Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-17T17:26:16.175Z Has data issue: false hasContentIssue false
  • English
  • Français

Blood culture utilization at an academic hospital: Addressing a gap in benchmarking

Published online by Cambridge University Press:  28 September 2018

Annie I. Chen Open the ORCID record for Annie I. Chen [Opens in a new window] ,
Warren B. Bilker ,
Keith W. Hamilton ,
Judith A. O’Donnell  and
Irving Nachamkin
Annie I. Chen
Affiliation:
Cell and Molecular Biology Graduate Group, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Warren B. Bilker
Affiliation:
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Keith W. Hamilton
Affiliation:
Department of Medicine, Division of Infectious Diseases, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
Judith A. O’Donnell
Affiliation:
Department of Medicine, Division of Infectious Diseases, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
Irving Nachamkin*
Affiliation:
Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
*
Author for correspondence: Irving Nachamkin DrPH, MPH, Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, 7-046 Founders Pavilion, 3400 Spruce Street, Philadelphia, PA 19104-4283. E-mail: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

To describe the pattern of blood culture utilization in an academic university hospital setting.

Design

Retrospective cohort study.

Setting

A 789-bed tertiary-care university hospital that processes 40,000+blood cultures annually.

Methods

We analyzed blood cultures collected from adult inpatients at the Hospital of the University of Pennsylvania between July 1, 2014, and June 30, 2015. Descriptive statistics and regression models were used to analyze patterns of blood culture utilization: frequency of blood cultures, use of repeat cultures following a true-positive culture, and number of sets drawn per day.

Results

In total, 38,939 blood culture sets were drawn during 126,537 patient days (incidence rate, 307.7 sets per 1,000 patient days). The median number of blood culture sets drawn per hospital encounter was 2 (range, 1–76 sets). The median interval between blood cultures was 2 days (range, 1–71 days). Oncology services and cultures with gram-positive cocci were significantly associated with greater odds of having repeat blood cultures drawn the following day. Emergency services had the highest rate of drawing single blood-culture sets (16.9%), while oncology services had the highest frequency of drawing ≥5 blood culture sets within 24 hours (0.91%). Approximately 10% of encounters had at least 1 true-positive culture, and 89.2% of those encounters had repeat blood cultures drawn. The relative risk of a patient having repeat blood cultures was lower for those in emergency, surgery, and oncology services than for those in general medicine.

Conclusions

Ordering practices differed by service and culture results. Analyzing blood culture utilization can contribute to the development of guidelines and benchmarks for appropriate usage.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 11 , November 2018 , pp. 1353 - 1359
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

PREVIOUS PRESENTATION: Preliminary findings were presented as a poster at the 2017 American Society of Microbiology (ASM) Microbe meeting on June 1–5, 2017, in New Orleans, Louisiana.

