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Bamber D, Fahy N, Coats T, Gillies C, Jenkins DR, Krockow EM, Locke A, Prendiville A, Shallcross L, Tarrant C. Factors associated with blood culture sampling for adult acute care hospital patients with suspected severe infection: a scoping review using a socioecological framework. JAC Antimicrob Resist 2025; 7:dlaf043. [PMID: 40115169 PMCID: PMC11924178 DOI: 10.1093/jacamr/dlaf043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2024] [Accepted: 03/06/2025] [Indexed: 03/23/2025] Open
Abstract
Background Reliable blood culture sampling for patients with suspected severe infection is critical, but evidence suggests that blood culture samples are not always reliably collected for acute hospital patients with severe infection. There is a pressing need to understand the barriers and facilitators of optimal sampling practices for patient safety and antimicrobial stewardship. Methods We conducted a scoping review to identify evidence of factors associated with reliable blood culture sampling, for adult patients with suspected severe infection in acute care in high-income countries. We searched bibliographic databases (MEDLINE, Scopus, Web of Science, CINAHL), reference lists and citations between 2013 and February 2024. Findings were mapped to a socioecological framework. Results We retrieved 1823 records from the database searches; 7 studies were eligible for inclusion, with 8 additional studies identified from reference lists and citation searches. All 15 included papers identified factors at the individual level of influence, including patient factors (demographics, clinical signs and symptoms) and staff factors (knowledge of guidelines, attitudes and beliefs, emotion, clinical experience and training, and perception of economic cost). Evidence gaps existed in relation to factors at interpersonal, situational, organizational, community and policy levels. Conclusions Our review provides insights into blood culture sampling practices in hospitals, and highlights possible evidence gaps as potential areas to guide future research and inform the development of interventions to improve blood culture sampling in hospitals. Existing research has been dominated by a focus on individual levels of influence, with a paucity of evidence on influences at the interpersonal, situational, organization, community and policy levels.
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Affiliation(s)
- Deborah Bamber
- Department of Population Health Sciences, University of Leicester, Leicester LE1 7RH, UK
| | | | - Tim Coats
- Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK
| | - Clare Gillies
- Department of Population Health Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - David R Jenkins
- Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK
| | - Eva M Krockow
- School of Psychology and Vision Sciences, University of Leicester, Leicester LE1 7RH, UK
| | | | | | - Laura Shallcross
- Institute of Health Informatics, University College London, London WC1E 6BT, UK
| | - Carolyn Tarrant
- Department of Population Health Sciences, University of Leicester, Leicester LE1 7RH, UK
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2
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Duguid RC, Tanti D, Elvy JA, Outhred AC, McMullan BJ. Assessing paediatric blood culture quality: surveys of clinician and laboratory practices in Australia and New Zealand. Pathology 2025; 57:361-367. [PMID: 39848845 DOI: 10.1016/j.pathol.2024.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 09/12/2024] [Accepted: 09/27/2024] [Indexed: 01/25/2025]
Abstract
Paediatric blood cultures are vital for the diagnosis of paediatric bloodstream infections. Quality of paediatric blood culture collection, processing and reporting depend on multiple factors, with a paucity of literature describing these in practice. We conducted separate surveys of clinicians and laboratory staff to assess quality standards and knowledge related to paediatric blood culture collection, analysis, and interpretation to identify improvement opportunities. We received 144 clinician and 28 laboratory responses to our surveys from respondents principally located in Australia and Aotearoa New Zealand and principally working in tertiary paediatric hospitals and associated laboratories. In the clinician survey, knowledge regarding optimal blood culture volume collection and related practices varied widely, with a lack of local guidelines on blood culture collection. Only 10 (7%) of 144 respondents were aware of a hospital guideline containing age-based or weight-based volume recommendations for paediatric blood culture collection. In the laboratory survey, the majority (21/27, 78%) of laboratories reported not routinely measuring adequacy of blood culture fill volume, nor blood culture contamination rates (18/26, 69%). There is substantial room for improvement of paediatric blood culture quality, even in well-resourced settings.
