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2014. Assessment of Cost, Morbidity, and Mortality Associated with Blood Culture Contamination

BACKGROUND: Blood cultures are the primary diagnostic tool for bloodstream infections, but accuracy of results is dependent on collection technique. Decreasing blood culture contaminations is a priority for antimicrobial stewardship programs as false positives can expose patients to adverse effects...

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Autores principales: Davis, Kevin A, Painter, Jacob, Lakkad, Mrinmayee, Dare, Ryan K
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6809141/
http://dx.doi.org/10.1093/ofid/ofz360.1694
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author Davis, Kevin A
Painter, Jacob
Lakkad, Mrinmayee
Dare, Ryan K
author_facet Davis, Kevin A
Painter, Jacob
Lakkad, Mrinmayee
Dare, Ryan K
author_sort Davis, Kevin A
collection PubMed
description BACKGROUND: Blood cultures are the primary diagnostic tool for bloodstream infections, but accuracy of results is dependent on collection technique. Decreasing blood culture contaminations is a priority for antimicrobial stewardship programs as false positives can expose patients to adverse effects of unnecessary antibiotics. In this study, we present an analysis comparing clinical outcomes and cost associated with false-positive and true negative blood cultures at our institution. METHODS: We conducted a single-center, retrospective, case–control study in patients admitted following blood culture collection in the emergency department from 2014 to 2018. Demographic and clinical characteristics were evaluated in patients with false-positive blood cultures (cases) and negative blood cultures (controls). Contaminants were identified per American Society of Microbiology recommendations. Clinical outcomes were compared between cases and controls, and adjusted analyses were performed with logistic regression, linear regression, and generalized linear models controlling for age, race, body mass index, and sepsis. Statistical analysis was performed using SAS 9.4. RESULTS: A total of 1,102 cases and 11,266 controls were included in analysis. All clinical outcome measures were significantly higher in patients with contaminated blood cultures (see table). Select clinical outcomes remained significant when controlling for potential confounders. CONCLUSION: To the best of our knowledge, this is the largest study evaluating the clinical and financial impact of blood culture contamination with inclusion of >1,000 cases during a 5-year period. Our study shows that blood culture contamination is associated with increased length of stay, unnecessary exposure to antibiotics and procedures, development of antibiotic-associated adverse events, and higher hospital charges as reported in smaller studies. However, this study is the first to the best of our knowledge reporting increased mortality associated with blood culture contamination. Implementation of innovative strategies to reduce contamination should be pursued. Antimicrobial stewardship programs should prioritize identification of contaminants and rapid de-escalation of inappropriate antibiotics in these patients to improve patient care. [Image: see text] DISCLOSURES: All authors: No reported disclosures.
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spelling pubmed-68091412019-10-28 2014. Assessment of Cost, Morbidity, and Mortality Associated with Blood Culture Contamination Davis, Kevin A Painter, Jacob Lakkad, Mrinmayee Dare, Ryan K Open Forum Infect Dis Abstracts BACKGROUND: Blood cultures are the primary diagnostic tool for bloodstream infections, but accuracy of results is dependent on collection technique. Decreasing blood culture contaminations is a priority for antimicrobial stewardship programs as false positives can expose patients to adverse effects of unnecessary antibiotics. In this study, we present an analysis comparing clinical outcomes and cost associated with false-positive and true negative blood cultures at our institution. METHODS: We conducted a single-center, retrospective, case–control study in patients admitted following blood culture collection in the emergency department from 2014 to 2018. Demographic and clinical characteristics were evaluated in patients with false-positive blood cultures (cases) and negative blood cultures (controls). Contaminants were identified per American Society of Microbiology recommendations. Clinical outcomes were compared between cases and controls, and adjusted analyses were performed with logistic regression, linear regression, and generalized linear models controlling for age, race, body mass index, and sepsis. Statistical analysis was performed using SAS 9.4. RESULTS: A total of 1,102 cases and 11,266 controls were included in analysis. All clinical outcome measures were significantly higher in patients with contaminated blood cultures (see table). Select clinical outcomes remained significant when controlling for potential confounders. CONCLUSION: To the best of our knowledge, this is the largest study evaluating the clinical and financial impact of blood culture contamination with inclusion of >1,000 cases during a 5-year period. Our study shows that blood culture contamination is associated with increased length of stay, unnecessary exposure to antibiotics and procedures, development of antibiotic-associated adverse events, and higher hospital charges as reported in smaller studies. However, this study is the first to the best of our knowledge reporting increased mortality associated with blood culture contamination. Implementation of innovative strategies to reduce contamination should be pursued. Antimicrobial stewardship programs should prioritize identification of contaminants and rapid de-escalation of inappropriate antibiotics in these patients to improve patient care. [Image: see text] DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2019-10-23 /pmc/articles/PMC6809141/ http://dx.doi.org/10.1093/ofid/ofz360.1694 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Davis, Kevin A
Painter, Jacob
Lakkad, Mrinmayee
Dare, Ryan K
2014. Assessment of Cost, Morbidity, and Mortality Associated with Blood Culture Contamination
title 2014. Assessment of Cost, Morbidity, and Mortality Associated with Blood Culture Contamination
title_full 2014. Assessment of Cost, Morbidity, and Mortality Associated with Blood Culture Contamination
title_fullStr 2014. Assessment of Cost, Morbidity, and Mortality Associated with Blood Culture Contamination
title_full_unstemmed 2014. Assessment of Cost, Morbidity, and Mortality Associated with Blood Culture Contamination
title_short 2014. Assessment of Cost, Morbidity, and Mortality Associated with Blood Culture Contamination
title_sort 2014. assessment of cost, morbidity, and mortality associated with blood culture contamination
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6809141/
http://dx.doi.org/10.1093/ofid/ofz360.1694
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