Program Schedule

1425
Financial Impact of Pediatric Blood Culture Contamination: Is There Room for Improvement?

Session: Poster Abstract Session: Diagnostic Microbiology: Blood Culture Methodology/Clinical Utilization
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Posters
  • Contaminated Blood Cultures.pdf (56.1 kB)
  • Background: Blood cultures (BC) are integral in clinical practice to detect pathogens and guide antibiotic therapy.  Contaminated BC are a problem in many emergency departments (ED) and rates have been reported as high as 11%.  Increased BC contamination leads to unnecessary use of antibiotics, repeat testing, and increased healthcare costs.  The rate of isolation of true pathogens from BC is directly related to the volume of blood collected and inadequate blood volumes have been linked to isolating contaminants.  The objective of this study is to assess the financial impact of BC contaminants and the association with blood volume.

    Methods: Retrospectively reviewed medical records of children who had BC obtained in the Pediatric ED over a 19-month period (1/1/2012 to 7/31/2013).  Positive BC were further analyzed to determine if isolated organisms were contaminants. Associated healthcare charges (ED visits, admissions, antibiotics and laboratory testing) were calculated.  The associations between BC volume and contamination were assessed using chi-square test.

    Results: There were 8916 pediatric BC specimens obtained during the 19-month period.  There were 461 (5.17%) positive BC: 336 (72.9%) contaminated and 125 (27.1%) true positive.  The total charges for the 336 contaminated BC was almost 5 million dollars ($4,780,781) with a median of $12,950 per patient.  Of the 461 positive BC, 406 (88%) contained inadequate volume. Contaminated BC were more likely to contain inadequate volume compared to true positive BC (odds ratio [OR] 3.93, 95%CI: 2.20-7.00) (p<.0001, chi-square test). Among children 12 months of age or younger, contaminated BC had 4.5 times higher odds of containing inadequate volume compared to true positive BC (OR 4.53, 95% CI: 1.34-15.24).

    Conclusion: Contaminated BC lead to a substantial increase in healthcare costs and inappropriate antibiotic use. A major factor contributing to isolating BC contaminants is inadequate blood volume, especially among infants. Future research is ongoing to assess the impact of implementing volume guidelines at our children’s hospital on reducing BC contamination and healthcare costs.

    Leigh Bragg, MD, Pediatric Infectious Diseases & Immunology, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, Ana Alvarez, MD, Pediatric Infectious Diseases and Immunology,, University of Florida, Jacksonville, FL and Diane Halstead, PhD, Baptist Health, Jacksonville, FL; Jacksonville Pathology Consultants, P.A./Baptist Health, Jacksonville, FL

    Disclosures:

    L. Bragg, None

    A. Alvarez, None

    D. Halstead, None

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