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Affiliation(s)
- Robert C Duguid
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia.
| | - Daniel Tanti
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Juliet A Elvy
- Department of Microbiology, Awanui Labs, Dunedin Hospital, Dunedin, New Zealand; Royal College of Pathologists of Australasia Quality Assurance Programs, St Leonards, NSW, Australia
| | - Alexander C Outhred
- Department of Infectious Diseases and Microbiology, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Brendan J McMullan
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia; Department of Microbiology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia; School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
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3
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Doern CD, Whitman M, Doll M, Lavoie S, Friedel D, Bearman G, Kim J, Masters H, Roseff S, Willis J, Mercer R, Hill A, Feeser R, Dhindsa H, Petruzella F, Jackson A, Vitto M, Plauny J, Bryson A. Blood culture bottle shortage mitigation efforts: analysis of impact on ordering and patient impact. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2025; 5:e6. [PMID: 39810856 PMCID: PMC11729487 DOI: 10.1017/ash.2024.474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Revised: 10/22/2024] [Accepted: 11/07/2024] [Indexed: 01/16/2025]
Abstract
Objective design In June of 2024, Becton Dickinson experienced a blood culture bottle shortage for their BACTEC system, forcing health systems to reduce usage or risk exhausting their supply. Virginia Commonwealth University Health System (VCUHS) in Richmond, VA decided that it was necessary to implement austerity measures to preserve the blood culture bottle supply. Setting VCUHS includes a main campus in Richmond, VA as well as two affiliate hospitals in South Hill, VA (Community Memorial Hospital (CMH)) and Tappahannock Hospital in Tappahannock, VA. It also includes a free-standing Emergency Department in New Kent, VA. Patients Blood cultures from both pediatric and adult patients were included in this study. Interventions VCUHS intervened to decrease blood culture utilization across the entire health system. Interventions included communication of blood culture guidance as well as an electronic health record order designed to guide providers and discourage wasteful ordering. Results Post-implementation analyses showed that interventions reduced overall usage by 35.6% (P < .0001) and by greater than 40% in the Emergency Departments. The impact of these changes in utilization on positivity were analyzed, and it was found that the overall positivity rate increased post-intervention from 8.8% to 12.1% (P = .0115) and in the ED specifically from 10.2% to 19.5% (P < .0001). Conclusions These findings strongly suggest that some basic stewardship interventions can significantly change blood culture practice in a manner that minimizes the impact on patient care.
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Affiliation(s)
- Christopher D. Doern
- Department of Pathology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Melissa Whitman
- Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Michelle Doll
- Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Suzanne Lavoie
- Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - David Friedel
- Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Gonzalo Bearman
- Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Jeffrey Kim
- Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Heather Masters
- Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Susan Roseff
- Department of Pathology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Jim Willis
- Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Roxanne Mercer
- Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Aaron Hill
- Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Ramana Feeser
- Department of Emergency Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Harinder Dhindsa
- Department of Emergency Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Frank Petruzella
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Anne Jackson
- Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Michael Vitto
- Department of Emergency Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Josh Plauny
- Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Alexandra Bryson
- Department of Pathology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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4
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Fabre V, Hsu YJ, Carroll KC, Salinas AB, Gadala A, Bower C, Boyd S, Degnan KO, Dhaubhadel P, Diekema DJ, Drees M, Feeser B, Fisher MA, Flynn C, Ford B, Gettler EB, Glaser LJ, Howard-Anderson J, Johnson JK, Kim JJ, Martinez M, Mathers AJ, Mermel LA, Moehring RW, Nelson GE, O’Horo JC, Pepe DE, Robinson ED, Rodríguez-Nava G, Ryder JH, Salinas JL, Schrank GM, Shah A, Shelly M, Spivak ES, Stewart KO, Talbot TR, Van Schooneveld TC, Wasylyshyn A, Cosgrove SE. Blood Culture Use in Medical and Surgical Intensive Care Units and Wards. JAMA Netw Open 2025; 8:e2454738. [PMID: 39813030 PMCID: PMC11736503 DOI: 10.1001/jamanetworkopen.2024.54738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Accepted: 11/11/2024] [Indexed: 01/16/2025] Open
Abstract
