Lab efficiency and improvements in the management of bloodstream infections: a before and after study

May combine two claims.

Multivariable models were used to compare periods, adjusting for relevant patient characteristics showing a significant difference between periods at p<0.20.

“Multivariable models were used to compare periods, adjusting for relevant patient characteristics.”

• Also stated in: § Statistical analysis · plain

  “Multivariate analyses were used to compare antimicrobial times (linear or log-linear model), 30-day mortality (Cox proportional hazards model), cumulative incidence of ICU and hospital discharge (Fine and Gray sub-distribution hazard model considering death as a competitive risk) between the two periods, adjusting on relevant patient characteristics showing a significant difference between periods”

• cites [5] Brock GN, Barnes C, Ramirez JA, Myers J (2011) How to handle mortality when investigating length of hospital stay and time to clinical stability. BMC Med Res Methodol 11:144. https://doi.org/10.1186/1471-2288-11-144 sourceDisputed

  The Discussion states that the authors did not address incorporating additional risk factors through regression models. The Methods section instead describes tests comparing patient groups, not multivariable models adjusting for patient characteristics. No page numbers are available in our copy. (LLM, conf=0.88)

  Checked by a reasoning model — may be wrong.

  Experimental — accuracy not yet measured
• cites [6] Keene CM, Dondorp A, Crawley J, Ohuma EO, Mukaka M (2018) A Competing-Risk approach for modeling length of stay in severe malaria patients in South-East Asia and the implications for planning of hospital services. Clin Infect Dis 67(7):1053–1062. https://doi.org/10.1093/cid/ciy211 sourcePartly supported

  The Methods (Statistical Methods; page unavailable) confirm that the paper used multivariable models and adjusted for treatment and country. They describe models for discharge and death, not comparisons between periods, and specify P < .05 rather than P < .20 for selecting factors and assessing significance. (LLM, conf=0.90)

  Experimental — accuracy not yet measured
• cites [7] Mishima Y, Nawa N, Asada M, Nagashima M, Aiso Y, Nukui Y, Fujiwara T, Shigemitsu H (2023) Impact of antibiotic Time-Outs in multidisciplinary ICU rounds for antimicrobial stewardship program on patient survival: A controlled Before-and-After study. Crit Care Explor 5(1):e0837. https://doi.org/10.1097/CCE.0000000000000837 sourcePartly supported

  The Statistical Analyses section says the authors compared phases with a Fine-Gray model that included patient characteristics, and Table 2 confirms multivariable adjustment. The supplied claim’s additional p<0.20 selection criterion is not supported: the listed predictors include characteristics with between-phase p values above 0.20 in Table 1. That criterion does not appear in the verbatim citing sentence. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim.

Rapid ID and AST result availability contributes to faster therapy modification.

“It is known that rapid ID and AST result availability contributes to faster therapy modification [16–18].”

• cites [16] Banerjee R, Komarow L, Virk A, Rajapakse N, Schuetz AN, Dylla B, Earley M, Lok J, Kohner P, Ihde S, Cole N, Hines L, Reed K, Garner OB, Chandrasekaran S, de St Maurice A, Kanatani M, Curello J, Arias R, Swearingen W, Doernberg SB, Patel R (2021) Randomized trial evaluating clinical impact of rapid identification and susceptibility testing for Gram-negative bacteremia: RAPIDS-GN. Clin Infect Dis 73(1):e39–e46. https://doi.org/10.1093/cid/ciaa528 sourceSupported
• cites [17] Banerjee R, Teng CB, Cunningham SA, Ihde SM, Steckelberg JM, Moriarty JP, Shah ND, Mandrekar JN, Patel R (2015) Randomized trial of rapid multiplex polymerase chain Reaction-Based blood culture identification and susceptibility testing. Clin Infect Dis 61(7):1071–1080. https://doi.org/10.1093/cid/civ447 sourceSupported
• cites [18] Lopez-Pintor JM, Sanchez-Lopez J, Navarro-San Francisco C, Sanchez-Diaz AM, Loza E, Canton R (2021) Real life clinical impact of antimicrobial stewardship actions on the blood culture workflow from a microbiology laboratory. Antibiot (Basel) 10(12). https://doi.org/10.3390/antibiotics10121511 sourceSupported

Classified as probably not a substantial claim. May combine two claims.

A rapid introduction of an adequate antimicrobial treatment is essential for optimal care, reducing mortality and length of hospital stay, and to fight antibiotic resistance.

