Two Blood Cultures With Age-Appropriate Volume Enhance Suspected Sepsis Decision-Making

Abstract

Background Multiple blood cultures have been shown to improve pathogen yield and antimicrobial stewardship for adult patients with suspected serious bacterial infection (SBI). For children, the use of multiple blood cultures is less common and volume recommendations are more complicated, often resulting in single cultures with low volume. Methods In 2010, Children’s Hospital Colorado instituted electronic medical record (EMR) decision support to recommend collection of 2 blood cultures before administration of antibiotics for suspected SBI. Recommended blood culture volumes were calculated by age rather than weight. We evaluated all children admitted to inpatient units between 2008 and 2009 (pre-intervention) and 2011 and 2013 (postintervention) who received antibiotics in the hospital after having blood cultures drawn in the emergency department, excluding those with a length of stay >8 days. We compared blood culture yield, isolate classification (pathogen vs contaminant), and antimicrobial modifications before and after the interventions. Results A total of 3948 children were included in the study. EMR guidelines were associated with a significantly higher number of children with multiple blood cultures drawn before antibiotic administration (88.0% vs 12.3%; P < .001) and an increased percentage of blood cultures with the recommended volume (74.3% vs 15.2%; P < .001), resulting in a significantly higher pathogen isolation rate and improved antimicrobial decisions. Multiple cultures helped define the role of common contaminants in the clinical decision process. Conclusions Multiple blood cultures with age-based volumes taken before starting antibiotics increase pathogen isolation rates and appropriate modification of antimicrobial treatment in children.

Analysis of Blood Culture Collection and Laboratory Processing Practices in Israel

“…Interventions can correct the weaknesses identified in this study. During sample collection, decision support reminders in the electronic medical record can reduce solitary BCs . Contamination can be reduced by initial specimen diversion, using dedicated phlebotomists, and avoiding blood draws from intravenous catheters .…”

“…During sample collection, decision support reminders in the electronic medical record can reduce solitary BCs. 22 Contamination can be reduced by initial specimen diversion, 23 using dedicated phlebotomists, 24 and avoiding blood draws from intravenous catheters. 25 Blood culture positivity can be increased by increasing the volume of blood collected through education and feedback for personnel, marking the 10-mL point on bottles, 26 and supplying clinical decision tools to avoid BCs in patients at low risk of BSI.…”

Epidemiology and Antimicrobial Susceptibility of Invasive Bacterial Infections in Children—A Population-Based Study From Norway

“…A recently published study reported that multiple blood cultures with age adjusted volume before antibiotics increased the chance of pathogen isolation in children. 28 Regarding pattern of antibiotic use, reports from Norwegian hospitals show that children use less broad-spectrum antibiotics compared with the entire population. 5,16 This is relevant since detection of pathogen is more difficult if broad-spectrum antibiotics are administrated before blood culture is obtained.…”

Barriers and enablers to blood culture sampling: a systematic review and theoretical domains framework survey in Indonesia, Thailand and Vietnam

“…feedback) and computer systems to support doctors to order BC per guidelines. [38][39][40][41][42][43] In our survey, the most common procedures to support or regulate doctors to order BC in their hospitals was presence of local hospital guidelines (33.2%, 352/1,060), followed by case reviews (e.g. grand rounds or morning ward rounds, and BC is often mentioned) (30.8%, 326/1,060), standard order forms to remind ordering BC (29.9%, 317/1,060), stewardship programmes and reviewing BC is included in the programmes (19.5%, 207/1,060), posters (15.4%, 163/1,060) and computer systems to remind ordering BC (10.7%, 113/1,060).…”