Early microbiological diagnosis of bloodstream infections is essential to guide therapy, limit unnecessary antibiotic use, and reduce selective pressure. In 2024, the FDA reported a global shortage of BACTEC (BD) blood culture vials, requiring contingency and diagnostic stewardship measures integrated with antimicrobial stewardship programs.

To describe the design and implementation of a contingency plan based on prospective audit and feedback by the clinical pharmacy team to optimize the use of blood culture vials during the shortage, and to assess its impact on clinical processes and outcomes.

Conducted in a tertiary pediatric hospital (369 beds; 60% public system coverage), this study established a multidisciplinary technical group (pharmacists, infectious disease specialists, microbiologists, and administrators) to: review literature on blood culture yield and clinical indications; create a clinical decision flowchart for blood culture collection; provide multidisciplinary training led by pharmacists to improve request assessment; and perform prospective audits of requests in real time, evaluating justification, number of vials, requesting units, withholding unjustified requests, and discussing uncertain cases within the task group. Sepsis kits remained exempt from prior authorization.

Historical monthly consumption averaged 938 blood culture collections. A retrospective analysis of 144 requests over 12 days revealed 56.3% noncompliance (routine or admission requests without justification). During the prospective audit month, 410 collections were performed (–56.8% compared to baseline). Of 309 audited requests, 188 (45.9%) were canceled and 121 (29.5%) approved. Main requesting units included bone marrow transplant (15.6%), public emergency (13.9%), and private emergency (13.4%). Follow-up within 48 h after cancellations showed no cases of sepsis, shock, or death related to denied requests, and no decrease in bloodstream infection diagnoses. Educational actions and “handshake stewardship” reinforced adherence.

The multiprofessional contingency plan, combined with clinical auditing and feedback, reduced unnecessary blood culture requests without compromising diagnostic accuracy. The revision of the flowchart and the implementation of mandatory justifications reinforced the rational use of laboratory resources and strengthened collaboration between clinical care teams and the clinical pharmacy.