“A rapid introduction of an adequate antimicrobial treatment is essential for optimal care, reducing mortality and length of hospital stay, and to fight antibiotic resistance [1].”

• cites [1] Maurer FP, Christner M, Hentschke M, Rohde H (2017) Advances in rapid identification and susceptibility testing of Bacteria in the clinical microbiology laboratory: implications for patient care and antimicrobial stewardship programs. Infect Dis Rep 9(1):6839. https://doi.org/10.4081/idr.2017.6839 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

Use of inadequate and unnecessarily broad empiric antibiotics is linked to higher mortality.

“Literature highlights that the use of inadequate and unnecessarily broad empiric antibiotics is linked to higher mortality [21, 22].”

• cites [21] Hung YP, Lee CC, Ko WC (2022) Effects of inappropriate administration of empirical antibiotics on mortality in adults with bacteraemia: systematic review and Meta-Analysis. Front Med (Lausanne) 9:869822. https://doi.org/10.3389/fmed.2022.869822 sourcePartly supported

  The Results report that inappropriate empirical antibiotic therapy was associated with higher mortality in adults with bacteraemia. The Methods define appropriateness by whether the antimicrobial was active against the causative organism; the paper does not establish that unnecessarily broad therapy is linked to higher mortality. Page numbers are unavailable in our copy. (LLM, conf=0.89)

  Experimental — accuracy not yet measured
• cites [22] Rhee C, Kadri SS, Dekker JP, Danner RL, Chen HC, Fram D, Zhang F, Wang R, Klompas M, Program CDCPE (2020) Prevalence of antibiotic-Resistant pathogens in Culture-Proven Sepsis and outcomes associated with inadequate and Broad-Spectrum empiric antibiotic use. JAMA Netw Open 3(4):e202899. https://doi.org/10.1001/jamanetworkopen.2020.2899 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

In the Morquin et al. study, result delivery accounted for almost 40% of the time.

“while result delivery accounted for almost 40% of the time”

• cites [19] Morquin D, Lejeune J, Agostini C, Godreuil S, Reynes J, Le Moing V, Lamy B (2024) Time is of the essence: achieving prompt and effective antimicrobial therapy of bloodstream infection with advanced hospital information systems. Clin Infect Dis 78(6):1434–1442. https://doi.org/10.1093/cid/ciad744 sourcePartly supported

  In “Time in the Overall Process” (p. 1437), the paper says the time after result production and delivery accounted for close to 40% of the overall time. It does not say result delivery itself took that share; the section describes a substantial delay between viewing results and changing treatment. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

Improvements in TAT and faster treatment adaptation have been attributed to better outcomes in patients with BSI, including improved survival rates in some studies.

“While the exact cause of this finding cannot be determined due to the observational nature of the study, improvements in TAT and faster treatment adaptation have been attributed to better outcomes in patients with BSI, including improved survival rates in some studies [23–25].”

• cites [23] Babowicz F, LaPlante R, Mitchell C, O’Donnell JN, Tobin E, George M, Carreno JJ (2021) Impact of accelerate pheno and bact/alert virtuo on clinical processes and outcomes in patients with Sepsis and concurrent Gram-Negative bacteremia. Antimicrob Agents Chemother 65(6). https://doi.org/10.1128/AAC.02364-20 sourceSupported
• cites [24] MacVane SH, Dwivedi HP (2024) Evaluating the impact of rapid antimicrobial susceptibility testing for bloodstream infections: a review of actionability, antibiotic use and patient outcome metrics. J Antimicrob Chemother 79(Supplement1):i13–i25. https://doi.org/10.1093/jac/dkae282 sourceSupported
• cites [25] Moon RC, MacVane SH, David J, Morton JB, Rosenthal N, Claeys KC (2024) Clinical outcomes of early Phenotype-Desirable antimicrobial therapy for enterobacterales bacteremia. JAMA Netw Open 7(12):e2451633. https://doi.org/10.1001/jamanetworkopen.2024.51633 sourcePartly supported

  The Introduction (page unavailable) links delayed identification and susceptibility results to delayed treatment optimization and poorer bloodstream-infection outcomes, including increased mortality risk with discordant therapy. The Discussion (page unavailable) reports better overall outcomes with earlier targeted treatment, but explicitly says this study found no mortality difference. It therefore supports the general link, not a survival benefit from improved turnaround time in this study. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

In the Morquin et al. study, the median time to appropriate treatment administration was ~53.5 h (IQR, 28.9; 98.0).

