Decreasing Blood Culture Collection in Hospitalized Patients with CAP, SSTI, and UTI

Monica D Combs; Danica B Liberman; Vivian Lee

doi:10.1097/pq9.0000000000000705

Decreasing Blood Culture Collection in Hospitalized Patients with CAP, SSTI, and UTI

Pediatr Qual Saf. 2023 Dec 5;8(6):e705. doi: 10.1097/pq9.0000000000000705. eCollection 2023 Nov-Dec.

Authors

Monica D Combs^{1

2}, Danica B Liberman^{2

3

4}, Vivian Lee^{1

2}

Affiliations

¹ From the Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, Calif.
² Department of Pediatrics, Keck School of Medicine of University of Southern California, Los Angeles, Calif.
³ Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Los Angeles, Calif.
⁴ Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, Calif.

Abstract

Background: Blood culture collection in pediatric patients with community-acquired pneumonia (CAP), skin and soft tissue infections (SSTI), and urinary tract infections (UTI) remains high despite evidence of its limited utility. We aimed to decrease the number of cultures collected in children hospitalized for CAP, SSTI, and UTI by 25% over 11 months.

Methods: Quality improvement initiative at a children's hospital among well-appearing patients aged 2 months or more to 18 years diagnosed with CAP, SSTI, or UTI. Our primary and secondary outcomes were blood culture collection rate and positivity rate, respectively. Interventions focused on three key drivers: academic detailing, physician awareness of personal performance, and data transparency.

Results: Over the 2-year study period, there were 105 blood cultures collected in 223 hospitalized patients. Blood culture collection rates demonstrated special cause variation, decreasing from 63.5% to 24.5%. For patients with UTI, 86% (18/21) of blood cultures were negative, whereas 100% were negative for CAP and SSTI. All three patients with bacteremic UTI had a concurrent urine culture growing the same pathogen. Balancing measures remained unchanged, including escalation to a higher level of care and return to the emergency department or hospital within 14 days for the same infection.

Conclusions: A multifaceted quality improvement approach can reduce blood culture collection for hospitalized patients with CAP, SSTI, and UTI without significant changes to balancing measures. Despite the reduction achieved, the near-universal negative culture results suggest continued overutilization and highlight the need for more targeted approaches to blood culture collection.