Blood culture algorithm implementation in emergency department patients as a diagnostic stewardship intervention

Blood cultures (BCx) are important for selecting appropriate antibiotic treatment. Ordering BCx for conditions with a low probability of bacteremia has limited utility, thus improved guidance for ordering BCx is needed. Inpatient studies have implemented BCx algorithms, but no studies examine the in...

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Veröffentlicht in:American journal of infection control Jg. 52; H. 9; S. 985 - 991
Hauptverfasser: Theophanous, Rebecca, Ramos, John, Calland, Alyssa R., Krcmar, Rachel, Shah, Priya, da Matta, Lucas T., Shaheen, Stephen, Wrenn, Rebekah H., Seidelman, Jessica
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States Elsevier Inc 01.09.2024
Schlagworte:
Antibiotic stewardship
Bloodstream infection
Emergency room
Infectious Disease
Bloodstream infection
Antibiotic stewardship
Emergency room
blood culture algorithm
blood culture
diagnostic stewardship
ISSN:0196-6553, 1527-3296, 1527-3296
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Zusammenfassung:Blood cultures (BCx) are important for selecting appropriate antibiotic treatment. Ordering BCx for conditions with a low probability of bacteremia has limited utility, thus improved guidance for ordering BCx is needed. Inpatient studies have implemented BCx algorithms, but no studies examine the intervention in an Emergency Department (ED) setting. We performed a quasi-experimental pre and postintervention study from January 12, 2020, to October 31, 2023, at a single academic adult ED and implemented a BCx algorithm. The primary outcome was the blood culture event rates (BCE per 100 ED admissions) pre and postintervention. Secondary outcomes included adverse event rates (30-day ED and hospital readmission and antibiotic days of therapy). Seven ED physicians and APP reviewed BCx for appropriateness, with monthly feedback provided to ED leadership and physicians. After the BCx algorithm implementation, the BCE rate decreased from 12.17 BCE/100 ED admissions to 10.50 BCE/100 ED admissions. Of the 3,478 reviewed BCE, we adjudicated 2,153 BCE (62%) as appropriate, 653 (19%) as inappropriate, and 672 (19%) as uncertain. Adverse safety events were not statistically different pre and postintervention. Implementation of an ED BCx algorithm demonstrated a reduction in BCE, without increased adverse safety events. Future studies should compare outcomes of BCx algorithm implementation in a community hospital ED without intensive chart review. •BCx are crucial for treating bloodstream infections in the ED.•High false-positive BCx rates lead to unnecessary treatments.•BCx algorithm implementation reduced inappropriate orders in the ED.•No increase in adverse events was noted after BCx algorithm use.
Bibliographie:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
ISSN:0196-6553
1527-3296
1527-3296
DOI:10.1016/j.ajic.2024.04.198