This article is more than 5 years old. Information may no longer be current.
Limiting blood culture use did not reduce antibiotic use
Research published in Infection Control & Hospital Epidemiology suggests that using an intervention that decreases blood culture use for patients receiving care in a pediatric ICU may not affect the rate at which antibiotics are prescribed.
“Blood cultures are essential for the evaluation of sepsis,” Anna C. Sick-Samuels, MD, MPH, a pediatric infectious disease fellow at Johns Hopkins School of Medicine, and colleagues wrote. “However, they may sometimes be obtained inappropriately, leading to high false-positive rates, largely due to contamination.”
Clinician decision support tools were implemented at The Johns Hopkins Hospital in April 2014. These tools, which included a guideline on blood culture obtainment, assisted in assessing children receiving treatment in the pediatric ICU (PICU) with fever or signs of sepsis. The researchers noted that the guidelines resulted in a 46% decrease in blood culture use.
Sick-Samuels and colleagues led a retrospective observational study that examined antibiotic prescribing in the 12 months before the tools were used and during the implementation of the guidelines.
One year before guideline use, the researchers identified 11,196 patient days, 6,255 days of antibiotic therapy and 701 broad-spectrum antibiotic regimens started. The researchers observed that cefepime accounted for 36% of the days of antibiotic therapy, followed by vancomycin (31%), piperacillin-tazobactam (23%), meropenem (10%) and imipenem-cilastatin (0.6%). The antibiotics commonly used for PICU patients did not change after the guideline was implemented.
Sick-Samuels and colleagues observed no difference in the overall number of days of antibiotic use before and after the guidelines were implemented (559 per 1,000 patient days vs. 556 per 1,000 patient days; incidence rate ratio [IRR] = 0.99; 95% CI, 0.96-1.03).
Additionally, the researchers did not observe changes in the overall number of broad-spectrum antibiotic regimens after the implementation of the guidelines (63 vs. 62; IRR = 0.98; 95% CI, 0.89-1.10).
Sick-Samuels and colleagues wrote that they were worried that some clinicians who used the guidelines may increase their use of empiric antibiotic therapy because of concerns about “missing” bacteremia when blood cultures were not used and that this therapy would not be discontinued after 48 to 72 hours.
“Antibiotic use related to changes in blood culture practice remains an important balancing measure to evaluate,” the researchers wrote. “Additional larger, multicenter analyses are needed to better understand the association of improved blood culture use and antibiotic prescribing.” – by Katherine Bortz
Disclosures: Sick-Samuels reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
