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Blood Culture Utilization and Results for Common Inpatient Pediatric Diagnoses

Sunday, October 21, 2012
Room 281-282 (Morial Convention Center)
Kavita Parikh, MD, Aisha Davis, Deena Zeltser and Padma Pavuluri, Hospitalist Division, Children's National Medical Center, Washington DC, DC

Purpose: Blood culture over-utilization is a widespread problem and leads to high rates of negative and contaminant results.  Both types of results are associated with increased resource utilization and costs.  The purpose of this study is to describe the rate of blood culture negativity and contamination for three common inpatient pediatric diagnoses: skin and soft tissue infection (SSTI), pneumonia (PNA), and bronchiolitis.

Methods: This was a retrospective, cohort study of patients greater than 6 months of age. Hospital administrative data were used to identify patients with a primary discharge diagnosis of SSTI, PNA, or bronchiolitis over the one year study period (January – December 2011).  Patients with any intensive care stay, immunodeficiency, central venous catheter or ventriculo-peritoneal shunt were excluded.  Chart review identified culture results and, if positive, the clinical decision of pathogen (true positive) vs. contaminant (false positive).

Results: Thirteen hundred patients age greater than 6 months were identified with one of the three primary diagnoses.  504 (38%) had at least one blood culture drawn during the admission. Blood cultures were drawn in 48% of patients with SSTI, 45% of patients with PNA, and 18% of patients with bronchiolitis. A random 20% chart sampling revealed 76 of 98 (78%) patients met inclusion criteria.  Negative blood culture results were common among patients with any diagnosis: SSTI (97%), PNA (93%), and bronchiolitis (100%).  There were 2 (2.5%) contaminant cultures, and only two (2.5%) cultures were pathogenic (one each for SSTI and PNA).

Conclusions: The high total percentage of negative and contaminant blood cultures, but low percentage of pathogenic blood cultures, suggests blood culture over-utilization in these three common pediatric inpatient diagnoses.  Quality improvement efforts to reduce resource utilization should target clinical decision support to limit blood cultures utilization for when there is a high index of suspicion for bacteremia.