Things We Do For No Reason: Blood Cultures for Uncomplicated Skin and Soft Tissue Infections in Children

Zwemer, Eric; Stephens, John

doi:10.12788/jhm.2984

Cited by 6 publications

(3 citation statements)

References 17 publications

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“…MRSA detection can be performed on clinical isolates from several anatomical sites like wound exudates (pus), nasal swabs, skin swabs, and blood samples with nasal swabs being preferred by clinical test kits (40,41). However, the relevance of pus culture over other anatomic samples, especially blood, is recently reported in the literature with new tests being developed based on pus cultures (14,42,43).…”

Section: Discussionmentioning

confidence: 99%

Probing the dissonance among the diagnostic outputs of multiple approaches used for detection of Methicillin-resistant Staphylococcus aureus (MRSA)

Dahiya

Sikidar

Sharma

et al. 2020

Preprint

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Methicillin-resistant staphylococcus aureus (MRSA) is an extremely infectious hospital acquired bacterial pathogen often found in post-surgical patients globally. Early detection of such pathogens is a critical requirement to eliminate or reduce the incidence of antimicrobial resistance as well as for effective management of the disease. Despite the development of multiple biochemical, microbiological and nucleic acid amplification techniques (NAATs), conventional culture methods are widely used clinically owing to high variability between the methods, technical skills, and infrastructural needs. Further, multiple reports suggest a significant variation among diagnostic output for MRSA detection. This work attempts to probe the discordance among the diagnostic output of three commonly used methods while trying to understand the underlying cause of variability. MRSA detection on 217 clinical pus isolates was carried out using three different methods namely, conventional culture method, qPCR-based amplification, and a modern LAMP-based detection approach. Also, to confirm the presence of MRSA and distinguish from coagulase-negative staphylococci (CoNS), as well as to investigate the observed differences between qPCR and LAMP outputs, melt curve analysis was performed on discordant samples. LAMP-based MRSA detection was found to be the optimum method. In summary, this study evaluates the diagnostic efficiency of the different detection methods, while probing for possible explanations for the observed differences.

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Section: Discussionmentioning

confidence: 99%

Probing the dissonance among the diagnostic outputs of multiple approaches used for detection of Methicillin-resistant Staphylococcus aureus (MRSA)

Dahiya

Sikidar

Sharma

et al. 2020

Preprint

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“…9,10 Among SSTI, despite the increasing prevalence of methicillin-resistant Staphylococcus aureus , evidence discourages routine collection of blood cultures in immunocompetent children. 11–14 For both CAP and SSTI, multiple studies have identified a higher rate of contaminants than true pathogens. 4,5,7,12 Finally, bacteremia infrequently occurs in children with UTI and, when identified, is nearly always identical to the urine culture isolate, signifying that blood cultures may represent a low-value test.…”

Section: Introductionmentioning

confidence: 99%

Decreasing Blood Culture Collection in Hospitalized Patients with CAP, SSTI, and UTI

Combs,

Liberman,

Lee

2023

Pediatric Quality &Amp; Safety

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Background: Blood culture collection in pediatric patients with community-acquired pneumonia (CAP), skin and soft tissue infections (SSTI), and urinary tract infections (UTI) remains high despite evidence of its limited utility. We aimed to decrease the number of cultures collected in children hospitalized for CAP, SSTI, and UTI by 25% over 11 months. Methods: Quality improvement initiative at a children’s hospital among well-appearing patients aged 2 months or more to 18 years diagnosed with CAP, SSTI, or UTI. Our primary and secondary outcomes were blood culture collection rate and positivity rate, respectively. Interventions focused on three key drivers: academic detailing, physician awareness of personal performance, and data transparency. Results: Over the 2-year study period, there were 105 blood cultures collected in 223 hospitalized patients. Blood culture collection rates demonstrated special cause variation, decreasing from 63.5% to 24.5%. For patients with UTI, 86% (18/21) of blood cultures were negative, whereas 100% were negative for CAP and SSTI. All three patients with bacteremic UTI had a concurrent urine culture growing the same pathogen. Balancing measures remained unchanged, including escalation to a higher level of care and return to the emergency department or hospital within 14 days for the same infection. Conclusions: A multifaceted quality improvement approach can reduce blood culture collection for hospitalized patients with CAP, SSTI, and UTI without significant changes to balancing measures. Despite the reduction achieved, the near-universal negative culture results suggest continued overutilization and highlight the need for more targeted approaches to blood culture collection.

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“…4 Overuse of BCx in uSSTIs has also been highlighted in the Journal of Hospital Medicine' s Choosing Wisely series: Things We Do For No Reason. 21 The value of CBC, CRP, 7 and ESR 22 has also come into question for uSSTIs because there is little published evidence demonstrating that these aid in diagnosis or management.…”

mentioning

confidence: 99%

Reducing Unnecessary Testing in Uncomplicated Skin and Soft Tissue Infections: A Quality Improvement Approach

Lee

Hershey

Patel

et al. 2020

Hospital Pediatrics

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Skin and soft tissue infections are common pediatric diagnoses with substantial costs. Recent studies suggest blood cultures are not useful in management of uncomplicated skin and soft tissue infections (uSSTIs). Complete blood cell count, erythrocyte sedimentation rate, and C-reactive protein are also of questionable value. We aimed to decrease these tests by 25% for patients with uSSTIs admitted to the pediatric hospital medicine service within 3 months. METHODS: An interdisciplinary team led a quality improvement (QI) project. Baseline assessment included review of the literature and 12 months of medical records. Key stakeholders identified drivers that informed the creation of an electronic order set and development of a pediatric hospital medicine-emergency department collaborative QI project. The primary outcome measure was mean number of tests per patient encounter. Balancing measures included unplanned readmissions and missed diagnoses. RESULTS: Our baseline-year rate was 3.4 tests per patient encounter (573 tests and 169 patient encounters). During the intervention year, the rate decreased by 35% to 2.2 tests per patient encounter (286 tests and 130 patient encounters) and was sustained for 14 months postintervention. There were no unplanned readmissions or missed diagnoses for the study period. Order set adherence was 80% (83 out of 104) during the intervention period and sustained at 87% postintervention. CONCLUSIONS: Our interdisciplinary team achieved our aim, reducing unnecessary laboratory testing in patients with an uSSTI without patient harm. Awareness of local culture, creation of an order set, defining appropriate patient selection and testing indications, and implementation of a collaborative QI project helped us achieve our aim.

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Things We Do For No Reason: Blood Cultures for Uncomplicated Skin and Soft Tissue Infections in Children

Cited by 6 publications

References 17 publications

Probing the dissonance among the diagnostic outputs of multiple approaches used for detection of Methicillin-resistant Staphylococcus aureus (MRSA)

Probing the dissonance among the diagnostic outputs of multiple approaches used for detection of Methicillin-resistant Staphylococcus aureus (MRSA)

Decreasing Blood Culture Collection in Hospitalized Patients with CAP, SSTI, and UTI

Reducing Unnecessary Testing in Uncomplicated Skin and Soft Tissue Infections: A Quality Improvement Approach

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