Background
Blood culture contamination (BCC) has been associated with prolonged antibiotic use (AU) and increased healthcare utilization; however, this has not been widely re-evaluated in the era of increased attention to antibiotic stewardship. We evaluated the impact of BCC on AU, resource utilization, and length of stay (LOS) in Dutch and United States patients.
Methods
Retrospective observational study of adults admitted to two hospitals in the Netherlands and five hospitals in the US undergoing ≥2 blood culture (BC) sets. Exclusion criteria included: neutropenia, no hospital admission, or death within 48 hours of hospitalization. The impact of BCC on clinical outcomes (overall inpatient days of antibiotic therapy (DOT), test utilization, LOS, and mortality) was determined using a multivariable regression model.
Results
22,927 patient-admissions were evaluated (650 [4.1%] and 339 [4.8%] with BCC, and 11,437 [71.8%] and 4,648 [66.3%] with negative BC from the Netherlands and the US, respectively). Dutch and US BCC patients had 1.74 ± SE 0.27 (P < 0.001) and 1.58 ± SE 0.45 (P < 0.001) more DOT, respectively, than negative BC patients. They also had 0.6 ± SE 0.1 (P < 0.001) more BC drawn. Dutch but not US BCC patients had longer hospital stays (3.36 days; P < 0.001). There was no difference in mortality between groups in either cohort. AU remained higher in US but not in Dutch BCC patients in a subanalysis limited to BC obtained ≤first 24 hours of admission.
Conclusions
BCC remains associated with higher inpatient AU and healthcare utilization compared to patients with negative BC, although the impact on these outcomes differs by country.