review · Frontiers in Medicine
Bloodstream infections contribute heavily to global illness and death, with rising concern across low- and middle-income countries. Although automated incubation systems are standard in wealthier nations, high costs and limited durability hinder their deployment in resource-constrained regions. Manual blood culture techniques offer a practical alternative, utilising basic broth media in standard incubators accompanied by daily visual inspection. Achieving diagnostic sensitivity depends heavily on drawing adequate blood volumes, whilst strict antisepsis is critical to minimise contamination from skin and environmental bacteria. Practical manual methods can reliably detect and accelerate pathogen growth without complex machinery. Nevertheless, establishing sustainable blood culture services in these settings requires overcoming persistent operational barriers, particularly regarding biosafety protocols, fragile supply chains, and safe laboratory waste disposal.
Bloodstream infections, including non-typhoidal Salmonella in young children, can cause higher mortality than malaria in developing regions. Reliable diagnosis using blood cultures is crucial for guiding clinical care. Identifying viable, non-automated diagnostic procedures helps healthcare facilities in resource-limited areas detect dangerous infections accurately without relying on expensive, fragile technologies that are impractical for local conditions.
The findings outline applied and tested manual protocols intended for clinical laboratories and healthcare providers in low- and middle-income countries. While focused on operational guidelines rather than proprietary inventions, the work points to immediate market opportunities for manufacturers of low-cost broth bottles, simple growth-detection aids, and durable laboratory consumables designed to withstand fragile supply chains and resource-constrained working environments.
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Bloodstream infections (BSI) have a substantial impact on morbidity and mortality worldwide. Despite scarcity of data from many low- and middle-income countries (LMICs), there is increasing awareness of the importance of BSI in these countries. For example, it is estimated that the global mortality of non-typhoidal <i>Salmonella</i> bloodstream infection in children under 5 already exceeds that of malaria. Reliable and accurate diagnosis of these infections is therefore of utmost importance. Blood cultures are the reference method for diagnosis of BSI. LMICs face many challenges when implementing blood cultures, due to financial, logistical, and infrastructure-related constraints. This review aims to provide an overview of the state-of-the-art of sampling and processing of blood cultures, with emphasis on its use in LMICs. Laboratory processing of blood cultures is relatively straightforward and can be done without the need for expensive and complicated equipment. Automates for incubation and growth monitoring have become the standard in high-income countries (HICs), but they are still too expensive and not sufficiently robust for imminent implementation in most LMICs. Therefore, this review focuses on "manual" methods of blood culture, not involving automated equipment. In manual blood cultures, a bottle consisting of a broth medium supporting bacterial growth is incubated in a normal incubator and inspected daily for signs of growth. The collection of blood for blood culture is a crucial step in the process, as the sensitivity of blood cultures depends on the volume sampled; furthermore, contamination of the blood culture (accidental inoculation of environmental and skin bacteria) can be avoided by appropriate antisepsis. In this review, we give recommendations regarding appropriate blood culture sampling and processing in LMICs. We present feasible methods to detect and speed up growth and discuss some challenges in implementing blood cultures in LMICs, such as the biosafety aspects, supply chain and waste management.
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DOI: 10.3389/fmed.2019.00131
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