559. Blood Culture and Antimicrobial Use in Pediatric and Neonatal Intensive Care Units After Implementation of Mandatory Public Reporting of Bloodstream Infections
Session: Oral Abstract Session: Advancing Public Reporting and Surveillance of HAIs
Thursday, October 3, 2013: 2:15 PM
Room: The Moscone Center: 200-212
Background:   Mandatory public reporting of healthcare-associated infections (HAIs) has been implemented in many states and may drive decreased infection rates.  Still, its impact on physician behavior remains unclear.  In pediatrics, where central line-associated bloodstream infections (CLABSI) are the most common HAI, physicians could be influenced to send fewer blood cultures and/or extend antimicrobial treatment to decrease reportable infections.    

Methods: To evaluate the impact of mandatory reporting on blood culture and antimicrobial use, we conducted an interrupted time-series analysis centered on state-specific dates for implementation of mandatory reporting of CLABSI.  Using data from the Pediatric Health Information System, we determined monthly rates for blood cultures and antimicrobial length of therapy (LOT) in neonatal and pediatric intensive care units (NICU and PICU) at U.S. children’s hospitals during the 24 months before and after public reporting began.  Poisson regression models were used to compare rates pre- and post-implementation, adjusting for median age (PICU only), case mix index, complex chronic condition, infection, surgical procedure, total parenteral nutrition, and malignancy. 

Results: Twenty pediatric hospitals began mandatory public CLABSI reporting between January 2005 and June 2010 and 16 provided adequate data throughout the study period.  After mandatory reporting, blood culture rates in the PICU decreased significantly from 259 to 235 cultures per 1000 patient-days [adjusted rate ratio (ARR) 0.91, 95% CI 0.90-0.92].  PICU antibiotic LOT decreased significantly from 473 to 459 days per 1000 patient-days [ARR 0.98, 95% CI 0.97-0.99] during the same time period.  In the NICU, blood culture rates decreased significantly from 88 to 78 cultures per 1000 patient-days [ARR 0.88, 95% CI 0.86-0.89] and antibiotic LOT decreased significantly from 334 to 300 days per 1000 patient-days [ARR 0.91, 95% CI 0.90-0.92]. 

Conclusion: While blood culture utilization decreased in the period after mandatory reporting, the concurrent decrease in antimicrobial use suggests that mandatory CLABSI reporting has not driven overuse of antimicrobials.

Kelly B. Flett, MD1, Al Ozonoff, PhD2, Thomas J. Sandora, MD, MPH1, Gregory P. Priebe, MD1,3 and Dionne A. Graham, PhD4, (1)Division of Infectious Diseases, Department of Medicine and Laboratory Medicine, Boston Children's Hospital, Boston, MA, (2)Clinical Research Center, Design and Analysis Core, Boston Children's Hospital, Boston, MA, (3)Division of Critical Care Medicine, Department of Anesthesiology, Boston Children's Hospital, Boston, MA, (4)Boston Children's Hospital, Boston, MA


K. B. Flett, None

A. Ozonoff, None

T. J. Sandora, None

G. P. Priebe, None

D. A. Graham, None

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