“The Morquin, et al.. study showed that the median time to appropriate treatment administration was with ~ 53.5 h (IQR, 28.9; 98.0)”

• cites [19] Morquin D, Lejeune J, Agostini C, Godreuil S, Reynes J, Le Moing V, Lamy B (2024) Time is of the essence: achieving prompt and effective antimicrobial therapy of bloodstream infection with advanced hospital information systems. Clin Infect Dis 78(6):1434–1442. https://doi.org/10.1093/cid/ciad744 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

In the Morquin et al. study, only 50% of that time was dedicated to the actual testing.

“and that only 50% of that time was dedicated to the actual testing”

• cites [19] Morquin D, Lejeune J, Agostini C, Godreuil S, Reynes J, Le Moing V, Lamy B (2024) Time is of the essence: achieving prompt and effective antimicrobial therapy of bloodstream infection with advanced hospital information systems. Clin Infect Dis 78(6):1434–1442. https://doi.org/10.1093/cid/ciad744 sourceSupported

May combine two claims.

The implementation of total laboratory automation increases efficiency (reducing turnaround times and increasing productivity) and improves testing quality, sample management, traceability, and operator's safety.

“The implementation of total laboratory automation increases efficiency (reducing turnaround times (TAT) and increasing productivity) and improves the testing quality, sample management, traceability, and operator’s safety [2].”

• cites [2] Trigueiro G, Oliveira C, Rodrigues A, Seabra S, Pinto R, Bala Y, Gutierrez Granado M, Vallejo S, Gonzalez V, Cardoso C (2024) Conversion of a classical microbiology laboratory to a total automation laboratory enhanced by the application of lean principles. Microbiol Spectr 12(2):e0215323. https://doi.org/10.1128/spectrum.02153-23 sourcePartly supported

  The Introduction states that total laboratory automation increases efficiency, improves testing quality, and lowers biological risk to operators. The Abstract and Discussion also report improvements in turnaround time and productivity. However, the Introduction says automation offers a *possibility* of better sample management and traceability; the claim presents those improvements as certain. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Progress in BSI management is based on a bundle approach, including optimisation of pre-analytical parameters, use of rapid methods, laboratory organisation, and involvement of antimicrobial stewardship teams.

“As highlighted by Lamy, et al.., progress in BSI management is based on a bundle approach, including the optimisation of the pre-analytical parameters, the use of rapid methods, laboratory organisation (e.g., 24/7, transportation service) and the involvement of antimicrobial stewardship teams [20].”

• cites [20] Lamy B, Sundqvist M, Idelevich EA (2020) Bloodstream infections - Standard and progress in pathogen diagnostics. Clin Microbiol Infect 26(2):142–150. https://doi.org/10.1016/j.cmi.2019.11.017 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

Fast de-escalation was shown to be associated with a decreased risk.

“and a fast de-escalation was shown to be associated with a decreased risk [26, 27].”

• cites [26] Bell BG, Schellevis F, Stobberingh E, Goossens H, Pringle M (2014) A systematic review and meta-analysis of the effects of antibiotic consumption on antibiotic resistance. BMC Infect Dis 14:13. https://doi.org/10.1186/1471-2334-14-13 sourcePartly supported

  The Discussion (page unavailable) reports that decreased antibiotic consumption was associated with decreased bacterial resistance. It does not establish that fast de-escalation specifically was associated with decreased risk; a search for de-escalation found no such finding in our copy. (LLM, conf=0.84)

  Experimental — accuracy not yet measured
• cites [27] Teshome BF, Park T, Arackal J, Hampton N, Kollef MH, Micek ST (2024) Preventing new Gram-negative resistance through Beta-lactam De-escalation in hospitalized patients with sepsis: A retrospective cohort study. Clin Infect Dis 79(4):826–833. https://doi.org/10.1093/cid/ciae253 sourcePartly supported

  The Outcomes section reports that beta-lactam de-escalation was associated with less new gram-negative resistance than no change (HR 0.59, 95% CI 0.48–0.73). But the Discussion says patients were classified using their entire beta-lactam exposure, not just the early treatment phase; the paper therefore does not establish the added claim about *fast* de-escalation. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Antibiotic resistance is correlated with antibiotic use.