Importance Blood culture (BC) use benchmarks in US hospitals have not been defined. Objective To characterize BC use in adult intensive care units (ICUs) and wards in US hospitals. Design, Setting, and Participants A retrospective cross-sectional study of BC use in adult medical ICUs, medical-surgical ICUs, medical wards, and medical-surgical wards from acute care hospitals from the 4 US geographic regions was conducted. Critical access hospitals, less than 6 months of BC data, and non-US hospitals were excluded. The study included BC use data from September 1, 2019, to August 31, 2021. Data were analyzed from February 23 to July 14, 2024. Main Outcomes and Measures The primary outcome was BC use per 1000 patient-days. Adjusted means with 95% CIs were calculated using mixed-effects negative binomial regression models adjusted for unit type, hospital bed size, geographic region, seasonality, and state COVID-19 case load, with random intercepts accounting for clustering at unit and hospital levels. Secondary outcomes included blood culture positivity, single BCs, BC contamination, and minimum threshold for BC use where blood culture positivity would be optimized. Results A total of 362 327 blood cultures were analyzed from 27 medical ICUs, 35 medical-surgical ICUs, 121 medical wards, and 109 medical-surgical wards from 48 hospitals in 19 states and the District of Columbia. The adjusted mean BC use per 1000 patient-days was 273.1 (95% CI, 270.2-275.9) for medical ICUs, 146.0 (95% CI, 144.5-147.5) for medical-surgical ICUs, 80.3 (95% CI, 79.8-80.7) for medical wards, and 65.1 for medical-surgical wards. Blood culture use was significantly higher across all 4 unit types in hospitals with more than 500 beds compared with 500 or less beds and in the West-Midwest compared with other regions. Single blood culture and positive blood culture rates were below 10% across all 4 unit types. Of the 292 units, 97% had a mean BC contamination rate within 3% of the recommended threshold, and 51% were within 1%. The minimum BC use thresholds (ie, BC use below this number may represent undertesting) were 120 BCs per 1000 patient-days for medical ICUs, 80 BCs per 1000 patient-days for medical-surgical ICUs, and 30 BCs per 1000 patient-days for medical-surgical wards. Conclusions and Relevance The findings of this study suggest that blood culture positivity may help determine appropriate BC use for individual unit types.
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Affiliation(s)
- Valeria Fabre
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yea-Jen Hsu
- Department of Health Policy and Management, Johns Hopkins Bloomberg of School of Public Health, Baltimore, Maryland
| | - Karen C. Carroll
- Department of Pathology, Division of Medical Microbiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alejandra B. Salinas
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Avinash Gadala
- Department of Hospital Epidemiology and Infection Control, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Chris Bower
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - Sarah Boyd
- Saint Luke’s Health System, Kansas City, Missouri
| | - Kathleen O. Degnan
- Department of Medicine, Division of Infectious Diseases, University of Pennsylvania, Philadelphia
| | | | - Daniel J. Diekema
- Department of Medicine, Division of Infectious Diseases, University of Iowa Hospitals and Clinics, Iowa City
| | | | - Baevin Feeser
- Division of Infection Control/Hospital Epidemiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Mark A. Fisher
- Department of Pathology, University of Utah School of Medicine, Salt Lake City
| | | | - Bradley Ford
- Department of Pathology, University of Iowa Carver College of Medicine and University of Iowa Hospitals and Clinics, Iowa City
| | - Erin B. Gettler
- Division of Infectious Diseases, Duke University, Durham, North Carolina
| | - Laurel J. Glaser
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia
| | - Jessica Howard-Anderson
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - J. Kristie Johnson
- Department of Epidemiology, University of Maryland School of Medicine, Baltimore
| | - Justin J. Kim
- Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Amy J. Mathers
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health, Charlottesville
| | - Leonard A. Mermel
- Lifespan Hospital System, Providence, Rhode Island
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - George E. Nelson
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - John C. O’Horo
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota
| | - Dana E. Pepe
- Department of Medicine, Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Evan D. Robinson
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health, Charlottesville
| | | | - Jonathan H. Ryder
- Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha
| | - Jorge L. Salinas
- Division of Infectious Diseases, Stanford University School of Medicine, Stanford, California
| | - Gregory M. Schrank
- Department of Medicine, University of Maryland School of Medicine, Baltimore
| | - Aditya Shah
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mark Shelly
- Geisinger Medical Center, Danville, Pennsylvania
| | - Emily S. Spivak
- Division of Infectious Diseases, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Kathleen O. Stewart
- Department of Quality Assurance and Safety, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Thomas R. Talbot
