Journal article
Blood Culture Use in Medical and Surgical Intensive Care Units and Wards
JAMA network open, Vol.8(1), e2454738
01/02/2025
DOI: 10.1001/jamanetworkopen.2024.54738
PMCID: PMC11736503
PMID: 39813030
Abstract
Blood culture (BC) use benchmarks in US hospitals have not been defined.
To characterize BC use in adult intensive care units (ICUs) and wards in US hospitals.
A retrospective cross-sectional study of BC use in adult medical ICUs, medical-surgical ICUs, medical wards, and medical-surgical wards from acute care hospitals from the 4 US geographic regions was conducted. Critical access hospitals, less than 6 months of BC data, and non-US hospitals were excluded. The study included BC use data from September 1, 2019, to August 31, 2021. Data were analyzed from February 23 to July 14, 2024.
The primary outcome was BC use per 1000 patient-days. Adjusted means with 95% CIs were calculated using mixed-effects negative binomial regression models adjusted for unit type, hospital bed size, geographic region, seasonality, and state COVID-19 case load, with random intercepts accounting for clustering at unit and hospital levels. Secondary outcomes included blood culture positivity, single BCs, BC contamination, and minimum threshold for BC use where blood culture positivity would be optimized.
A total of 362 327 blood cultures were analyzed from 27 medical ICUs, 35 medical-surgical ICUs, 121 medical wards, and 109 medical-surgical wards from 48 hospitals in 19 states and the District of Columbia. The adjusted mean BC use per 1000 patient-days was 273.1 (95% CI, 270.2-275.9) for medical ICUs, 146.0 (95% CI, 144.5-147.5) for medical-surgical ICUs, 80.3 (95% CI, 79.8-80.7) for medical wards, and 65.1 for medical-surgical wards. Blood culture use was significantly higher across all 4 unit types in hospitals with more than 500 beds compared with 500 or less beds and in the West-Midwest compared with other regions. Single blood culture and positive blood culture rates were below 10% across all 4 unit types. Of the 292 units, 97% had a mean BC contamination rate within 3% of the recommended threshold, and 51% were within 1%. The minimum BC use thresholds (ie, BC use below this number may represent undertesting) were 120 BCs per 1000 patient-days for medical ICUs, 80 BCs per 1000 patient-days for medical-surgical ICUs, and 30 BCs per 1000 patient-days for medical-surgical wards.
The findings of this study suggest that blood culture positivity may help determine appropriate BC use for individual unit types.
Details
- Title: Subtitle
- Blood Culture Use in Medical and Surgical Intensive Care Units and Wards
- Creators
- Valeria Fabre - Johns Hopkins MedicineYea-Jen Hsu - Johns Hopkins UniversityKaren C Carroll - Johns Hopkins MedicineAlejandra B Salinas - Johns Hopkins MedicineAvinash Gadala - Johns Hopkins HospitalChris Bower - Emory UniversitySarah Boyd - Saint Luke's Health SystemKathleen O Degnan - University of PennsylvaniaPragya Dhaubhadel - Geisinger Medical CenterDaniel J Diekema - University of IowaMarci Drees - Christiana Care Health SystemBaevin Feeser - Beth Israel Deaconess Medical CenterMark A Fisher - University of UtahCynthia Flynn - Christiana Care Health SystemBradley Ford - University of IowaErin B Gettler - Duke UniversityLaurel J Glaser - University of PennsylvaniaJessica Howard-Anderson - Emory UniversityJ Kristie Johnson - University of Maryland, BaltimoreJustin J Kim - Dartmouth–Hitchcock Medical CenterMarvin Martinez - LifespanAmy J Mathers - University of VirginiaLeonard A Mermel - LifespanRebekah W Moehring - Duke UniversityGeorge E Nelson - Vanderbilt UniversityJohn C O'Horo - Mayo ClinicDana E Pepe - Beth Israel Deaconess Medical CenterEvan D Robinson - University of VirginiaGuillermo Rodríguez-Nava - Stanford UniversityJonathan H Ryder - University of Nebraska Medical CenterJorge L Salinas - Stanford UniversityGregory M Schrank - University of Maryland, BaltimoreAditya Shah - Mayo Clinic in FloridaMark Shelly - Geisinger Medical CenterEmily S Spivak - University of UtahKathleen O Stewart - Dartmouth–Hitchcock Medical CenterThomas R Talbot - Vanderbilt UniversityTrevor C Van Schooneveld - University of Nebraska Medical CenterAnastasia Wasylyshyn - University of MichiganSara E Cosgrove - Johns Hopkins MedicineCenters for Disease Control and Prevention (CDC) Prevention Epicenters Program
- Resource Type
- Journal article
- Publication Details
- JAMA network open, Vol.8(1), e2454738
- DOI
- 10.1001/jamanetworkopen.2024.54738
- PMID
- 39813030
- PMCID
- PMC11736503
- NLM abbreviation
- JAMA Netw Open
- ISSN
- 2574-3805
- eISSN
- 2574-3805
- Publisher
- AMER MEDICAL ASSOC
- Grant note
- CDC Epicenters Program: 51 U54 CK000617-02-00, 5U54CK00617-03-001 CDC Epicenters Program
This work was supported by CDC Epicenters Program grants 51 U54 CK000617-02-00 and5U54CK00617-03-001.
- Language
- English
- Date published
- 01/02/2025
- Academic Unit
- Infectious Diseases; Pathology; Internal Medicine
- Record Identifier
- 9984774236402771
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