Do We Need This Blood Culture?

Parikh, Kavita; Davis, Aisha; Pavuluri, Padmaja

doi:10.1542/hpeds.2013-0053

Cited by 24 publications

(35 citation statements)

References 24 publications

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“…BC remains still the gold standard approach to determine the presence or absence of pathogens in a child with a suspected serious bacterial infection or fever of unknown origin [10,[14][15][16][17][18]. However, the value of BC in febrile children in the ED has been questioned recently [10,19,20]. In hospital-based studies, the proportion of patients with a positive blood culture was less than 3% [16], even reported to be low as 2% [21].…”

Section: Introductionmentioning

confidence: 99%

“…Unnecessary administration of antibiotics creates diagnostic confusion and is associated with increased antibiotic resistance [8,24]. In contrast, delayed antibiotic therapy may result in morbidity and mortality for children who do have a serious bacterial infection [16][17][18][19]. Consequently, the issue of the value of blood cultures for children presenting to the ED is an important one.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Outcome of Blood Cultures in Febrile Children Presenting at theEmergency Department

Salameh¹,

Gz²,

Alkume³

et al. 2016

Neonat Pediatr Med

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Background: An unknown number of children who attend an Emergency Department may have a serious underlying, systemic infection as a cause of their fever. Blood culture (BC) remains the gold standard approach to establish the diagnosis and presence of pathogens in a child with a suspected, serious bacterial infection. This study investigated the proportion of positive blood cultures and the correlation with basic laboratory investigations (Creactive protein, white blood cell count, and absolute neutrophil count), prescription of antibiotics in patients visiting a pediatric emergency department in a primary hospital

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Outcome of Blood Cultures in Febrile Children Presenting at theEmergency Department

Salameh¹,

Gz²,

Alkume³

et al. 2016

Neonat Pediatr Med

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“…We also detected both a high rate of negative and false-positive blood culture results among this medical cohort. It is known that there is a low rate of clinically significant truepositive (pathogenic) culture results for common medical inpatient diagnoses such as pneumonia and skin infection [22]. This indicates that the clinical syndrome of the patient should be a defining factor in influencing whether or not blood cultures should be collected [22].…”

Section: Discussionmentioning

confidence: 99%

Blood Culture Sampling Practices among Internal Medicine Inpatients

Friedman¹,

Braun²,

Fallach³

et al. 2017

Clin Microbiol Infect Dis

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Objective: Blood cultures are essential for the diagnosis of bloodstream infections; however, they carry a risk of both low yield and culturing skin contaminants. The optimal culturing threshold which results in a high sensitivity of detecting bacteremia yet has a low contamination rate is not well defined. We sought to analyze the blood culture sampling practices, rates and results among patients admitted under internal medicine. Methods:Retrospective analysis of prospectively collected patient data on over 160,000 patient admissions from July 2008 through end of June 2015 at Tel Aviv Sourasky Medical Centre, a 1440-bed tertiary care teaching hospital in Tel Aviv, Israel.Results: Blood cultures were drawn in 35% of internal medicine admissions. The overall blood culture sampling rate was 168 blood cultures per 1,000 patient days. 70% of episodes of suspected bacteremia occurred during the first 48 hours of admission. 4% of blood cultures yielded a bloodstream infection, while the contamination rate was 3.5%. Single aerobic blood cultures were collected in 35% of episodes of suspected bacteremia, and the BSI rate among these episodes was 5.3%. Conclusions:The hospital practice of blood culture sampling varies predominantly by ward and therefore likely by clinician practice. In an internal medicine patient population where the median age was over 70 years the overall blood culture sampling rate was 168 blood cultures per 1,000 patient days and the incidence of BSI was 4%. Single blood cultures are frequently collected, and approximately half of all positive cultures are due to contaminants.

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“…3,5,12,25,26 Heine et al 3 described 330 patients seen at a pediatric hospital for CAP, of which 40% were discharged from the ED and 60% were admitted. Blood cultures were performed in 47% of the patients in their cohort and 3.2% grew pathogenic bacteria.…”

Section: Discussionmentioning

confidence: 99%

Improvement Methodology Increases Guideline Recommended Blood Cultures in Children With Pneumonia

et al. 2015

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BACKGROUND AND OBJECTIVE: A national evidence-based guideline for the management of community-acquired pneumonia (CAP) in children recommends blood cultures for patients admitted with moderate to severe illness. Our primary aim was to increase ordering of blood cultures for children hospitalized with CAP from 53% to 90% in 6 months. The secondary aim was to evaluate the effect of obtaining blood cultures on length of stay (LOS). METHODS:At a tertiary children's hospital, interventions to increase blood cultures focused on 3 key drivers and were tested separately in the emergency department and inpatient units by using multiple plan-do-study-act cycles. The impact of the interventions was tracked over time on run charts. The association of ordering blood cultures and LOS was estimated by using linear regression models.RESULTS: Within 6 months, the percentage of patients admitted with CAP who had blood cultures ordered increased from 53% to 100%. This change has been sustained for 12 months. Overall, 239 (79%) of the 303 included patients had a blood culture ordered; of these, 6 (2.5%) were positive. Patients who had a blood culture did not have an increased LOS compared with those without a blood culture.CONCLUSIONS: Quality improvement methods were used to increase adherence to evidence-based national guidelines for performing blood cultures on children hospitalized with CAP; LOS did not increase. These results support obtaining blood cultures on all patients admitted with CAP without negative effects on LOS in a setting with a reliably low false-positive blood culture rate. Dr Murtagh Kurowski participated in the design of the study, developed the data collection criteria, carried out the statistical analysis, performed chart reviews, designed and executed interventions, and drafted the initial manuscript; Dr Shah participated in the design of the study, participated in the design of the interventions, developed the data collection criteria, and reviewed all drafts of the manuscript; Drs Thomson and Statile participated in the design of the study, performed chart reviews, designed and executed interventions, and reviewed all drafts of the manuscript; Ms Sheehan participated in the design of the study, performed chart reviews, carried out statistical analysis, and reviewed all drafts of the manuscript; Dr Iyer participated in the design of the study, participated in the design of the interventions, supervised the statistical analysis, and reviewed all drafts of the manuscript; Dr White participated in the design of the study, participated in the design of the interventions, developed the data collection criteria, and reviewed all drafts of the manuscript; Dr Ambroggio participated in the design of the study, developed the data collection criteria, performed chart reviews, carried out the statistical analysis, executed interventions, and reviewed all drafts of the manuscript; and all authors approved the final manuscript for submission.www.pediatrics.org/cgi

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Do We Need This Blood Culture?

Abstract: There was a high rate of negative or false-positive blood culture results for these common inpatient diagnoses. In addition, there was a low rate of clinically significant true-positive (pathogenic) culture results. These results identify points of potential blood culture overutilization.

Cited by 24 publications

References 24 publications

The Outcome of Blood Cultures in Febrile Children Presenting at theEmergency Department

The Outcome of Blood Cultures in Febrile Children Presenting at theEmergency Department

Blood Culture Sampling Practices among Internal Medicine Inpatients

Improvement Methodology Increases Guideline Recommended Blood Cultures in Children With Pneumonia

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