Impact of Mandatory Public Reporting of Central Line–Associated Bloodstream Infections on Blood Culture and Antibiotic Utilization in Pediatric and Neonatal Intensive Care Units

Flett, Kelly B.; Ozonoff, Al; Sandora, Thomas J.; Priebe, Gregory P.

doi:10.1017/ice.2015.100

Cited by 15 publications

(20 citation statements)

References 35 publications

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“…Multiple national organizations recommend comprehensive approaches to antimicrobial stewardship (12), and neonatal providers are actively pursuing approaches to optimize antibiotic use among NICU patients (13). In a study using the Pediatric Health Information System database, antibiotic utilization decreased ~5% per year from 2004 to 2012 among hospitals without mandatory public reporting requirements for central line-associated bloodstream infection (14); similar secular trends in NICU antibiotic use were observed among hospitals subject to such reporting requirements. Neonatal antimicrobial stewardship programs at individual centers and collaboratives also report success in safely decreasing overall NICU antibiotic utilization (15-17).…”

Section: Discussionmentioning

confidence: 93%

Prolonged duration of early antibiotic therapy in extremely premature infants

et al. 2019

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Background: Prolonged early antibiotics in extremely premature infants may have negative effects. We aimed to assess prevalence and outcomes of provision of prolonged early antibiotics to extremely premature infants in the absence of culture-confirmed infection or NEC. Methods: Cohort study of infants from 13 centers born without a major birth defect from 2008-2014 who were 401-1000 grams birth weight, 22-28 weeks gestation, and survived ≥5 days without culture-confirmed infection, NEC, or spontaneous intestinal perforation. We determined the proportion of infants who received prolonged early antibiotics, defined as ≥5 days of antibiotic therapy started at ≤72 hours of age, by center and over time. Associations between prolonged early antibiotics and adverse outcomes were assessed using multivariable logistic regression. Results: A total of 5730 infants were included. The proportion of infants receiving prolonged early antibiotics varied from 30-69% among centers and declined from 49% in 2008 to 35% in 2014. Prolonged early antibiotics was not significantly associated with death (adjusted odds ratio 1.17 [95% CI, 0.99-1.40], p=0.07) and was not associated with NEC. Conclusions: The proportion of extremely premature infants receiving prolonged early antibiotics decreased, but significant center variation persists. Prolonged early antibiotics was not significantly associated with increased odds of death or NEC.

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Section: Discussionmentioning

confidence: 93%

Prolonged duration of early antibiotic therapy in extremely premature infants

et al. 2019

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“…In addition, blood culture utilization has not been well quantified, and only a few studies have published utilization rates per patient. [14][15][16] While there are some guidelines for blood culture utilization, they do not provide clear indications for obtaining blood cultures, and many recommendations lack a consensus among different professional organizations. [17][18][19] The level of evidence for some recommendations is low, indicating a need for more rigorous evaluations of these existing guidelines.…”

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confidence: 99%

Blood culture utilization at an academic hospital: Addressing a gap in benchmarking

Chen

Bilker

Hamilton

et al. 2018

Infect. Control Hosp. Epidemiol.

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ObjectiveTo describe the pattern of blood culture utilization in an academic university hospital setting.DesignRetrospective cohort study.SettingA 789-bed tertiary-care university hospital that processes 40,000+blood cultures annually.MethodsWe analyzed blood cultures collected from adult inpatients at the Hospital of the University of Pennsylvania between July 1, 2014, and June 30, 2015. Descriptive statistics and regression models were used to analyze patterns of blood culture utilization: frequency of blood cultures, use of repeat cultures following a true-positive culture, and number of sets drawn per day.ResultsIn total, 38,939 blood culture sets were drawn during 126,537 patient days (incidence rate, 307.7 sets per 1,000 patient days). The median number of blood culture sets drawn per hospital encounter was 2 (range, 1–76 sets). The median interval between blood cultures was 2 days (range, 1–71 days). Oncology services and cultures with gram-positive cocci were significantly associated with greater odds of having repeat blood cultures drawn the following day. Emergency services had the highest rate of drawing single blood-culture sets (16.9%), while oncology services had the highest frequency of drawing ≥5 blood culture sets within 24 hours (0.91%). Approximately 10% of encounters had at least 1 true-positive culture, and 89.2% of those encounters had repeat blood cultures drawn. The relative risk of a patient having repeat blood cultures was lower for those in emergency, surgery, and oncology services than for those in general medicine.ConclusionsOrdering practices differed by service and culture results. Analyzing blood culture utilization can contribute to the development of guidelines and benchmarks for appropriate usage.

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“…Table 3 provides examples of research publications using different types of administrative data. -Centers for Medicare and Medicaid Services (CMS): MedPar, 69,70 state inpatient databases (SID), 35,52,[71][72][73] Medicaid Analytical eXtract (MAX), 74 Truven Health MarketScan® Multi-State Medicaid Database 75 -TRICARE 76 -University HealthSystem Consortium (UHC) 49 -Kids' Inpatient Database (KID) 77 -Pediatric Health Information System (PHIS) 47 -Premier Perspective 78,79 -Private insurers 11,12 85 -Individual health systems/ consortiums 9,12,23,27,28,37,[86][87][88][89] Surveillance, laboratory, or registry data -Defined as systematic collection of data for a clearly stated purpose -Can include both administrative and clinical data -Programs may allow multiple institutions to pool deidentified data for a common study.…”

Section: Pitfalls and Tipsmentioning

confidence: 99%

“…One prominent example is the increase in laws and regulations related to public reporting of HAI. Several researchers have studied the impact of these laws on blood culture and antibiotic utilization 47 and on central-line–associated bloodstream infection (CLABSI) rates. Interestingly, while hospitals in states with mandatory public reporting were more likely to participate in a national CLABSI prevention program and these participants trended toward greater CLABSI reduction, 48 other investigators have found no difference in HAI reduction in states with mandatory reporting 49 …”

Section: Published Examples In Healthcare Epidemiology and Antimicrobmentioning

confidence: 99%

Research Methods in Healthcare Epidemiology and Antimicrobial Stewardship: Use of Administrative and Surveillance Databases

Drees

Gerber

Morgan

et al. 2016

Infect. Control Hosp. Epidemiol.

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Administrative and surveillance data are used frequently in healthcare epidemiology and antimicrobial stewardship (HE&AS) research because of their wide availability and efficiency. However, data quality issues exist, requiring careful consideration and potential validation of data. This methods paper presents key considerations for using administrative and surveillance data in HE&AS, including types of data available and potential use, data limitations, and the importance of validation. After discussing these issues, we review examples of HE&AS research using administrative data with a focus on scenarios when their use may be advantageous. A checklist is provided to help aid study development in HE&AS using administrative data. Infect Control Hosp Epidemiol 2016;1-10.

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Impact of Mandatory Public Reporting of Central Line–Associated Bloodstream Infections on Blood Culture and Antibiotic Utilization in Pediatric and Neonatal Intensive Care Units

Abstract: Mandatory public reporting of central line-associated bloodstream infection did not impact blood culture and antibiotic utilization, suggesting that clinicians have not shifted their practice in an attempt to detect fewer infections.

Cited by 15 publications

References 35 publications

Prolonged duration of early antibiotic therapy in extremely premature infants

Prolonged duration of early antibiotic therapy in extremely premature infants

Blood culture utilization at an academic hospital: Addressing a gap in benchmarking

Research Methods in Healthcare Epidemiology and Antimicrobial Stewardship: Use of Administrative and Surveillance Databases

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