Blood culture collection practice prior to empiric piperacillin/tazobactam in patients requiring hospitalization: a potential target for antimicrobial stewardship from a single-center retrospective observational study.

BACKGROUND

The current clinical paradigm recommends appropriate blood culture collection based on the patient's severity and suspected diagnosis. Beyond providing microbiological diagnosis, blood cultures can facilitate the de-escalation of broad-spectrum antibiotics. Nonetheless, blood culture collection practices upon prescription of broad-spectrum antibiotics remain largely unexplored.

METHODS

A retrospective observational study was conducted at a tertiary care academic hospital in Tokyo, Japan. Patients who required hospitalization and underwent empiric piperacillin/tazobactam prescription on day of admission from 2016/4/1 to 2017/12/31 were included. Patients ≤18 years old, who finished piperacillin/tazobactam on or before day 1, and duplicates were excluded. A total of 250 patients were randomly selected to assess the frequency and factors associated with blood culture collection.

RESULTS

Blood culture collection was fulfilled in 163 patients (65.2%). The use of immunosuppressive agents (odds ratio [OR], 3.47; confidence interval [CI], 1.43-9.43), systemic inflammatory response syndrome criteria ≥2 (OR, 4.42; CI, 2.22-9.23) were associated with blood culture collection. On the contrary, intraabdominal infection (OR, 0.28; CI 0.11-0.65), and surgical specialty (OR, 0.33; CI, 0.18-0.61) were associated with withholding of blood culture collection.

CONCLUSIONS

Withholding of blood culture collection was observed prior to empiric piperacillin/tazobactam prescription in one-third of patients warranting hospitalization. Surgical specialty was associated with potential missed opportunities for blood culture collection. Tailored implementation strategies may optimize blood culture collection practices among different specialties.