Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-22T23:57:12.706Z Has data issue: false hasContentIssue false
  • English
  • Français

Risk factors and clinical outcomes associated with blood culture contamination

Published online by Cambridge University Press:  26 April 2021

Justin M. Klucher Open the ORCID record for Justin M. Klucher [Opens in a new window] ,
Kevin Davis ,
Mrinmayee Lakkad Open the ORCID record for Mrinmayee Lakkad [Opens in a new window] ,
Jacob T. Painter Open the ORCID record for Jacob T. Painter [Opens in a new window]  and
Ryan K. Dare Open the ORCID record for Ryan K. Dare [Opens in a new window]
Justin M. Klucher
Affiliation:
College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
Kevin Davis
Affiliation:
Mercy Hospital, Fort Smith, Arkansas
Mrinmayee Lakkad
Affiliation:
Division of Pharmaceutical Evaluation and Policyt, University of Arkansas for Medical Sciences, Little Rock, Arkansas
Jacob T. Painter
Affiliation:
Division of Pharmaceutical Evaluation and Policyt, University of Arkansas for Medical Sciences, Little Rock, Arkansas
Ryan K. Dare*
Affiliation:
Division of Infectious Diseases, University of Arkansas for Medical Sciences, Little Rock, Arkansas
*
Author for correspondence: Ryan K. Dare, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To determine patient-specific risk factors and clinical outcomes associated with contaminated blood cultures.

Design:

A single-center, retrospective case-control risk factor and clinical outcome analysis performed on inpatients with blood cultures collected in the emergency department, 2014–2018. Patients with contaminated blood cultures (cases) were compared to patients with negative blood cultures (controls).

Setting:

A 509-bed tertiary-care university hospital.

Methods:

Risk factors independently associated with blood-culture contamination were determined using multivariable logistic regression. The impacts of contamination on clinical outcomes were assessed using linear regression, logistic regression, and generalized linear model with γ log link.

Results:

Of 13,782 blood cultures, 1,504 (10.9%) true positives were excluded, leaving 1,012 (7.3%) cases and 11,266 (81.7%) controls. The following factors were independently associated with blood-culture contamination: increasing age (adjusted odds ratio [aOR], 1.01; 95% confidence interval [CI], 1.01–1.01), black race (aOR, 1.32; 95% CI, 1.15–1.51), increased body mass index (BMI; aOR, 1.01; 95% CI, 1.00–1.02), chronic obstructive pulmonary disease (aOR, 1.16; 95% CI, 1.02–1.33), paralysis (aOR 1.64; 95% CI, 1.26–2.14) and sepsis plus shock (aOR, 1.26; 95% CI, 1.07–1.49). After controlling for age, race, BMI, and sepsis, blood-culture contamination increased length of stay (LOS; β = 1.24 ± 0.24; P < .0001), length of antibiotic treatment (LOT; β = 1.01 ± 0.20; P < .001), hospital charges (β = 0.22 ± 0.03; P < .0001), acute kidney injury (AKI; aOR, 1.60; 95% CI, 1.40–1.83), echocardiogram orders (aOR, 1.51; 95% CI, 1.30–1.75) and in-hospital mortality (aOR, 1.69; 95% CI, 1.31–2.16).

Conclusions:

These unique risk factors identify high-risk individuals for blood-culture contamination. After controlling for confounders, contamination significantly increased LOS, LOT, hospital charges, AKI, echocardiograms, and in-hospital mortality.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 3 , March 2022 , pp. 291 - 297
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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.)