“Antibiotic resistance being correlated with antibiotic use, in terms of antimicrobial stewardship, it is crucial that antibiotics are only used when indicated”

• cites [26] Bell BG, Schellevis F, Stobberingh E, Goossens H, Pringle M (2014) A systematic review and meta-analysis of the effects of antibiotic consumption on antibiotic resistance. BMC Infect Dis 14:13. https://doi.org/10.1186/1471-2334-14-13 sourceSupported
• cites [27] Teshome BF, Park T, Arackal J, Hampton N, Kollef MH, Micek ST (2024) Preventing new Gram-negative resistance through Beta-lactam De-escalation in hospitalized patients with sepsis: A retrospective cohort study. Clin Infect Dis 79(4):826–833. https://doi.org/10.1093/cid/ciae253 sourceSupported

May combine two claims.

TAT was improved for clinically significant monomicrobial episodes and for PBCs processed during the night shift.

“Indeed, TAT was improved for clinically significant monomicrobial episodes and for PBCs processed during the night shift.”

May combine two claims.

No difference was observed for time to positivity and Gram stain between periods.

“No difference was observed for time to positivity and Gram stain, whereas times to ID (-2.2 h median difference; p = 0.004) and TAT (-2.7 h; p = 0.009) were significantly shorter for PBCs flagged positive during the night shift.”

May combine two claims.

In 2019, 73,400 plates (45% of total plates) were inoculated by one WASP instrument; in 2021, 215,000 plates (86% of total plates) were inoculated by two WASP instruments.

“In 2019, 73,400 plates, corresponding to 45% of total plates processed, were inoculated by one WASP® instrument. In 2021, 215,000 plates were inoculated by two WASP® instruments, corresponding to 86% of the total plates.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The proportion of time for training remained similar (16% vs 15%).

“The proportion of time for training remained similar (16% versus 15%).”

May combine two claims.

Microbiologists and clinicians considered 86 (83.5%) and 85 (73.9%) of the 103 and 115 monomicrobial ID episodes clinically significant pre- and post-conversion, respectively.

“Microbiologists and clinicians considered 86 (83.5%) and 85 (73.9%) of the 103 and 115 monomicrobial ID episodes clinically significant pre- and post-conversion, respectively (Supplementary Data 3).”

• AssumptionRests on an assumption: The clinical significance classification by clinicians and microbiologists is valid for defining the clinically significant episode subpopulation.

May combine two claims.

Post-conversion instantaneous observations showed reductions in administrative (19% vs 31%), movements (9% vs 13%), transports, and walking (16% vs 20%).

“whilst administrative (19% versus 31%), movements (9% versus 13%), transports, and walking (16% versus 20%) were reduced.”

May combine two claims.

The study included 244 BSI episodes, 116 pre-conversion and 128 post-conversion, in 104 and 112 patients, respectively.

“The study included a total of 244 BSI episodes, of which 116 occurred pre-conversion and 128 post-conversion, in 104 and 112 patients, respectively.”

May combine two claims.

Post-conversion showed better separation of areas dedicated to Day 0 and Day 1, while total laboratory surface remained constant.

“The post-conversion period showed a better separation of areas dedicated to Day 0 and Day 1, whilst the laboratory’s total surface remained constant.”

May combine two claims.

In a French survey, laboratories without WASPLab did not meet activity split targets (27% technical, 21% administrative, 18% movement, 7% transport, 11% displacement, and 16% others), whereas laboratories operating WASPLab did (46% technical, 12% administrative, 13% movement, 9% transport, 9% displacement, and 11% others).

“A French survey monitored 15 laboratories without WASPLab® and four equipped with WASPLab®. Laboratories without WASPLab® did not meet the activity split targets (27% technical, 21% administrative, 18% movement, 7% transport, 11% displacement, and 16% others), whereas the ones operating WASPLab® did (46% technical, 12% administrative, 13% movement, 9% transport, 9% displacement, and 11% others) (i”

May combine two claims.

Organisational improvements led to an increase in lean indicators by 14 points on Day 0 and by 20 points on Day 1.

“Organisational improvements led to an increase in lean indicators by 14 points on Day 0 and by 20 points on Day 1 (Supplementary data 5).”

May combine two claims.

Treatment modification occurred in 76 (65.5%) pre-conversion and 81 (63.3%) post-conversion episodes.

“Treatment modification occurred in 76 (65.5%) and 81 (63.3%) of episodes”

May combine two claims.

