Costs of Blood Culture Contamination: Justification for Rapid Diagnostics in a Community Hospital

BACKGROUND: We evaluated the cost impact of blood cultures contaminated with coagulase negative Staphylococci species (CoNS) at a community hospital in the Seattle metropolitan area. Data were used to justify acquisition of the rapid diagnostics system, Verigene. METHODS: All blood isolates of CoNS from January 2017 were included. Data were evaluated by patient. The cost analysis included length of hospital stay, days of vancomycin therapy, vancomycin drug concentrations, and pharmacist time spent on vancomycin drug monitoring. Documented adverse drug effects and renal dysfunction were recorded. Based on preliminary data using Verigene, we estimated a 1-day time to organism identification and antibiotic de-escalation following culture draw. RESULTS: 72 blood cultures with CoNS were identified among 51 patients. Physician-documented CoNS infection was present in 5 patients (10%). Of 46 patients with CoNS contamination, 26 (57%) were initially treated with vancomycin, 14 (30%) had therapeutic drug monitoring of vancomycin. One patient was hospitalized 4 additional days due to delay in implanting a cardiac pacing device while infection was ruled out. Four patients were monitored for infection which contributed to hospital stay; each had comorbidities also requiring ongoing hospitalization. Excess care included 20 drug concentrations, 39 days of vancomycin, and 4 additional days of hospitalization. This contributed to a cost/month of $12,992 which annualized to $187,104. One patient with documented CoNS infection had C. difficile infection while on vancomycin; 16 patients had baseline renal impairment either acutely on admission or due to chronic kidney disease. CONCLUSION: Reducing time to identification of blood culture contamination represents an opportunity to improve patient care by minimizing unnecessary antibiotic therapy, drug monitoring, and reducing hospital length of stay. Our institution anticipates an annual cost savings of $143,504 based on rapid identification of CoNS in blood. This justifies the acquisition and operation of a rapid diagnostics system. DISCLOSURES: All authors: No reported disclosures.