Do we need this blood culture?

Area of Science:

• Pediatric infectious diseases
• Clinical microbiology
• Healthcare quality improvement

Background:

• Blood cultures are a common diagnostic tool in pediatric inpatient settings.
• Assessing the utility of blood cultures for low-risk pediatric patients is crucial for optimizing healthcare resource allocation.
• Previous studies have not comprehensively evaluated blood culture use across multiple common pediatric diagnoses.

Purpose of the Study:

• To determine blood culture collection rates, analyze results, and estimate microbiology laboratory charges for four common pediatric inpatient diagnoses: asthma, bronchiolitis, pneumonia, and skin and soft tissue infections (SSTI).
• To identify potential areas of overutilization of blood cultures in low-risk pediatric populations.

Main Methods:

• Retrospective cohort study at an urban academic children's hospital from January 1, 2011, to December 31, 2011.
• Inclusion of patients aged 6 months to 18 years with primary diagnoses of asthma, bronchiolitis, SSTI, or community-acquired pneumonia, excluding those with complex chronic conditions.
• Data collected via administrative billing and chart review; descriptive statistics and appropriate statistical tests (chi-squared, nonparametric) were employed.

Main Results:

• Of 5159 encounters, 1629 were inpatient. Inpatient blood culture utilization was 21% overall, varying by diagnosis (asthma 4%, bronchiolitis 15%, pneumonia 36%, SSTI 46%).
• Blood cultures for asthma and bronchiolitis were 100% negative. Pneumonia and SSTI cultures were 99% and 98% negative or false-positive, respectively.
• Gross microbiology laboratory charges approximated $100,000 annually for these four diagnoses.

Conclusions:

• A high proportion of blood cultures for common pediatric inpatient diagnoses yield negative or false-positive results.
• Clinically significant true-positive results are infrequent, suggesting potential overutilization of blood cultures.
• These findings highlight opportunities to refine blood culture ordering practices in pediatric care.