References

1. Fleischmann, C, Scherag, A, Adhikari, NK, et al. Assessment of global incidence and mortality of hospital-treated sepsis: current estimates and limitations. Am J Respir Crit Care Med 2016;193:259–272.Google Scholar
2. Stoller, J, Halpin, L, Weis, M, et al. Epidemiology of severe sepsis: 2008–2012. J Crit Care 2016;31:58–62.Google Scholar
3. Gaieski, DF, Edwards, JM, Kallan, MJ, Carr, BG. Benchmarking the incidence and mortality of severe sepsis in the United States. Crit Care Med 2013;41:1167–1174.Google Scholar
4. Stevenson, EK, Rubenstein, AR, Radin, GT, Wiener, RS, Walkey, AJ. Two decades of mortality trends among patients with severe sepsis: a comparative meta-analysis. Crit Care Med 2014;42:625–631.Google Scholar
5. Vincent, JL, Marshall, JC, Namendys-Silva, SA, et al. Assessment of the worldwide burden of critical illness: the intensive care over nations (ICON) audit. Lancet Respir Med 2014;2:380–386.Google Scholar
6. Deutschman, CS, Tracey, KJ. Sepsis: current dogma and new perspectives. Immunity 2014;40:463–475.Google Scholar
7. Coburn, B, Morris, AM, Tomlinson, G, Detsky, AS. Does this adult patient with suspected bacteremia require blood cultures? JAMA 2012;308:502–511.Google Scholar
8. Hall, KK, Lyman, JA. Updated review of blood culture contamination. Clin Microbiol Rev 2006;19:788–802.Google Scholar
9. Paolo, WF, Poreda, AR, Grant, W, Scordino, D, Wojcik, S. Blood culture results do not affect treatment in complicated cellulitis. J Emerg Med 2013;45:163–167.Google Scholar
10. Afshar, N, Tabas, J, Afshar, K, Silbergleit, R. Blood cultures for community-acquired pneumonia: are they worthy of two quality measures? A systematic review. J Hosp Med 2009;4:112–123.Google Scholar
11. Campbell, SG, Marrie, TJ, Anstey, R, Dickinson, G, Ackroyd-Stolarz, S. The contribution of blood cultures to the clinical management of adult patients admitted to the hospital with community-acquired pneumonia: a prospective observational study. Chest 2003;123:1142–1150.Google Scholar
12. Chen, Y, Nitzan, O, Saliba, W, Chazan, B, Colodner, R, Raz, R. Are blood cultures necessary in the management of women with complicated pyelonephritis? J Infect 2006;53:235–240.Google Scholar
13. Velasco, M, Martinez, JA, Moreno-Martinez, A, et al. Blood cultures for women with uncomplicated acute pyelonephritis: are they necessary? Clin Infect Dis 2003;37:1127–1130.Google Scholar
14. Woods-Hill, CZ, Fackler, J, Nelson McMillan, K, et al. Association of a clinical practice guideline with blood culture use in critically ill children. JAMA Pediatr 2017;171:157–164.Google Scholar
15. Flett, KB, Ozonoff, A, Graham, DA, Sandora, TJ, Priebe, GP. Impact of mandatory public reporting of central-line–associated bloodstream infections on blood culture and antibiotic utilization in pediatric and neonatal intensive care units. Infect Control Hosp Epidemiol 2015;36:878–885.Google Scholar
16. Willems, E, Smismans, A, Cartuyvels, R, et al. The preanalytical optimization of blood cultures: a review and the clinical importance of benchmarking in 5 Belgian hospitals. Diagn Microbiol Infect Dis 2012;73:1–8.Google Scholar
17. Miller, JM, Binnicker, MJ, Campbell, S, et al. A guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2018 update by the Infectious Diseases Society of America and the American Society for Microbiology. Clin Infect Dis 2018. doi: 10.1093/cid/ciy381.Google Scholar
18. Gould, FK, Denning, DW, Elliott, TS, et al. Guidelines for the diagnosis and antibiotic treatment of endocarditis in adults: a report of the Working Party of the British Society for Antimicrobial Chemotherapy. J Antimicrob Chemother 2012;67:269–289.Google Scholar
19. Baddour, LM, Wilson, WR, Bayer, AS, et al. Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the American Heart Association. Circulation 2015;132:1435–1486.Google Scholar
20. Weinstein, MP, Towns, ML, Quartey, SM, et al. The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults. Clin Infect Dis 1997;24:584–602.Google Scholar
21. Clinical and Laboratory Standards Institute. Principles and procedures for blood cultures: Approved guidelines. CLSI document M47-A. Wayne, PA: Clinical and Laboratory Standards Institute; 2007.Google Scholar
22. Wiggers, JB, Xiong, W, Daneman, N. Sending repeat cultures: Is there a role in the management of bacteremic episodes? (SCRIBE study). BMC Infect Dis 2016;16:286.Google Scholar
23. Hartig, F. DHARMa: Residual diagnostics for hierarchical (multi-level/mixed) regression models. The Comprehensive R Archive Network website. https://cran.r-project.org/web/packages/DHARMa/vignettes/DHARMa.html. Published 2017. Accessed August 23, 2018.Google Scholar
24. R Studio Team. RStudio: Integrated development environment for R. R Studio website. http://www.rstudio.com/. Published 2015. Accessed August 23, 2018.Google Scholar
25. R Core Team. R: A language and environment for statistical computing. R: A language and environment for statistical computing. R Foundation for Statistical Computing website. http://www.R-project.org. Published 2013. Accessed August 23, 2018.Google Scholar
26. Lee, A, Mirrett, S, Reller, LB, Weinstein, MP. Detection of bloodstream infections in adults: How many blood cultures are needed? J Clin Microbiol 2007;45:3546–3548.Google Scholar
27. Bouza, E, Sousa, D, Rodriguez-Creixems, M, Lechuz, JG, Munoz, P. Is the volume of blood cultured still a significant factor in the diagnosis of bloodstream infections? J Clin Microbiol 2007;45:2765–2769.Google Scholar
28. Lamy, B, Dargere, S, Arendrup, MC, Parienti, JJ, Tattevin, P. How to optimize the use of blood cultures for the diagnosis of bloodstream infections? a state-of-the art. Front Microbiol 2016;7:697.Google Scholar
29. Baron, EJ, Weinstein, MP, Dunne, WM Jr, Yagupsky, P, Welch, DF, Wilson, DM. Cumitech 1C, Blood Cultures IV. Washington, DC: ASM Press; 2005.Google Scholar
30. Novis, DA, Dale, JC, Schifman, RB, Ruby, SG, Walsh, MK. Solitary blood cultures: a College of American Pathologists Q-Probes study of 132,778 blood culture sets in 333 small hospitals. Arch Pathol Lab Med 2001;125:1290–1294.Google Scholar
31. Schifman, RB, Bachner, P, Howanitz, PJ. Blood culture quality improvement: a College of American Pathologists Q-Probes study involving 909 institutions and 289,572 blood culture sets. Arch Pathol Lab Med 1996;120:999–1002.Google Scholar
32. Bates, DW, Cook, EF, Goldman, L, Lee, TH. Predicting bacteremia in hospitalized patients: a prospectively validated model. Ann Intern Med 1990;113:495–500.Google Scholar
33. Leibovici, L, Greenshtain, S, Cohen, O, Mor, F, Wysenbeek, AJ. Bacteremia in febrile patients: a clinical model for diagnosis. Arch Intern Med 1991;151:1801–1806.Google Scholar
34. Snyder, SR, Favoretto, AM, Baetz, RA, et al. Effectiveness of practices to reduce blood culture contamination: a laboratory medicine best practices systematic review and meta-analysis. Clin Biochem 2012;45:999–1011.Google Scholar
35. Garcia, RA, Spitzer, ED, Kranz, B, Barnes, S. A national survey of interventions and practices in the prevention of blood culture contamination and associated adverse healthcare events. Am J Infect Control 2018;46:571–576.Google Scholar
36. Morgan, DJ, Malani, P, Diekema, DJ. Diagnostic stewardship-leveraging the laboratory to improve antimicrobial use. JAMA 2017;318:607–608.Google Scholar
37. Messacar, K, Parker, SK, Todd, JK, Dominguez, SR. Implementation of rapid molecular infectious disease diagnostics: the role of diagnostic and antimicrobial stewardship. J Clin Microbiol 2017;55:715–723.Google Scholar
38. Bates, DW, Kuperman, GJ, Rittenberg, E, et al. A randomized trial of a computer-based intervention to reduce utilization of redundant laboratory tests. Am J Med 1999;106:144–150.Google Scholar