Fabre Valeria, Hsu Yea-Jen, Carroll Karen C, Salinas Alejandra B, Gadala Avinash, Bower Chris, Boyd Sarah, Degnan Kathleen O, Dhaubhadel Pragya, Diekema Daniel J, Drees Marci, Feeser Baevin, Fisher Mark A, Flynn Cynthia, Ford Bradley, Gettler Erin B, Glaser Laurel J, Howard-Anderson Jessica, Johnson J Kristie, Kim Justin J, Martinez Marvin, Mathers Amy J, Mermel Leonard A, Moehring Rebekah W, Nelson George E, O'Horo John C, Pepe Dana E, Robinson Evan D, Rodríguez-Nava Guillermo, Ryder Jonathan H, Salinas Jorge L, Schrank Gregory M, Shah Aditya, Shelly Mark, Spivak Emily S, Stewart Kathleen O, Talbot Thomas R, Van Schooneveld Trevor C, Wasylyshyn Anastasia, Cosgrove Sara E
Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Health Policy and Management, Johns Hopkins Bloomberg of School of Public Health, Baltimore, Maryland.
JAMA Netw Open. 2025 Jan 2;8(1):e2454738. doi: 10.1001/jamanetworkopen.2024.54738.
Blood culture (BC) use benchmarks in US hospitals have not been defined.
To characterize BC use in adult intensive care units (ICUs) and wards in US hospitals.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective cross-sectional study of BC use in adult medical ICUs, medical-surgical ICUs, medical wards, and medical-surgical wards from acute care hospitals from the 4 US geographic regions was conducted. Critical access hospitals, less than 6 months of BC data, and non-US hospitals were excluded. The study included BC use data from September 1, 2019, to August 31, 2021. Data were analyzed from February 23 to July 14, 2024.
The primary outcome was BC use per 1000 patient-days. Adjusted means with 95% CIs were calculated using mixed-effects negative binomial regression models adjusted for unit type, hospital bed size, geographic region, seasonality, and state COVID-19 case load, with random intercepts accounting for clustering at unit and hospital levels. Secondary outcomes included blood culture positivity, single BCs, BC contamination, and minimum threshold for BC use where blood culture positivity would be optimized.
A total of 362 327 blood cultures were analyzed from 27 medical ICUs, 35 medical-surgical ICUs, 121 medical wards, and 109 medical-surgical wards from 48 hospitals in 19 states and the District of Columbia. The adjusted mean BC use per 1000 patient-days was 273.1 (95% CI, 270.2-275.9) for medical ICUs, 146.0 (95% CI, 144.5-147.5) for medical-surgical ICUs, 80.3 (95% CI, 79.8-80.7) for medical wards, and 65.1 for medical-surgical wards. Blood culture use was significantly higher across all 4 unit types in hospitals with more than 500 beds compared with 500 or less beds and in the West-Midwest compared with other regions. Single blood culture and positive blood culture rates were below 10% across all 4 unit types. Of the 292 units, 97% had a mean BC contamination rate within 3% of the recommended threshold, and 51% were within 1%. The minimum BC use thresholds (ie, BC use below this number may represent undertesting) were 120 BCs per 1000 patient-days for medical ICUs, 80 BCs per 1000 patient-days for medical-surgical ICUs, and 30 BCs per 1000 patient-days for medical-surgical wards.
The findings of this study suggest that blood culture positivity may help determine appropriate BC use for individual unit types.
美国医院血培养（BC）使用基准尚未明确。
描述美国医院成人重症监护病房（ICU）和病房的血培养使用情况。
设计、设置和参与者：对来自美国4个地理区域的急性护理医院的成人内科ICU、内科-外科ICU、内科病房和内科-外科病房的血培养使用情况进行了一项回顾性横断面研究。排除了临界接入医院、血培养数据少于6个月的医院以及非美国医院。该研究纳入了2019年9月1日至2021年8月31日的血培养使用数据。于2024年2月23日至7月14日进行数据分析。
主要结局是每1000患者日的血培养使用量。使用混合效应负二项回归模型计算调整后的均值及95%置信区间，该模型针对单位类型、医院床位规模、地理区域、季节性和州新冠病例负荷进行了调整，随机截距考虑了单位和医院层面的聚类情况。次要结局包括血培养阳性率、单次血培养、血培养污染以及优化血培养阳性率时血培养使用的最低阈值。
对来自19个州和哥伦比亚特区48家医院的27个内科ICU、35个内科-外科ICU、121个内科病房和109个内科-外科病房的362327次血培养进行了分析。内科ICU每1000患者日的调整后平均血培养使用量为273.1（95%置信区间，270.2 - 275.9），内科-外科ICU为146.0（95%置信区间，144.5 - 147.5），内科病房为80.3（95%置信区间，79.8 - 80.7），内科-外科病房为65.1。与床位500张及以下的医院相比，床位超过500张的医院中所有4种单位类型的血培养使用量均显著更高；与其他地区相比，中西部地区的血培养使用量显著更高。所有4种单位类型的单次血培养和血培养阳性率均低于10%。在292个单位中，97%的单位平均血培养污染率在推荐阈值的3%以内，51%的单位在1%以内。内科ICU每1000患者日血培养使用的最低阈值（即低于此数量的血培养使用可能表示检测不足）为120次血培养，内科-外科ICU为每1000患者日80次血培养，内科-外科病房为每1000患者日3次血培养。
本研究结果表明，血培养阳性率可能有助于确定各单位类型合适的血培养使用量。
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