Pediatric Blood Culture Contamination Rates and Risk Factors in a Large Integrated Health System

Area of Science:

• Clinical Microbiology
• Pediatric Infectious Diseases
• Healthcare Quality Improvement

Background:

• Contaminated blood cultures lead to unnecessary antibiotic use and exposure.
• Pediatric blood culture contamination (BCC) rates and risk factors are not well understood.
• Studies indicate US contamination rates range from 0.6% to 6%.

Purpose of the Study:

• To determine BCC rates across different pediatric age groups.
• To identify specific risk factors associated with BCC in children.
• To inform targeted interventions for reducing BCC.

Main Methods:

• Retrospective cohort study of 89,948 blood cultures from 2014-2022.
• Inclusion of outpatient and hospital settings across a multicenter health care system.
• Multivariable logistic regression used to identify risk factors and estimate odds ratios (OR) and 95% confidence intervals (CI).

Main Results:

• Overall BCC rate was 1.8% (1594/89,948 cultures).
• Highest BCC rates observed in infants: 2.0% (0-28 days), 5.4% (29-90 days), and 2.7% (90 days-1 year).
• Emergency department (ED) nurses had higher odds of contamination (OR=2.79) compared to phlebotomists; inpatient nurses' odds varied by age.

Conclusions:

• Younger pediatric age and blood cultures drawn by ED nurses are associated with increased BCC odds.
• Findings suggest a need for enhanced training in collection techniques.
• Results support developing staffing models that prioritize phlebotomist collections to minimize BCC.