Mera María I Font, Oswalt Cameron, McManus Hannah D, Seidelman Jessica L
Division of Medical Oncology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
Division of Infectious Diseases, Department of Internal Medicine, Duke University School of Medicine, Durham, NC, USA.
Support Care Cancer. 2025 Aug 12;33(9):780. doi: 10.1007/s00520-025-09835-6.
Unnecessary blood cultures (BCx) increase healthcare costs, BCx contamination, and antibiotic overuse, particularly in cancer patients. Recent shortages in BCx bottles have amplified the need for more judicious BCx practices, especially in high-risk populations like oncology patients. This study evaluates the impact of a BCx algorithm on BCx rates and clinical outcomes in a solid-tumor oncology unit at Duke University Hospital.
We implemented a BCx algorithm in a solid-tumor oncology unit at Duke University Hospital. The primary objective was to compare BCx events in the pre- (2/2021-1/2023) and post-intervention (2/2023-7/2024) periods, which we defined as the collection of one or more BCx sets ordered by a clinician for a specific clinical indication per 100 inpatient days. Secondary outcomes were analyzed during the same periods and included length of stay, in-hospital mortality, 30-day readmission rates, and antibiotic days of therapy (DOT). BCx appropriateness was also assessed. An interrupted time-series analysis using Poisson regression assessed changes in BCx rates over time.
Following the implementation of the algorithm, there was a 38% reduction in the rate of BCx events per 100 patient days. Additionally, BCx appropriateness improved, and we observed no increase in adverse outcomes including DOT, in-hospital mortality, and 30-day readmission rates.
A BCx algorithm implementation in a solid-tumor oncology unit led to a substantial decrease in BCx event rates without an increase in adverse outcomes. This suggests that judicious BCx stewardship through algorithmic guidance is a viable strategy for reducing unnecessary testing in oncology patients.
不必要的血培养（BCx）会增加医疗成本、血培养污染率以及抗生素的过度使用，尤其是在癌症患者中。近期血培养瓶的短缺加剧了对更明智的血培养操作的需求，特别是在肿瘤患者等高风险人群中。本研究评估了血培养算法对杜克大学医院实体肿瘤肿瘤科血培养率和临床结局的影响。
我们在杜克大学医院的实体肿瘤肿瘤科实施了血培养算法。主要目标是比较干预前（2021年2月 - 2023年1月）和干预后（2023年2月 - 2024年7月）期间的血培养事件，我们将其定义为临床医生为特定临床指征每100个住院日开出的一个或多个血培养套餐的采集量。在同一时期分析次要结局，包括住院时间、院内死亡率、30天再入院率以及抗生素治疗天数（DOT）。还评估了血培养的适宜性。使用泊松回归的中断时间序列分析评估血培养率随时间的变化。
实施该算法后，每100个患者日的血培养事件率降低了38%。此外，血培养的适宜性得到改善，并且我们观察到包括DOT、院内死亡率和30天再入院率在内的不良结局没有增加。
在实体肿瘤肿瘤科实施血培养算法导致血培养事件率大幅下降，且不良结局没有增加。这表明通过算法指导进行明智的血培养管理是减少肿瘤患者不必要检测的可行策略。
