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Evaluation of hospital blood culture utilization rates to identify opportunities for diagnostic stewardship

Published online by Cambridge University Press:  08 August 2022

Bobby G. Warren Open the ORCID record for Bobby G. Warren [Opens in a new window] ,
Michael E. Yarrington Open the ORCID record for Michael E. Yarrington [Opens in a new window] ,
Christopher R. Polage ,
Deverick J. Anderson Open the ORCID record for Deverick J. Anderson [Opens in a new window]  and
Rebekah W. Moehring
Bobby G. Warren*
Affiliation:
Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
Michael E. Yarrington
Affiliation:
Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
Christopher R. Polage
Affiliation:
Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina Department of Pathology, Duke University School of Medicine, Durham, North Carolina
Deverick J. Anderson
Affiliation:
Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
Rebekah W. Moehring
Affiliation:
Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
*
Author for correspondence: Bobby Warren, E-mail: bobby.warren@duke.edu
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Abstract

Objectives:

To evaluate the pattern of blood-culture utilization among a cohort of 6 hospitals to identify potential opportunities for diagnostic stewardship.

Methods:

We completed a retrospective analysis of blood-culture utilization during adult inpatient or emergency department (ED) encounters in 6 hospitals from May 2019 to April 2020. We investigated 2 measures of blood-culture utilization rates (BCURs): the total number of blood cultures, defined as a unique accession number per 1,000 patient days (BCX) and a new metric of blood-culture events per 1,000 patient days to account for paired culture practices. We defined a blood-culture event as an initial blood culture and all subsequent samples for culture drawn within 12 hours for patients with an inpatient or ED encounter. Cultures were evaluated by unit type, positivity and contamination rates, and other markers evaluating the quality of blood-culture collection.

Results:

In total, 111,520 blood cultures, 52,550 blood culture events, 165,456 inpatient admissions, and 568,928 patient days were analyzed. Overall, the mean BCUR was 196 blood cultures per 1,000 patient days, with 92 blood culture events per 1,000 patient days (range, 64–155 among hospitals). Furthermore, 7% of blood-culture events were single culture events, 55% began in the ED, and 77% occurred in the first 3 hospital days. Among all blood cultures, 7.7% grew a likely pathogen, 2.1% were contaminated, and 5.9% of first blood cultures were collected after the initiation of antibiotics.

Conclusions:

Blood-culture utilization varied by hospital and was heavily influenced by ED culture volumes. Hospital comparisons of blood-culture metrics can assist in identifying opportunities to optimize blood-culture collection practices.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 44 , Issue 2 , February 2023 , pp. 200 - 205
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Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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