The percent of PBCs with AST results available within 24 h decreased for daytime PBCs, without reaching statistical significance (48.8% vs 35.0%, p=0.20).

“and decreased for daytime PBCs, without reaching statistical significance (48.8% versus 35.0%, p = 0.20) (Fig. 1B).”

Classified as probably not a substantial claim.

The two compared periods lasted a full year to be comparable.

“The two compared periods lasted a full year to be comparable.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The analysis plan did not allow assessment of whether time savings led to communication of microbiological results at an hour of the day with optimal probability of being actioned promptly.

“It should be noted that our analysis plan did not allow us to assess whether time savings led to a communication of microbiological results at an hour of the day with optimal probability of being actioned promptly.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Clinical information was collected from the hospital's Electronic Patients Record system and reviewed by the same infectious disease specialist and an intensive care physician.

“Clinical information was collected from the hospital’s Electronic Patients Record system and reviewed by the same infectious disease specialist and an intensive care physician.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Around the clock BSI diagnostics is known to shorten TAT and, in turn, to reduce delays in appropriate treatment introduction.

“Around the clock BSI diagnostics is known to shorten TAT and, in turn, to reduce delays in appropriate treatment introduction [10].”

• cites [10] Chirio D, Demonchy E, Le Marechal M, Gaudart A, Lotte R, Carles M, Ruimy R (2023) 24/7 workflow for bloodstream infection diagnostics in microbiology laboratories: the first step to improve clinical management. Clin Chem Lab Med 61(2):349–355. https://doi.org/10.1515/cclm-2022-0667 sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

The year 2020 was excluded due to the potential impact of the initial COVID-19 waves on the laboratory workflow.

“The year 2020 was excluded due to the potential impact of the initial COVID-19 waves on the laboratory workflow.”

May combine two claims.

Following the laboratory automation and reorganisation, the Centre Hospitalier de Valenciennes achieved lean targets, making a proportion of time available for high added-value activities.

“Following the laboratory automation and reorganisation, the Centre Hospitalier de Valenciennes achieved lean targets, making a proportion of time available for high added-value activities.”

Probably not a substantial claim: may not pass S3 (load-bearing).

According to the results of the French Society of Microbiology national survey, the Centre Hospitalier de Valenciennes belongs to well-organised laboratories for BSI management.

“According to the results, the Centre Hospitalier de Valenciennes belongs to well-organised laboratories for BSI management [15].”

• cites [15] Cattoen C, Lamy B (2022) Restitution de l’observatoire National des bactériémies. Microbes 2022 17e congres. National de la SFM, MontpellierNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The impact of automation is greater when laboratories are running 24/7 and is particularly important for sepsis management.

“Studies show that the impact of automation is greater when laboratories are running 24/7 and is particularly important for sepsis management [3].”

• cites [3] Bou G, Calbo E, Crespo M, Canton R, Alvarez de Luna FF, Garcia Rodriguez J, Angel Goenaga M, Gonzalez-Garcia J, Gonzalez J, Larrosa N, Martinez-Martinez L, Navarro D, Ramon Pano J, Rivero A, Carlos Rodriguez J, Tomas M, Vilaj J (2022) Justification for 24/7 clinical microbiology services. Enferm Infecc Microbiol Clin (Engl Ed) 40(1):1–4. https://doi.org/10.1016/j.eimce.2021.08.014 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Missing data on covariates were not replaced.

“Missing data on covariates were not replaced.”

May combine two claims.

Laboratory reorganisation improved laboratory efficiency, leading to improvements in the management of patients with BSIs.

“Laboratory reorganisation improved laboratory efficiency, leading to improvements in the management of patients with BSIs.”

• AssumptionRests on an assumption: The pre-conversion and post-conversion periods are comparable except for the laboratory reorganisation, with no other secular changes or unmeasured confounders affecting the outcomes.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Laboratory variables and antimicrobial consumption data were collected from the Laboratory Information System and reviewed by two microbiologists.

“Laboratory variables and antimicrobial consumption data were collected from the Laboratory Information System and reviewed by two microbiologists from Laboratory Information System.”

May combine two claims.

Laboratory conversion and reorganisation at the Centre Hospitalier de Valenciennes allowed for the processing of increased sample numbers and led to an improvement in the efficiency and timeliness of diagnostic results in the laboratory.

