Blood culture algorithm implementation in emergency department patients as a diagnostic stewardship intervention - 15/08/24
Résumé |
Objective |
Blood cultures (BCx) are important for selecting appropriate antibiotic treatment. Ordering BCx for conditions with a low probability of bacteremia has limited utility, thus improved guidance for ordering BCx is needed. Inpatient studies have implemented BCx algorithms, but no studies examine the intervention in an Emergency Department (ED) setting.
Methods |
We performed a quasi-experimental pre and postintervention study from January 12, 2020, to October 31, 2023, at a single academic adult ED and implemented a BCx algorithm. The primary outcome was the blood culture event rates (BCE per 100 ED admissions) pre and postintervention. Secondary outcomes included adverse event rates (30-day ED and hospital readmission and antibiotic days of therapy). Seven ED physicians and APP reviewed BCx for appropriateness, with monthly feedback provided to ED leadership and physicians.
Results |
After the BCx algorithm implementation, the BCE rate decreased from 12.17 BCE/100 ED admissions to 10.50 BCE/100 ED admissions. Of the 3,478 reviewed BCE, we adjudicated 2,153 BCE (62%) as appropriate, 653 (19%) as inappropriate, and 672 (19%) as uncertain. Adverse safety events were not statistically different pre and postintervention.
Conclusions |
Implementation of an ED BCx algorithm demonstrated a reduction in BCE, without increased adverse safety events. Future studies should compare outcomes of BCx algorithm implementation in a community hospital ED without intensive chart review.
Le texte complet de cet article est disponible en PDF.Highlights |
• | BCx are crucial for treating bloodstream infections in the ED. |
• | High false-positive BCx rates lead to unnecessary treatments. |
• | BCx algorithm implementation reduced inappropriate orders in the ED. |
• | No increase in adverse events was noted after BCx algorithm use. |
Keywords : Bloodstream infection, Emergency room, Antibiotic stewardship
Plan
Meetings: This work was presented at IDWeek 2023. Oral Abstract, October 13, 2023. Boston, MA. |
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Conflicts of interest: JLS wishes to disclose that she receives royalties from UpToDate as a content expert for pelvic osteomyelitis. Received support for attending the IDWeek 2023 meeting to speak about prosthetic joint infection. Compensated as an expert witness for 3M, Woods Rogers Vandevenier Black PLC, Frith & Ellerman Law Firm, Ross Feller & Casey for litigation related to prosthetic joint infection. |
Vol 52 - N° 9
P. 985-991 - septembre 2024 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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