Diagnostic disruption during a blood culture bottle shortage: clinical and laboratory adaptation strategies

ABSTRACT In 2024, a global shortage of BD BACTEC blood culture bottles disrupted clinical practices worldwide. This study assessed the impact of the shortage on blood culture performance metrics and evaluated the effectiveness of the management strategies implemented at a tertiary care hospital. This single-center, cross-sectional, observational analysis was conducted at a tertiary healthcare center, spanning from October 2024 to November 2024. During the shortage, clinicians were requested to collect one Microxpress Colorcult culture vial (Tulip Diagnostics), including a 10 mL aerobic culture bottle per patient, with certain exceptions allowed for specific conditions. A total of 4,595 blood cultures were collected during the study period. The overall positivity rate, after excluding contaminated cultures, was found to be 2.8%. Candida species and Brucella species were isolated less frequently during the shortage period, while no significant changes were observed for other organisms. The adoption of simplified instructions enabled a rapid transition to single blood culture collection during the supply shortage. However, this approach reduced the blood culture positivity rate and hindered the bacteremia rate. These findings highlight the critical need for a stable supply of blood culture bottles and the importance of continued education on optimal blood culture collection practices. IMPORTANCE The 2024 global shortage of BD BACTEC bottles disrupted diagnostic workflows, requiring laboratories and healthcare systems to implement alternative strategies. We evaluated blood culture performance before, during, and after the shortage, and assessed the use of an alternative manual system (Colorcult, MicroXpress, Tulip Diagnostics). While these bottles allowed testing to continue, they showed reduced recovery rates, longer time-to-detection, and higher contamination compared with automated systems. These findings emphasize the diagnostic risks of non-automated alternatives, especially for slow-growing organisms, and underline the need for validated contingency strategies. To our knowledge, this is the first study from India to evaluate such adaptations during a global shortage.