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Blood culture utilization at an academic hospital: Addressing a gap in benchmarking

Published online by Cambridge University Press:  28 September 2018

Annie I. Chen
Affiliation:
Cell and Molecular Biology Graduate Group, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Warren B. Bilker
Affiliation:
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Keith W. Hamilton
Affiliation:
Department of Medicine, Division of Infectious Diseases, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
Judith A. O’Donnell
Affiliation:
Department of Medicine, Division of Infectious Diseases, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
Irving Nachamkin*
Affiliation:
Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
*Corresponding
Author for correspondence: Irving Nachamkin DrPH, MPH, Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, 7-046 Founders Pavilion, 3400 Spruce Street, Philadelphia, PA 19104-4283. E-mail: Irving.Nachamkin@uphs.upenn.edu.

Abstract

Objective

To describe the pattern of blood culture utilization in an academic university hospital setting.

Design

Retrospective cohort study.

Setting

A 789-bed tertiary-care university hospital that processes 40,000+blood cultures annually.

Methods

We analyzed blood cultures collected from adult inpatients at the Hospital of the University of Pennsylvania between July 1, 2014, and June 30, 2015. Descriptive statistics and regression models were used to analyze patterns of blood culture utilization: frequency of blood cultures, use of repeat cultures following a true-positive culture, and number of sets drawn per day.

Results

In total, 38,939 blood culture sets were drawn during 126,537 patient days (incidence rate, 307.7 sets per 1,000 patient days). The median number of blood culture sets drawn per hospital encounter was 2 (range, 1–76 sets). The median interval between blood cultures was 2 days (range, 1–71 days). Oncology services and cultures with gram-positive cocci were significantly associated with greater odds of having repeat blood cultures drawn the following day. Emergency services had the highest rate of drawing single blood-culture sets (16.9%), while oncology services had the highest frequency of drawing ≥5 blood culture sets within 24 hours (0.91%). Approximately 10% of encounters had at least 1 true-positive culture, and 89.2% of those encounters had repeat blood cultures drawn. The relative risk of a patient having repeat blood cultures was lower for those in emergency, surgery, and oncology services than for those in general medicine.

Conclusions

Ordering practices differed by service and culture results. Analyzing blood culture utilization can contribute to the development of guidelines and benchmarks for appropriate usage.

Type
Original Article
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

PREVIOUS PRESENTATION: Preliminary findings were presented as a poster at the 2017 American Society of Microbiology (ASM) Microbe meeting on June 1–5, 2017, in New Orleans, Louisiana.

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