Merlos Priscila Gabriella Carraro, Loesch Gustavo Henrique, Tuon Felipe Francisco
Laboratório de Doenças Infecciosas Emergentes, Faculdade de Medicina, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brasil.
Florida Christian University, Orlando, Florida, USA.
Rev Soc Bras Med Trop. 2025 Aug 8;58:e00942025. doi: 10.1590/0037-8682-0094-2025. eCollection 2025.
This study aimed to assess the clinical and economic impacts of blood culture contamination in a hospital situated in a low-middle-income country and the breakeven to implement strategies to avoid unnecessary antimicrobials.
This economic cross-sectional study was conducted at a tertiary hospital, and 8,072 blood cultures were analyzed. Antibiotic duration and cost were calculated in United States dollars (USD). A simulation with a breakeven curve to determine the balance between antimicrobial costs and time-to-result of coagulase-negative staphylococci in one blood culture (suggestive of contamination) was used to define the breakeven point between the cost of the diagnostic tests or prevention strategies and the balance with antimicrobial expense.
Of the 8,072 blood culture samples collected, the contamination rate was 9.9%. Antimicrobial therapy was initiated in 69.6% of the 682 cases of contamination. The median duration of unnecessary antibiotic use was 7 days. The direct costs totaled USD 83,910 annually, comprising USD 73,970 for unnecessary antimicrobials and USD 9,940 for microbiological tests. The extended length of hospital stay potentially contributed to an additional USD 3.87 million in annual hospital costs.
This study underscores the urgent need for strategies to reduce blood culture contamination, and emphasizes the potential benefits of rapid identification techniques for optimizing patient care and healthcare resource utilization. Addressing this issue is of paramount importance for mitigating unnecessary antibiotic exposure, reducing healthcare costs, and improving patient outcomes.
本研究旨在评估中低收入国家一家医院血培养污染的临床和经济影响，以及实施避免不必要使用抗菌药物策略的收支平衡点。
这项经济横断面研究在一家三级医院开展，共分析了8072份血培养样本。抗生素使用时长和费用以美元计算。采用收支平衡曲线模拟来确定一次血培养中凝固酶阴性葡萄球菌（提示污染）的抗菌药物成本与出结果时间之间的平衡，以界定诊断检测或预防策略成本与抗菌药物费用平衡之间的收支平衡点。
在收集的8072份血培养样本中，污染率为9.9%。在682例污染病例中，69.6%开始了抗菌治疗。不必要使用抗生素的中位时长为7天。每年直接成本总计83910美元，其中不必要的抗菌药物费用为73970美元，微生物检测费用为9940美元。住院时间延长可能使每年医院成本额外增加387万美元。
本研究强调迫切需要采取策略减少血培养污染，并强调快速鉴定技术对于优化患者护理和医疗资源利用的潜在益处。解决这一问题对于减轻不必要的抗生素暴露、降低医疗成本和改善患者结局至关重要。
