Wing Tech Inc., Menlo Park, CA, USA; Division of General Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.
Division of Infectious Diseases, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA; Division of Infectious Diseases, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA.
J Hosp Infect. 2019 Aug;102(4):438-444. doi: 10.1016/j.jhin.2019.03.012. Epub 2019 Mar 27.
Blood culture contamination (BCC) increases length of stay (LOS) and leads to unnecessary antimicrobial therapy and/or hospital-acquired conditions (HACs).
To quantify the magnitude of additional LOS, costs to hospitals and society, and harm to patients attributable to BCC.
A retrospective matched survival analysis was performed involving hospitalized patients with septicaemia-compatible symptoms. BCC costs, HACs and potential savings were calculated based on the primary LOS data, a modified Delphi process and published sources. The cost analysis compared standard care with interventions for reducing BCC, and estimated annual economic and clinical consequences for a typical hospital and for the USA as a whole.
Patients with BCC experienced a mean increase in LOS of 2.35 days (P=0.0076). Avoiding BCC would decrease costs by $6463 [$4818 from inpatient care (53% of which was from reduced LOS) and 26% from reduced antibiotic use]. Annually, in a typical 250- to 400-bed hospital, employing phlebotomists would save $1.3 million and prevent 24 HACs (including two cases of Clostridium difficile infection); based on clinical efficacy evidence, use of the studied initial specimen diversion device (ISDD) would save $1.9 million and prevent 34 HACs (including three cases of C. difficile infection). In the USA, the respective strategies would prevent 69,300 and 102,900 HACs (including 6000 and 8900 cases of C. difficile infection) and save $5 and $7.5 billion.
Costs and clinical burdens associated with false-positive cultures are substantial and can be reduced by available interventions, including phlebotomists and use of ISDD.
血培养污染（BCC）会延长住院时间（LOS），导致不必要的抗菌治疗和/或医院获得性感染（HACs）。
量化因 BCC 而导致的 LOS 延长、医院和社会的成本增加以及对患者的伤害。
对符合败血症症状的住院患者进行回顾性匹配生存分析。根据主要 LOS 数据、修改后的德尔菲法和已发表的资料，计算 BCC 相关成本、HAC 以及潜在的节省费用。成本分析比较了标准护理与减少 BCC 的干预措施，估算了一家典型医院和整个美国的年度经济和临床后果。
BCC 患者的 LOS 平均延长了 2.35 天（P=0.0076）。避免 BCC 可减少 6463 美元的成本[4818 美元来自住院治疗（其中 53%来自 LOS 减少），26%来自抗生素使用减少]。在一家典型的 250-400 床位医院中，每年雇佣采血员可节省 130 万美元，并预防 24 例 HACs（包括两例艰难梭菌感染）；根据临床疗效证据，使用所研究的初始标本分流装置（ISDD）可节省 190 万美元，并预防 34 例 HACs（包括三例艰难梭菌感染）。在美国，这两种策略将预防 69300 和 102900 例 HACs（包括 6000 和 8900 例艰难梭菌感染），并节省 50 亿美元和 75 亿美元。
与假阳性培养相关的成本和临床负担是巨大的，可以通过现有的干预措施来减少，包括采血员和使用 ISDD。
