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Blood culture sampling rate in hospitalised children as a quality indicator for diagnostic stewardship
André Ricardo Araujo da Silva1, Elena Jaszkowski2, Tilmann Schober2
1Universidade Federal Fluminense, Rua Professor Gabizo 252, bloco 6 apt 501, Niterói, Rio de Janeiro, 20271-062, Brazil. aricardo@id.uff.br.
Insights
This study analyzed blood culture rates and bloodstream infection rates across pediatric wards in a German hospital. Blood culture rates varied by ward, being highest in hematology/oncology patients who have a high risk of infection.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Microbiology
- Hospital Epidemiology
Background:
- Optimal blood culture (BC) utilization guidelines for pediatric patients are lacking.
- Understanding the correlation between BC rates and laboratory-confirmed bloodstream infection (LCBSI) rates is crucial for appropriate diagnostic strategies.
Purpose of the Study:
- To investigate the relationship between blood culture rates and laboratory-confirmed bloodstream infection rates in different pediatric wards.
- To analyze BC and LCBSI rates within a German tertiary-care center's pediatric units.
Main Methods:
- A retrospective cohort study was conducted between January 1 and December 31, 2018, at a pediatric university hospital.
- Data included all blood cultures from neonatal (NICU), pediatric intensive-care (PICU), hematology/oncology, and general pediatric wards.
- Blood culture rates (BCR) and LCBSI rates were calculated per 1000 patient-days for each unit.
Main Results:
- A total of 3072 BCs were collected from 3114 patients across the studied wards.
- Positive BCs accounted for 6.5% of all collected cultures.
- BC rates varied significantly by ward: NICU (61.6), PICU (196.2), hematology/oncology (358.4), and general pediatrics (52.3).
- LCBSI rates were 2.4 (NICU), 5.6 (PICU), 4.4 (hematology/oncology), and 1.0 (general pediatrics) per 1000 patient-days at risk.
Conclusions:
- Blood culture rates differ substantially across pediatric wards.
- Higher blood culture rates were observed in wards with patients at higher risk for bloodstream infections, such as hematology/oncology.
Purpose:
Recommendations regarding the optimal number of blood cultures in children are not available. The aim of this article is to describe the correlation between blood culture (BC) rates and laboratory-confirmed bloodstream infection (LCBSI) rates, on different paediatric wards of a tertiary-care centre in Germany.
Methods:
We conducted a retrospective cohort study in a paediatric university hospital, from 1st January to 31st December 2018. All blood cultures collected from neonatal (NICU) and paediatric intensive-care units (PICU), haematology/oncology, and general paediatric wards were included. There were no exclusion criteria. BC taken/1000 patients-days (BC rates/BCR) and LCBSI/1000 patient-days at risk (LCBSI rates) were calculated for each unit.
Results:
A total of 6040 patients were admitted to the hospital with 3114 of them into wards studied. Of the 3072 BCs collected, 200 (6.5%) were positive. Collection of BCs was performed in 51/77 (66.2%) of admitted patients on NICU, in 151/399 (37.8%) of PICU patients, in 163/755 (21.6%) of haematology/oncology patients, and in 281/1883 (14.9%) of children on general paediatric wards. Gram-positive bacteria were the most commonly detected organisms in blood cultures from all wards with exception of NICU. The BCR in NICU, PICU, haematology/oncology wards, and general wards were 61.6, 196.2, 358.4, and 52.3, respectively. Excluding commensal pathogens and possible contaminations, the LCBSI rates in the same units were 2.4, 5.6, 4.4, and 1.0, respectively.
Conclusion:
We found different BCR values according the ward studied, being higher in patients with high risk of bloodstream infection such as haematology/oncology patients.
