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Variation in Proportion of Blood Cultures Obtained for Children With Skin and Soft Tissue Infections

John R Stephens1, Matt Hall2, Jessica L Markham3

  • 1Department of Pediatrics, North Carolina Children's Hospital and School of Medicine, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina; stephenj@med.und.edu.

Hospital Pediatrics
|March 19, 2020
PubMed

Insights

Blood cultures are frequently obtained for pediatric skin and soft tissue infections (SSTIs), despite low clinical value and guidelines against the practice. There was significant variation in blood culture use among children's hospitals.

Area of Science:

  • Pediatric Infectious Diseases
  • Clinical Microbiology
  • Healthcare Quality Improvement

Background:

  • Blood cultures are often obtained for pediatric skin and soft tissue infections (SSTIs).
  • Existing guidelines suggest limited clinical utility for blood cultures in SSTI cases.
  • There is a need to understand current practices and variations in blood culture utilization.

Purpose of the Study:

  • To determine the variation in blood culture acquisition for pediatric skin and soft tissue infections (SSTIs) across children's hospitals.
  • To compare outcomes for SSTI encounters with and without blood cultures.

Main Methods:

  • Retrospective cohort study using the Pediatric Health Information System database (2012-2017).
  • Included children aged 2 months to 18 years with SSTI diagnosis codes.
  • Analyzed blood culture proportion, costs, length of stay, revisit/readmission rates, and bacteremia identification.

Main Results:

  • Over 289,000 SSTI encounters were analyzed across 38 hospitals.
  • Median blood culture proportion was 3.2% for ED-only and 51.6% for inpatient encounters.
  • Encounters with blood cultures showed higher costs and revisit/readmission rates, with low bacteremia rates (0.6%-1.0%).

Conclusions:

  • Blood cultures are frequently obtained for pediatric SSTIs, particularly in hospitalized patients, despite low demonstrated value.
  • Substantial institutional variation exists in blood culture practices for pediatric SSTIs.
  • Current practices deviate from evidence-based guidelines, suggesting a need for improved adherence.
Abstract

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