References

Weinstein, MP, Doern, GV. A critical appraisal of the role of the clinical microbiology laboratory in the diagnosis of bloodstream infections. J Clin Microbiol 2011;49 suppl 9:S26–S29.Google Scholar
Hall, KK, Lyman, JA. Updated review of blood culture contamination. Clin Microbiol Rev 2006;2:329–353.Google Scholar
Bates, DW, Goldman, L, Lee, TH. Contaminant blood cultures and resource utilization: the true consequences of false-positive results. JAMA 1991;265:365–369.Google ScholarPubMed
Dawson, S. Blood culture contaminants. J Hosp Infect 2014;87:1–10.Google ScholarPubMed
Alahmadi, YM, Aldeyab, MA, McElnay, JC, et al. Clinical and economic impact of contaminated blood cultures within the hospital setting. J Hosp Infect 2010;77:233–236.Google Scholar
Souvenir, D, Anderson, DE, Palpant, S, et al. Blood cultures positive for coagulase-negative staphylococci: antisepsis, pseudobacteremia, and therapy of patients. J Clin Microbiol 1998;36:1923–1926.Google ScholarPubMed
Gander, RM, Byrd, L, DeCrescenzo, M, Hirany, S, Bowen, M, Baughman, J. Impact of blood cultures drawn by phlebotomy on contamination rates and health care costs in a hospital emergency department. J Clin Microbiol 2009;47:1021–1024.Google Scholar
Bell, M, Bogar, C, Plante, J, Rasmussen, K, Winters, S. Effectiveness of a novel specimen collection system in reducing blood culture contamination rates: J Emerg Nurs 2018;44:570–575.Google ScholarPubMed
Bowen, CM, Coleman, T, Cunningham, D. Reducing blood culture contaminations in the emergency department: it takes a team: J Emerg Nurs 2016;42:306–311.Google ScholarPubMed
Garcia, RA, Spitzer, ED, Beaudry, J, et al. Multidisciplinary team review of best practices for collection and handling of blood cultures to determine effective interventions for increasing the yield of true-positive bacteremias, reducing contamination, and eliminating false-positive central line–associated bloodstream infections. Am J Infect Control 2015;43:1222–1237.Google ScholarPubMed
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
Hall, RT, Domenico, HJ, Self, WH, Hain, PD. Reducing the blood culture contamination rate in a pediatric emergency department and subsequent cost savings. Pediatrics 2013;131:e292–e297.Google Scholar
Ramirez, P, Gordón, M, Cortes, C, et al. Blood-culture contamination rate in an intensive care setting: Effectiveness of an education-based intervention. Am J Infect Control 2015;43:844–847.Google Scholar
Rupp, ME, Cavalieri, RJ, Marolf, C, Lyden, E. Reduction in blood culture contamination through use of initial specimen diversion device. Clin Infect Dis 2017;65:201–205.Google ScholarPubMed
Zimmerman, FS, Assous, MV, Yinnon, AM, Wiener-Well, Y. Reducing blood culture contamination using a departmental report card. J Hosp Infect 2018;99:236–237.Google ScholarPubMed
Chih-Jan, Chang, Chi-Jung, W, Hsiang-Chin, Hsu, et al. Factors associated with blood culture contamination in the emergency department: critical illness, end-stage renal disease, and old age. PLoS One 2015;10(10):e0137653.Google Scholar
Qamruddin, A, Khanna, N, Orr, D. Peripheral blood culture contamination in adults and venepuncture technique: prospective cohort study. J Clin Pathol 2008;61:509.Google ScholarPubMed
Core measures. Centers for Medicare and Medicaid Services website. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/Core-Measures.html. Updated 2016. Accessed March 24, 2021.Google Scholar
The Centers for Medicare & Medicaid Services, The Joint Commission. Severe sepsis and septic shock (SEP). specifications manual for national hospital inpatient quality measures: Discharges 10-01-15 (4Q15) through 06-30-16 (2Q16). The Joint Commission website. https://www.jointcommission.org/specifications_manual_for_national_hospital_inpatient_quality_measures.aspx. Updated 2015. Accessed March 24, 2021.Google Scholar
Surviving Sepsis Campaign Guidelines Committee. Updated bundles in response to new evidence. Surviving Sepsis website. http://www.survivingsepsis.org/SiteCollectionDocuments/SSC_Bundle.pdf. Updated 2015. Accessed March 24, 2021.Google Scholar
Severe sepsis and septic shock: management bundle. National Quality Forum website. http://www.qualityforum.org/QPS/0500. Updated 2013. Accessed March 24, 2021.Google Scholar
Self, WH, Mickanin, J, Grijalva, CG, et al. Reducing blood culture contamination in community hospital emergency departments: a multicenter evaluation of a quality improvement intervention. Acad Emerg Med 2014;21:274–282.Google ScholarPubMed
Self, WH, Talbot, TR, Paul, BR, Collins, SP, Ward, MJ. Cost analysis of strategies to reduce blood culture contamination in the emergency department: sterile collection kits and phlebotomy teams. Infect Control Hosp Epidemiol 2014;35:1021–1028.Google ScholarPubMed
van der, Heijden, Yuri, F, Miller, G, et al. Clinical impact of blood cultures contaminated with coagulase-negative staphylococci at an academic medical center. Infect Control Hosp Epidemiol 2011;32:623–625.Google Scholar
Supplementary material: Image

Klucher et al. supplementary material

Klucher et al. supplementary material 1

Download Klucher et al. supplementary material(Image)
Image 5 MB
Supplementary material: File

Klucher et al. supplementary material

Klucher et al. supplementary material 2

Download Klucher et al. supplementary material(File)
File 18.6 KB