratory performance, highlighting workforce capacity as a critical determinant of diagnostic performance. Common findings included:
- Many hospitals reported insufficient microbiology staffing, particularly during nights and weekends.
- Reduced staffing capacity was associated with delays in specimen handling, culture processing, and reporting.
- Inadequate training resources and personnel availability limited implementation of quality assurance and stewardship activities.
4. Diagnostic infrastructure and access to modern technology varied widely between hospitals, directly affecting diagnostic turnaround time and clinical decision-making.
- Availability of automated blood culture systems was common but not universal.
- Access to advanced diagnostic tools, including rapid identification technologies and molecular assays, varied significantly across regions.
- Laboratories with limited diagnostic platforms experienced longer time-to-result intervals.
5. Adherence to sepsis diagnostic protocols was inconsistent across hospitals, indicating gaps between policy adoption and operational implementation.
- Not all institutions reported adherence to international sepsis guidelines regarding blood culture collection practices.
- Protocol standardization and monitoring systems were inconsistently implemented.
- Hospitals with formalized protocols demonstrated better reported compliance metrics.
Bigger Picture: This survey highlights a fundamental systems-level reality in sepsis diagnostics: diagnostic accuracy depends not only on technique but also on infrastructure capacity. Even when clinical guidelines are well established, variability in staffing, laboratory availability, and diagnostic technology can significantly limit implementation fidelity.
From a health system perspective, the most actionable implication is the need for standardized minimum capacity benchmarks, including:
- Defined staffing ratios
- 24/7 microbiology access
- Minimum blood culture utilization targets
- Access to modern diagnostic platforms
Without addressing infrastructure-level disparities, improvements in training or workflow alone will not fully resolve gaps in sepsis diagnosis. For microbiology laboratories and healthcare systems, this reinforces the concept that reliable sepsis diagnostics are fundamentally an integrated systems problem involving workflow, workforce, and infrastructure readiness.
(Image Credit: iStock/ Christoph Burgstedt)
