Blood culture sampling rate in hospitalised children as a quality indicator for diagnostic stewardship

• Published in: Infection 2020-08, Vol.48 (4), p.569-575
• Main Authors: Araujo da Silva, André Ricardo, Jaszkowski, Elena, Schober, Tilmann, von Both, Ulrich, Meyer-Buehn, Melanie, Hübner, Ariana, Hübner, Johannes
• Format: Article
• Language: English
• Subjects: Adolescent; Bacteria; Blood; Blood culture; Blood Culture - statistics & numerical data; Child; Child, Hospitalized; Child, Preschool; Children; Cohort Studies; Diagnostic systems; Family Medicine; General Practice; Germany; Gram-positive bacteria; Hematology; Hospitalization; Humans; Infant; Infant, Newborn; Infectious Diseases; Internal Medicine; Medical diagnosis; Medicine; Medicine & Public Health; Neonates; Oncology; Original Paper; Pediatrics; Quality control; Quality Indicators, Health Care - statistics & numerical data; Retrospective Studies; Sampling Studies; Sepsis - diagnosis
• ISSN: 0300-8126; 1439-0973
• DOI: 10.1007/s15010-020-01439-y

Purpose Recommendations regarding the optimal number of blood cultures in children are not available. The aim of this article is to describe the correlation between blood culture (BC) rates and laboratory-confirmed bloodstream infection (LCBSI) rates, on different paediatric wards of a tertiary-care centre in Germany. Methods We conducted a retrospective cohort study in a paediatric university hospital, from 1st January to 31st December 2018. All blood cultures collected from neonatal (NICU) and paediatric intensive-care units (PICU), haematology/oncology, and general paediatric wards were included. There were no exclusion criteria. BC taken/1000 patients-days (BC rates/BCR) and LCBSI/1000 patient-days at risk (LCBSI rates) were calculated for each unit. Results A total of 6040 patients were admitted to the hospital with 3114 of them into wards studied. Of the 3072 BCs collected, 200 (6.5%) were positive. Collection of BCs was performed in 51/77 (66.2%) of admitted patients on NICU, in 151/399 (37.8%) of PICU patients, in 163/755 (21.6%) of haematology/oncology patients, and in 281/1883 (14.9%) of children on general paediatric wards. Gram-positive bacteria were the most commonly detected organisms in blood cultures from all wards with exception of NICU. The BCR in NICU, PICU, haematology/oncology wards, and general wards were 61.6, 196.2, 358.4, and 52.3, respectively. Excluding commensal pathogens and possible contaminations, the LCBSI rates in the same units were 2.4, 5.6, 4.4, and 1.0, respectively. Conclusion We found different BCR values according the ward studied, being higher in patients with high risk of bloodstream infection such as haematology/oncology patients.