Presenter Status
Fellow
Abstract Type
Research
Primary Mentor
Jessica Markham
Start Date
14-5-2025 12:45 PM
End Date
14-5-2025 1:00 PM
Presentation Type
Oral Presentation
Description
Background: Prior studies of blood culture (BC) testing in uncomplicated community acquired pneumonia (CAP), skin and soft tissue infections (SSTI), and urinary tract infections (UTI) have demonstrated low utility of routine testing given similar rates of pathogen versus contaminant detection and little effect on clinical management. Understanding patterns and outcomes of BC testing can identify opportunities to curb unnecessary testing.
Objectives: The objectives of this study were to: 1) Evaluate BC testing trends over time for children hospitalized for CAP, SSTI, and UTI; and 2) describe differences in clinical outcomes between hospital groups with low, moderate, or high testing rates.
Methods: We conducted a retrospective cohort study using the Pediatric Health Information System database to identify hospitalizations for patients aged 3 months to 18 years admitted with CAP, SSTI, or UTI from 2016-2023. We excluded encounters for complicated disease (e.g., empyema, necrotizing fasciitis), medical complexity, ICU admission, or length of stay (LOS) >7 days. We examined hospital-level BC rates by infection type averaged across the entire time period and changes in annual BC testing over time. Using k-means clustering, we grouped hospitals into low, moderate, and high BC testing groups based on similarities of BC testing rates in the 3 infections. We compared outcomes of LOS, costs, and ED revisits across testing groups using generalized estimating equations adjusted for condition, age, and HRISK severity.
Results: We identified 94,524 hospitalizations across 31 hospitals; BCs were obtained for 41% of CAP, 45% of SSTI, and 55% of UTI encounters. Hospital-level use of BCs varied widely across all 3 infections (e.g., CAP: 16% to 77%; Table 1). Trends over time showed 7 hospitals with statistically significant increases in annual testing while 7 demonstrated decreases in annual testing (Figure 1). Clustering resulted in 13 hospitals in the low, 10 in the moderate, and 8 in the high BC testing groups (Table 1). There were no significant differences in adjusted costs, LOS, or ED-revisits across BC testing groups (Table 2).
Conclusions: Among a large cohort of children admitted with CAP, SSTI, and UTI, BC testing rates remain high with substantial variation across hospitals. Many hospitals demonstrated no change or an increase in BC testing trends despite mounting evidence arguing against the practice. With current national shortages, it is paramount to evaluate blood culture practices and identify opportunities for safely reducing blood culture use.
Included in
Higher Education and Teaching Commons, Medical Education Commons, Pediatrics Commons, Science and Mathematics Education Commons
Variation in blood culture testing and outcomes in children hospitalized with three common infections.
Background: Prior studies of blood culture (BC) testing in uncomplicated community acquired pneumonia (CAP), skin and soft tissue infections (SSTI), and urinary tract infections (UTI) have demonstrated low utility of routine testing given similar rates of pathogen versus contaminant detection and little effect on clinical management. Understanding patterns and outcomes of BC testing can identify opportunities to curb unnecessary testing.
Objectives: The objectives of this study were to: 1) Evaluate BC testing trends over time for children hospitalized for CAP, SSTI, and UTI; and 2) describe differences in clinical outcomes between hospital groups with low, moderate, or high testing rates.
Methods: We conducted a retrospective cohort study using the Pediatric Health Information System database to identify hospitalizations for patients aged 3 months to 18 years admitted with CAP, SSTI, or UTI from 2016-2023. We excluded encounters for complicated disease (e.g., empyema, necrotizing fasciitis), medical complexity, ICU admission, or length of stay (LOS) >7 days. We examined hospital-level BC rates by infection type averaged across the entire time period and changes in annual BC testing over time. Using k-means clustering, we grouped hospitals into low, moderate, and high BC testing groups based on similarities of BC testing rates in the 3 infections. We compared outcomes of LOS, costs, and ED revisits across testing groups using generalized estimating equations adjusted for condition, age, and HRISK severity.
Results: We identified 94,524 hospitalizations across 31 hospitals; BCs were obtained for 41% of CAP, 45% of SSTI, and 55% of UTI encounters. Hospital-level use of BCs varied widely across all 3 infections (e.g., CAP: 16% to 77%; Table 1). Trends over time showed 7 hospitals with statistically significant increases in annual testing while 7 demonstrated decreases in annual testing (Figure 1). Clustering resulted in 13 hospitals in the low, 10 in the moderate, and 8 in the high BC testing groups (Table 1). There were no significant differences in adjusted costs, LOS, or ED-revisits across BC testing groups (Table 2).
Conclusions: Among a large cohort of children admitted with CAP, SSTI, and UTI, BC testing rates remain high with substantial variation across hospitals. Many hospitals demonstrated no change or an increase in BC testing trends despite mounting evidence arguing against the practice. With current national shortages, it is paramount to evaluate blood culture practices and identify opportunities for safely reducing blood culture use.