“Laboratory conversion and reorganisation at the Centre Hospitalier de Valenciennes allowed for the processing of increased sample numbers and led to an improvement in the efficiency and timeliness of diagnostic results in the laboratory.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Data collection for the two periods was performed by the same two healthcare professionals during the same period of time.

“Data collection for the two periods was performed by the same two healthcare professionals during the same period of time.”

May combine two claims.

There were no significant differences between pre- and post-conversion groups regarding demographics, comorbidities, reasons for hospital admission, site of infection, pathogen ID, or mechanisms of resistance.

“There were no significant differences between the two groups regarding demographics, comorbidities, reasons for hospital admission, site of infection, pathogen ID, or mechanisms of resistance (Supplementary Data 3).”

May combine two claims.

Laboratory conversion to full automation, together with lean reorganisation, improved BSI management and resulted in improvement of TAT, especially for night shift samples, impacting the time to first antimicrobial treatment modification.

“In conclusion, laboratory conversion to full automation, together with lean reorganisation, improved the BSI management and resulted in the improvement of TAT, especially for night shift samples impacting the time to first antimicrobial treatment modification.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The disruption of the post-conversion period by the COVID-19 pandemic could have introduced a bias related to populations studied, albeit SAPS were similar in both periods.

“post-conversion period by the COVID-19 pandemic could have introduced a bias related to populations studied, albeit simplified acute physiology scores (SAPS) [28] were similar in both periods.”

• cites [28] Le Gall JR, Lemeshow S, Saulnier F (1993) A new simplified acute physiology score (SAPS II) based on a european/north American multicenter study. JAMA 270(24):2957–2963. https://doi.org/10.1001/jama.270.24.2957 sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

The authors applied a robust statistical adjustment to account for potential differences in patients' characteristics during the two periods.

“We also applied a robust statistical adjustment to account for potential differences in patients’ characteristics during the two periods.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

Although the two study periods occurred only 3 years apart, actual practice and drug use in antimicrobial therapy may have evolved, making the comparison difficult.

“Although the two study periods occurred only 3 years apart, the actual practice and drug use in antimicrobial therapy may have evolved, making the comparison difficult.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

The distribution of isolated microorganisms reflected that normally seen in hospital practice and the ICU setting, where diagnostic results and antibiotic changes are likely to have the biggest impact on mortality and length of stay.

“Also, the distribution of the isolated microorganisms reflected that normally seen in a hospital practice and the ICU setting, where diagnostic results and antibiotic changes are likely to have the biggest impact on mortality and length of stay.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

The increased contamination rate in the post-intervention period could have contributed to the decrease in the percentage of blood samples flagged positive during the day shift with AST within 24 h, possibly linked to a delayed decision to run AST when contamination was suspected.

“The increased contamination rate in the post-intervention period could have contributed to the decrease in the percentage of blood samples flagged positive during the day shift, with AST within 24 h as maybe linked to a delayed decision to run AST, when there was a suspicion of contamination.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Changes observed may have been influenced by other factors unrelated to the intervention (e.g., higher contamination rate in the post-intervention period).

“Changes observed may have been influenced by other factors unrelated to the intervention (e.g., higher contamination rate in the.”

Classified as probably not a substantial claim.

To mitigate design limitations, the authors defined two 1-year observation periods to ensure the clinical relevance of the observed difference while limiting potential seasonal variability.

“However, to mitigate the design’s inherent limitations, we defined two 1-year observation periods to ensure the clinical relevance of the observed difference, while limiting potential seasonal variability.”

May combine two claims.

These findings showed, for the first time, how laboratory efficiency by automation and 24/7 conversion could improve BSI management and antibiotics consumption, having an impact at the patient level and global level, with antimicrobial resistance emergence prevention.

“These findings showed, for the first time, how laboratory efficiency by automation and 24/7 conversion could improve BSI management and antibiotics consumption having an impact at the patient level and global level, with antimicrobial resistance emergence prevention.”

May combine two claims.

Although a limited number of patients with BSI episodes were included, patient distribution was balanced with respect to demographic variables and underlying pathologies.

“Regarding the strengths, although a limited number of patients with BSI episodes were included, patient distribution was balanced with respect to demographic variables and underlying pathologies.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Other limitations comprised the lack of information on appropriate or effective antibiotic therapy, confounding variables, and the lack of data on other infection-management methods, such as surgical source control.

“Second, other limitations comprised the lack of information on appropriate or effective antibiotic therapy, confounding variables, and the lack of data on other infection-management methods, such as surgical source control.”