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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]
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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
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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