快速诊断管理和血液培养在儿科医疗中心的应用。

IF 9.7 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Esther Vaugon, Cristina Costales, Zein Assad, Thomas Barter, Leila C Posch, Etan Orgel, Deborah R Liu, Jennifer Dien Bard
{"title":"快速诊断管理和血液培养在儿科医疗中心的应用。","authors":"Esther Vaugon, Cristina Costales, Zein Assad, Thomas Barter, Leila C Posch, Etan Orgel, Deborah R Liu, Jennifer Dien Bard","doi":"10.1001/jamanetworkopen.2025.35580","DOIUrl":null,"url":null,"abstract":"<p><strong>Importance: </strong>A national shortage of blood culture bottles affected approximately half of US hospitals, necessitating changes in blood culture practices.</p><p><strong>Objective: </strong>To determine the association between restrictive blood culture stewardship measures and patient outcomes at a pediatric hospital.</p><p><strong>Design, setting, and participants: </strong>A retrospective cohort study was performed to determine the association between new restrictive stewardship measures and blood culture practices in a quaternary care pediatric medical center from July 1, 2023, to January 31, 2025. All children with blood cultures collected were included.</p><p><strong>Exposures: </strong>The following restrictive measures were enacted: (1) a 48-hour restriction on all aerobic blood cultures, (2) a 7-day restriction on all anaerobic blood cultures, (3) authorization to order an additional aerobic blood culture every 7 days, and (4) pooling of all central vein catheter lumens in 1 blood culture bottle.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was the monthly blood culture positivity rate, stratified and normalized per 100 emergency department (ED) visits and per 100 patient-days.</p><p><strong>Results: </strong>During the study period, a total of 18 132 blood cultures from 5063 patient visits (median [IQR] age, 5.6 [1.1-12.4] years; 2744 [54.2%] male; 358 [7.15%] Black, 3013 [58.5%] Latino/a/x/Hispanic, and 720 [14.2%] White patients) were collected from August 1, 2023, to July 31, 2024 (preintervention period), and 6449 blood cultures from 2495 patient visits (1391 [55.8%] male, median [IQR] age; 5.5 [1.1-12.5] years; 191 [7.7%] Black, 1452 [58.2%] Latino/a/x/Hispanic, and 375 [15.0%] White patients) were collected from August 1, 2024, to January 31, 2025 (postintervention period). Restrictive stewardship measures were associated with a significant decrease in the blood culture collection rate per 100 ED visits (cumulative change, -24.1%; 95% CI, -38.4% to -8.9%; P = .01) and per 100 patient-days (cumulative change, -45.8%; 95% CI, -64.7% to -26.9%; P < .001). In the ED and inpatient units, the blood culture positivity rate remained stable, with a 14.4% (95% CI, -23.1% to 52.0%) and 27.8% (95% CI, -13.7% to 69.3%) cumulative increase, respectively. There was no significant change in hospital mortality due to septic shock (0.13% vs 0.15%) or mean length of stay (5.4 days vs 6.4 days), but there was a significant decrease in readmissions (3.3 vs 2.7; cumulative change, -27.5%; 95% CI, -7.6% to -47.6%; P = .02).</p><p><strong>Conclusions and relevance: </strong>The implementation of restrictive blood culture measures, including pooling lumens and decreasing testing cadence, successfully reduced blood cultures collected without decreasing blood culture positivity rates and without an increase in mortality secondary to septic shock, readmission rates, or length of stay.</p>","PeriodicalId":14694,"journal":{"name":"JAMA Network Open","volume":"8 10","pages":"e2535580"},"PeriodicalIF":9.7000,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12501814/pdf/","citationCount":"0","resultStr":"{\"title\":\"Rapid Diagnostic Stewardship and Blood Culture Use in a Pediatric Medical Center.\",\"authors\":\"Esther Vaugon, Cristina Costales, Zein Assad, Thomas Barter, Leila C Posch, Etan Orgel, Deborah R Liu, Jennifer Dien Bard\",\"doi\":\"10.1001/jamanetworkopen.2025.35580\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Importance: </strong>A national shortage of blood culture bottles affected approximately half of US hospitals, necessitating changes in blood culture practices.</p><p><strong>Objective: </strong>To determine the association between restrictive blood culture stewardship measures and patient outcomes at a pediatric hospital.</p><p><strong>Design, setting, and participants: </strong>A retrospective cohort study was performed to determine the association between new restrictive stewardship measures and blood culture practices in a quaternary care pediatric medical center from July 1, 2023, to January 31, 2025. All children with blood cultures collected were included.</p><p><strong>Exposures: </strong>The following restrictive measures were enacted: (1) a 48-hour restriction on all aerobic blood cultures, (2) a 7-day restriction on all anaerobic blood cultures, (3) authorization to order an additional aerobic blood culture every 7 days, and (4) pooling of all central vein catheter lumens in 1 blood culture bottle.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was the monthly blood culture positivity rate, stratified and normalized per 100 emergency department (ED) visits and per 100 patient-days.</p><p><strong>Results: </strong>During the study period, a total of 18 132 blood cultures from 5063 patient visits (median [IQR] age, 5.6 [1.1-12.4] years; 2744 [54.2%] male; 358 [7.15%] Black, 3013 [58.5%] Latino/a/x/Hispanic, and 720 [14.2%] White patients) were collected from August 1, 2023, to July 31, 2024 (preintervention period), and 6449 blood cultures from 2495 patient visits (1391 [55.8%] male, median [IQR] age; 5.5 [1.1-12.5] years; 191 [7.7%] Black, 1452 [58.2%] Latino/a/x/Hispanic, and 375 [15.0%] White patients) were collected from August 1, 2024, to January 31, 2025 (postintervention period). Restrictive stewardship measures were associated with a significant decrease in the blood culture collection rate per 100 ED visits (cumulative change, -24.1%; 95% CI, -38.4% to -8.9%; P = .01) and per 100 patient-days (cumulative change, -45.8%; 95% CI, -64.7% to -26.9%; P < .001). In the ED and inpatient units, the blood culture positivity rate remained stable, with a 14.4% (95% CI, -23.1% to 52.0%) and 27.8% (95% CI, -13.7% to 69.3%) cumulative increase, respectively. There was no significant change in hospital mortality due to septic shock (0.13% vs 0.15%) or mean length of stay (5.4 days vs 6.4 days), but there was a significant decrease in readmissions (3.3 vs 2.7; cumulative change, -27.5%; 95% CI, -7.6% to -47.6%; P = .02).</p><p><strong>Conclusions and relevance: </strong>The implementation of restrictive blood culture measures, including pooling lumens and decreasing testing cadence, successfully reduced blood cultures collected without decreasing blood culture positivity rates and without an increase in mortality secondary to septic shock, readmission rates, or length of stay.</p>\",\"PeriodicalId\":14694,\"journal\":{\"name\":\"JAMA Network Open\",\"volume\":\"8 10\",\"pages\":\"e2535580\"},\"PeriodicalIF\":9.7000,\"publicationDate\":\"2025-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12501814/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JAMA Network Open\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1001/jamanetworkopen.2025.35580\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JAMA Network Open","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1001/jamanetworkopen.2025.35580","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0

