Multicenter evaluation of blood culture contamination and blood cultures practices in US acute care hospitals: time for standardization.
СтатьяМногоцентровое исследованиеПоддержка исследования: вне правительства СШАПоддержка NIH: внешняя программаНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Fabre Valeria, Hsu Yea-Jen, Carroll Karen C, Milstone Aaron M, Salinas Alejandra B, Abbo Lilian M, Bower Chris, Berry Jennifer, Boyd Sarah, Degnan Kathleen O, Dhaubhadel Pragya, Diekema Daniel J, Dress Marci, Feeser Baevin, Fisher Mark, Flynn Cynthia, Ford Bradley A, Gettler Erin B, Glasser Laurel J, Howard-Anderson Jessica, Johnson J Kristie, Karaba Sara M, Kim Justin J, Kubischta Alyssa, Landrum Benjamin M, Martinez Marvin, Mathers Amy J, Mermel Leonard, Moehring Rebekah W, O'Horo John C, Pepe Dana E, Qasba S Sonia, Rittmann Barry, Robinson Evan D, Rodríguez-Nava Guillermo, Rosa Rossana, Ryder Jonathan H, Salinas Jorge L, Shah Aditya, Schrank Gregory M, Shelly Mark, Spivak Emily S, Stewart Kathleen O, Talbot Thomas R, Van Schooneveld Trevor C, Wasylyshyn Anastasia, Gadala Avinash, Virk Zunaira, Cosgrove Sara E
Аннотация
Clinical and Laboratory Standards Institute (CLSI) recommends a blood culture contamination (BCC) threshold of <3%, with ≤1% considered optimal. However, there is not a standardized definition of BCC, and the effect of multiple definitions on BCC rates or what definitions laboratories use remain unknown. We surveyed 52 hospitals and analyzed 362,078 blood cultures (BCx) collected 1 September 2019 to 31 August 2021 from 62 intensive care units (ICUs) and 231 wards from 48 of these hospitals. We calculated and compared BCC rates using the College of American Pathologists (CAP) or CLSI criteria (both utilize a limited number of skin commensals to define BCC) and the comprehensive National Healthcare Safety Network (NHSN) commensal list. We characterized factors associated with BCC and related outcomes (central-line associated bloodstream infection [CLABSI] and vancomycin use). BCC, BCx positivity, and single BCx rates were monitored by 100%, 39%, and 21% of hospitals, respectively. Hospitals used CAP (65%), CLSI (17%), and NHSN (17%) criteria to define BCC. Mean BCC rate by CAP (CAP-BCC) was 1.38% for ICUs and 0.96% for wards. BCC rates remained similar by CLSI criteria but increased when using NHSN list. Sharing BCC data outside of the laboratory, measuring additional BCx quality indicators, and limiting central catheter-drawn BCx were associated with lower BCC rates. BCC was associated with higher CLABSI rates in ICUs. This study demonstrated variability in laboratory practices and opportunities to optimize BCx stewardship.IMPORTANCEBlood culture contamination (BCC) is associated with patient harm and unnecessary use of healthcare resources. BCC thresholds have been established; however, multiple BCC definitions exist. There is limited data on how BCC rates differ depending on the BCC definition used, what definitions laboratories most commonly use, or their approach to other blood cultures (BCx) quality indicators such as single rates or BCx positivity. A cross-sectional multicenter survey and analysis of BCx data from intensive care unit and wards revealed that most laboratories did not track single BCx or BCx positivity rates and that there was variability in how BCC was defined. Additionally, BCC rates were influenced by the definition used. BCC was associated with increased central-line associated bloodstream infection rates.