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

Abstract

BackgroundBlood 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.MethodsWe 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.ResultsA 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.ConclusionTo 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. Disclosures All authors: No reported disclosures.

The Sepsis Bundle Effect: An Evaluation of Culture Results and Utilization in Pediatric Appendicitis

“…False positives with contamination are more frequent than true positive cultures in children, resulting in unnecessary antibiotic therapy, increased length of stay, and hospital charges. 20 Although the one positive BCx within our study was positive for bacteria not usually considered contamination (Extended Spectrum Beta-Lactamase E. coli, Enterobacteriaceae, and S. anginosus), her clinical course did not follow that of untreated bacteremia; therefore, it was assumed a contaminant and managed as such. Clean catch specimens are the least contaminated of noninvasive UCx methods; however, the accepted contamination rate remains moderate at around 25%.…”