摘要

重要性:全国血液培养瓶短缺影响了大约一半的美国医院,需要改变血液培养做法。目的:探讨某儿科医院限制性血培养管理措施与患者预后的关系。设计、环境和参与者:进行了一项回顾性队列研究,以确定2023年7月1日至2025年1月31日在一家四级护理儿科医疗中心实施的新的限制性管理措施与血培养实践之间的关系。所有收集血培养的儿童均纳入研究。暴露:制定了以下限制性措施:(1)所有有氧血培养限制48小时,(2)所有无氧血培养限制7天,(3)授权每7天额外进行一次有氧血培养,(4)将所有中心静脉导管管腔集中在1个血培养瓶中。主要结局和指标:主要结局为每月血培养阳性率,每100次急诊科(ED)就诊和每100患者日分层和标准化。结果:在研究期间,从2023年8月1日至2024年7月31日(干预前),共收集5063例患者(年龄中位数为5.6[1.1-12.4]岁,男性2744例[54.2%],黑人358例[7.15%],拉丁裔/a/x/西班牙裔3013例[58.5%],白人720例[14.2%])的18 132例血培养,2495例患者(男性1391例[55.8%],年龄中位数[IQR], 5.5[1.1-12.5]岁,男性1391例[55.8%])的6449例血培养。2024年8月1日至2025年1月31日(干预后期),共收集黑人191例(7.7%),拉丁裔/a/x/西班牙裔1452例(58.2%),白人375例(15.0%)。限制性管理措施与每100次ED就诊的血液培养收集率显著下降相关(累积变化,-24.1%;95% CI, -38.4%至-8.9%;P =。结论和相关性:限制性血培养措施的实施,包括集中管腔和减少检测频率,成功地减少了血培养收集量,而没有降低血培养阳性率,也没有增加感染性休克的死亡率、再入院率或住院时间。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Rapid Diagnostic Stewardship and Blood Culture Use in a Pediatric Medical Center.

