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

Abstract

ObjectiveTo describe the pattern of blood culture utilization in an academic university hospital setting.DesignRetrospective cohort study.SettingA 789-bed tertiary-care university hospital that processes 40,000+blood cultures annually.MethodsWe 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.ResultsIn 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.ConclusionsOrdering practices differed by service and culture results. Analyzing blood culture utilization can contribute to the development of guidelines and benchmarks for appropriate usage.

The Development and Validation of a Machine Learning Model to Predict Bacteremia and Fungemia in Hospitalized Patients Using Electronic Health Record Data

“…The prevalence of bacteremia was 7.7% in our two centers, which is in the lower end of reported rates in the literature; the model's PPV may be higher in other medical centers with higher prevalence. (34)(35)(36) The high-risk patients identified by our model had over 30 times the risk of bacteremia and over 50 times the risk of potentially resistant organisms as low-risk patients. Given the high mortality from resistant organisms, it is essential to identify these high-risk patients early and potentially focus antibiotic therapy based on local resistance patterns.…”

Do we need blood culture stewardship programs? A quality control study and survey to assess the appropriateness of blood culture collection and the knowledge and attitudes among physicians in Swiss hospitals

“…The present study provides a comprehensive assessment of the appropriateness of BC collection in a Swiss university hospital by combining three different approaches: point prevalence, patientindividual longitudinal, and diseases-related analysis. To the best of our knowledge there is no study focusing on the appropriateness of BC collection according to local guidelines, not least because they are often nonexistent [20,27]. In addition there are no international BC collection guidelines available since most guidelines provide BC collection recommendations according to established diagnoses but poorly define clinical findings that should trigger BC collection.…”

The Changing Landscape of Uncomplicated Gram‐Negative Bacteremia: A Narrative Review to Guide Inpatient Management

“…The low yield of FUBC in many clinical settings suggests that it may not be helpful. [47][48][49][50] Despite the questionable impact on the clinical management of GN-BSI, FUBCs are routinely ordered in the hospital. 1,47 Although there is no high-quality evidence addressing the utility of FUBC, several observational studies suggest clinicians should reconsider routinely ordering FUBC.…”