Blood Culture Gaps in European Sepsis Care

• In Sepsis
• Tue, 31 Mar 2026

Blood cultures remain central to the diagnosis and management of sepsis, supporting pathogen identification and guiding antimicrobial therapy. Timely and accurate processing is essential to ensure appropriate treatment and enable de-escalation where possible. A cross-sectional analysis of the European Sepsis Care Survey evaluated blood culture collection practices and microbiological diagnostic capacity in acute care hospitals across 37 European countries during 2021 and 2022. Data from 907 hospitals were analysed, covering both preanalytical practices and laboratory infrastructure, including transport, opening hours, rapid testing capacity and reported turn-around times. The findings provide a broad overview of how blood cultures are collected, processed and reported in European hospitals of varying sizes and types and examine how microbiological capacity relates to diagnostic timeliness.

Must Read: Connecting ICU Data for Better Sepsis Care

Blood Culture Collection Practices Across Care Settings

Guidelines or protocols for blood culture collection were reported in 84.4% of participating hospitals. Availability varied between countries but exceeded 80% overall. Despite this, recommended practices were not consistently followed. Blood cultures were predominantly collected by nurses in emergency departments, wards and intensive care units, while physicians were involved in approximately 1/3 to 2/5 of cases depending on setting. Specialised phlebotomy teams were rarely used.

Multiple-site sampling was the preferred approach in most emergency departments, wards and intensive care units. Single-site sampling was reported less frequently. In suspected catheter infection, blood cultures were often obtained from catheters older than 24 hours. Regarding the number of sets collected, one set was frequently preferred in emergency departments, wards and intensive care units, while two sets were also commonly reported. Sampling of three or more sets was less frequent. Respondents acknowledged that preferred numbers were not always achieved in practice.

Contamination rates were reported by only 15.3% of participants, with a median rate of 10%. In 47.5% of hospitals, the number of blood cultures was systematically measured as a quality indicator. The limited reporting of contamination rates indicates that monitoring is not routine in many institutions.

Laboratory Infrastructure and Diagnostic Capacity

Of 838 hospitals providing information on microbiology laboratory location, 48.0% used on-site laboratories and 52.0% relied on external services. Immediate transfer of blood cultures to the laboratory after collection was reported in most emergency departments, wards and intensive care units, but was significantly more frequent in hospitals with on-site microbiology compared to those using external laboratories.

Real-time tracking of blood culture processing in hospital information systems was available in 22.6% of hospitals, while 46.5% reported tracking with delay and 19.2% had no tracking system. Initial microbiological findings were communicated through a combination of direct calls, clinical IT systems and other methods.

Around-the-clock microbiological services, including incubation, pathogen identification, antimicrobial susceptibility testing and reporting, were available in 10.0% of hospitals. Availability was slightly higher in hospitals with more than 500 beds but did not differ significantly by university status or laboratory location. Rapid pathogen identification from positive blood cultures was available in 43.7% of hospitals and rapid antimicrobial susceptibility testing in 23.9%. Both rapid identification and susceptibility testing were available in 14.4% of hospitals. Only 7.4% of hospitals reported having both 24/7 microbiology service and rapid testing capacity.

Turn-Around Times and Reported Impact

Most hospitals reported receiving final blood culture results within three days in wards and intensive care units. However, infrastructure was strongly associated with reported turn-around times. A higher proportion of final results were available within two days in hospitals offering both around-the-clock service and rapid testing compared with hospitals lacking these capacities. The likelihood of a final microbiological result within two days was highest in hospitals combining 24/7 service with rapid testing, while the risk of delayed results was greatest in hospitals with limited opening hours and no rapid testing.

When asked how microbiological diagnostic services could improve, 64.4% of respondents indicated that diagnostics of sepsis should be more rapid. Nearly half considered 24/7 microbiological service necessary, and 30.5% requested more specific clinical advice. Only 16.1% expressed satisfaction with their microbiology service.

Across 907 European hospitals, blood culture guidelines were widely available, yet recommended collection practices were often not adhered to. Limited monitoring of contamination and variability in sampling approaches were observed. Microbiological infrastructure was frequently constrained by restricted opening hours and incomplete rapid testing capacity. Only a small proportion of hospitals combined 24/7 services with rapid diagnostics, and this configuration was associated with shorter reported turn-around times. These findings indicate substantial variation in both preanalytical practices and laboratory capacity for sepsis diagnostics across Europe.

Source: The Lancet Regional Health – Europe

Image Credit: iStock