Importance: A national shortage of blood culture bottles affected approximately half of US hospitals, necessitating changes in blood culture practices.

Objective: To determine the association between restrictive blood culture stewardship measures and patient outcomes at a pediatric hospital.

Design, setting, and participants: A retrospective cohort study was performed to determine the association between new restrictive stewardship measures and blood culture practices in a quaternary care pediatric medical center from July 1, 2023, to January 31, 2025. All children with blood cultures collected were included.

Exposures: The following restrictive measures were enacted: (1) a 48-hour restriction on all aerobic blood cultures, (2) a 7-day restriction on all anaerobic blood cultures, (3) authorization to order an additional aerobic blood culture every 7 days, and (4) pooling of all central vein catheter lumens in 1 blood culture bottle.

Main outcomes and measures: The primary outcome was the monthly blood culture positivity rate, stratified and normalized per 100 emergency department (ED) visits and per 100 patient-days.

Results: During the study period, a total of 18 132 blood cultures from 5063 patient visits (median [IQR] age, 5.6 [1.1-12.4] years; 2744 [54.2%] male; 358 [7.15%] Black, 3013 [58.5%] Latino/a/x/Hispanic, and 720 [14.2%] White patients) were collected from August 1, 2023, to July 31, 2024 (preintervention period), and 6449 blood cultures from 2495 patient visits (1391 [55.8%] male, median [IQR] age; 5.5 [1.1-12.5] years; 191 [7.7%] Black, 1452 [58.2%] Latino/a/x/Hispanic, and 375 [15.0%] White patients) were collected from August 1, 2024, to January 31, 2025 (postintervention period). Restrictive stewardship measures were associated with a significant decrease in the blood culture collection rate per 100 ED visits (cumulative change, -24.1%; 95% CI, -38.4% to -8.9%; P = .01) and per 100 patient-days (cumulative change, -45.8%; 95% CI, -64.7% to -26.9%; P < .001). In the ED and inpatient units, the blood culture positivity rate remained stable, with a 14.4% (95% CI, -23.1% to 52.0%) and 27.8% (95% CI, -13.7% to 69.3%) cumulative increase, respectively. There was no significant change in hospital mortality due to septic shock (0.13% vs 0.15%) or mean length of stay (5.4 days vs 6.4 days), but there was a significant decrease in readmissions (3.3 vs 2.7; cumulative change, -27.5%; 95% CI, -7.6% to -47.6%; P = .02).

Conclusions and relevance: The implementation of restrictive blood culture measures, including pooling lumens and decreasing testing cadence, successfully reduced blood cultures collected without decreasing blood culture positivity rates and without an increase in mortality secondary to septic shock, readmission rates, or length of stay.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
JAMA Network Open
JAMA Network Open Medicine-General Medicine
CiteScore
16.00
自引率
2.90%
发文量
2126
审稿时长
16 weeks
期刊介绍: JAMA Network Open, a member of the esteemed JAMA Network, stands as an international, peer-reviewed, open-access general medical journal.The publication is dedicated to disseminating research across various health disciplines and countries, encompassing clinical care, innovation in health care, health policy, and global health. JAMA Network Open caters to clinicians, investigators, and policymakers, providing a platform for valuable insights and advancements in the medical field. As part of the JAMA Network, a consortium of peer-reviewed general medical and specialty publications, JAMA Network Open contributes to the collective knowledge and understanding within the medical community.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信