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Trevor C. Van Schooneveld
- Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha
| | - Anastasia Wasylyshyn
- Department of Medicine, Division of Infectious Disease, University of Michigan Health, Ann Arbor
| | - Sara E. Cosgrove
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
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5
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Fabre V, Cosgrove SE, Milstone AM, Salinas AB, Degnan KO, Gettler EB, Glaser LJ, Johnson JK, Moehring RW, Nelson GE, Rittmann B, Rodriguez-Nava G, Ryder JH, Salinas JL, Schrank GM, Talbot TT, Van Schooneveld TC, Wasylyshyn A, Xie A. Mixed-methods multicenter assessment of healthcare workers' knowledge, perceptions, and practices related to blood culture utilization in hospitalized adults. Infect Control Hosp Epidemiol 2024:1-9. [PMID: 39703070 DOI: 10.1017/ice.2024.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2024]
Abstract
OBJECTIVE To understand healthcare workers' (HCWs) beliefs and practices toward blood culture (BCx) use. DESIGN Cross-sectional electronic survey and semi-structured interviews. SETTING Academic hospitals in the United States. PARTICIPANTS HCWs involved in BCx ordering and collection in adult intensive care units (ICU) and wards. METHODS We administered an anonymous electronic survey to HCWs and conducted semi-structured interviews with unit staff and quality improvement (QI) leaders in these institutions to understand their perspectives regarding BCx stewardship between February and November 2023. RESULTS Of 314 HCWs who responded to the survey, most (67.4%) were physicians and were involved in BCx ordering (82.3%). Most survey respondents reported that clinicians had a low threshold to culture patients for fever (84.4%) and agreed they could safely reduce the number of BCx obtained in their units (65%). However, only half of them believed BCx was overused. Although most made BCx decisions as a team (74.1%), a minority reported these team discussions occurred daily (42.4%). A third of respondents reported not usually collecting the correct volume per BCx bottle, half were unaware of the improved sensitivity of 2 BCx sets, and most were unsure of the nationally recommended BCx contamination threshold (87.5%). Knowledge regarding the utility of BCx for common infections was limited. CONCLUSIONS HCWs' understanding of best collection practices and yield of BCx was limited.
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Affiliation(s)
- Valeria Fabre
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sara E Cosgrove
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aaron M Milstone
- Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alejandra B Salinas
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | | | | | - George E Nelson
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | | | - Jonathan H Ryder
- Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA
| | | | | | - Thomas T Talbot
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Trevor C Van Schooneveld
- Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Anping Xie
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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6
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Kaal AG, Meziyerh S, van Burgel N, Dane M, Kolfschoten NE, Mahajan P, Julián-Jiménez A, Steyerberg EW, van Nieuwkoop C. Procalcitonin for safe reduction of unnecessary blood cultures in the emergency department: Development and validation of a prediction model. J Infect 2024; 89:106251. [PMID: 39182652 DOI: 10.1016/j.jinf.2024.106251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 08/13/2024] [Accepted: 08/14/2024] [Indexed: 08/27/2024]
Abstract
OBJECTIVES Blood cultures (BCs) are commonly ordered in emergency departments (EDs), while a minority yields a relevant pathogen. Diagnostic stewardship is needed to safely reduce unnecessary BCs. We aimed to develop and validate a bacteremia prediction model for ED patients, with specific focus on the benefit of incorporating procalcitonin. METHODS We included adult patients with suspected bacteremia from a Dutch ED for a one-year period. We defined 23 candidate predictors for a "full model", of which nine were used for an automatable "basic model". Variations of both models with C-reactive protein and procalcitonin were constructed using LASSO regression, with bootstrapping for internal validation. External validation was done in an independent cohort of patients with confirmed infection from 71 Spanish EDs. We assessed discriminative performance using the C-statistic and calibration with calibration curves. Clinical usefulness was evaluated by sensitivity, specificity, saved BCs, and Net Benefit. RESULTS Among 2111 patients in the derivation cohort (mean age 63 years, 46% male), 273 (13%) had bacteremia, versus 896 (20%) in the external cohort (n = 4436). Adding procalcitonin substantially improved performance for all models. The basic model with procalcitonin showed most promise, with a C-statistic of 0.87 (0.86-0.88) upon external validation. At a 5% risk threshold, it showed a sensitivity of 99% and could have saved 29% of BCs while only missing 10 out of 896 (1.1%) bacteremia patients. CONCLUSIONS Procalcitonin-based bacteremia prediction models can safely reduce unnecessary BCs at the ED. Further validation is needed across a broader range of healthcare settings.
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Affiliation(s)
- Anna G Kaal
- Department of Internal Medicine, Haga Teaching Hospital, The Hague, the Netherlands; Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands.
| | - Soufian Meziyerh
- Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Nathalie van Burgel
- Department of Medical Microbiology, Haga Teaching Hospital, The Hague, the Netherlands
| | - Martijn Dane
- Department of Clinical Chemistry, Haga Teaching Hospital, The Hague, the Netherlands
| | - Nikki E Kolfschoten
- Department of Emergency Medicine, Haga Teaching Hospital, The Hague, the Netherlands
| | - Prashant Mahajan
- Department of Emergency Medicine, University of Michigan Hospital, United States
| | - Agustín Julián-Jiménez
- Department of Emergency Medicine, Complejo Hospitalario Universitario de Toledo, Spain; IDISCAM (Instituto de Investigación Sanitaria de Castilla La Mancha), Universidad de Castilla La Mancha, Toledo, Spain
| | - Ewout W Steyerberg
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Cees van Nieuwkoop
- Department of Internal Medicine, Haga Teaching Hospital, The Hague, the Netherlands; Health Campus The Hague, Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
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7
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Nelson SE, Tsetsou S, Liang J. Leaving no culture undrawn: Time to revisit the CLABSI and CAUTI metrics. J Crit Care 2024; 79:154442. [PMID: 37797403 DOI: 10.1016/j.jcrc.2023.154442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/18/2023] [Accepted: 09/26/2023] [Indexed: 10/07/2023]
Abstract
Central line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) are quality metrics for many ICUs, and financial ramifications can be applied to hospitals and providers who perform poorly on these measures. Despite some perceived benefits to tracking these metrics, there are a range of issues associated with this practice: lack of a solid evidence base that documenting them has led to decreased infection rates, moral distress associated with identifying these infections, problems with their definitions, and others. We discuss each of these concerns while also including international perspectives then recommend practical steps to attempt to remediate use of the CLABSI and CAUTI metrics. Specifically, we suggest forming a task force consisting of key stakeholders (e.g., providers, Centers for Medicare & Medicaid Services (CMS), patients/families) to review CLABSI and CAUTI-related issues and then to create a summary statement containing recommendations to improve the use of these metrics.
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Affiliation(s)
- Sarah E Nelson
- Departments of Neurosurgery and Neurology, Mount Sinai West, 1000 10(th) Avenue, Suite 10B-65, New York, NY 10019, USA; Department of Neurology, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA; Department of Neurology and Anesthesiology/Critical Care Medicine, Johns Hopkins University, 1800 Orleans Street, Baltimore, MD 21287, USA.
| | - Spyridoula Tsetsou
- Departments of Neurosurgery and Neurology, Mount Sinai West, 1000 10(th) Avenue, Suite 10B-65, New York, NY 10019, USA; Departments of Neurology and Neurosurgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - John Liang
- Departments of Neurosurgery and Neurology, Mount Sinai West, 1000 10(th) Avenue, Suite 10B-65, New York, NY 10019, USA
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8
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Huttner BD, Sharland M, Huttner A. On culture and blood cultures. Clin Microbiol Infect 2023; 29:1100-1102. [PMID: 37263416 DOI: 10.1016/j.cmi.2023.05.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 06/03/2023]
Affiliation(s)
- Benedikt D Huttner
- Secretariat of the Model List of Essential Medicines, Department of Health Product Policy and Standards, World Health Organization, Geneva, Switzerland.
| | - Mike Sharland
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's University London, London, UK
| | - Angela Huttner
- Geneva University Hospitals and University of Geneva Faculty of Medicine, Geneva, Switzerland
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9
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Affiliation(s)
- Hiroshi Ito
- Division of Hospital Medicine, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, Japan.
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10
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Dräger S, Osthoff M. Pitfalls for blood culture diagnostic stewardship. Author's Reply. Eur J Intern Med 2022; 105:102-103. [PMID: 36100473 DOI: 10.1016/j.ejim.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 09/06/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Sarah Dräger
- Division of Internal Medicine, University Hospital Basel, Petersgraben 4, Basel 4031, Switzerland; Department of Clinical Research, University of Basel, Schanzenstrasse 55, Basel 4056, Switzerland.
| | - Michael Osthoff
- Division of Internal Medicine, University Hospital Basel, Petersgraben 4, Basel 4031, Switzerland; Department of Clinical Research, University of Basel, Schanzenstrasse 55, Basel 4056, Switzerland
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