Abstracts of the 7th World Congress on Pediatric Critical Care
Background and aims: High numbers of blood cultures (BC) are taken in PICU with low positive yields.
Aims: We aimed to identify indications for cultures, rates of true positive bloodstream infections (BSI) and quality improvement areas.
Methods: Analysis of all PICU BC results to identify true BSIs over 10 months from January-October 2013. A 3 month audit analysed culture indications, physiological parameters and timing in relation to antimicrobial therapy. BC sampling guidelines were introduced in September 2013. Institutional consent requirement was waivered.
Results: Of 1123 PICU admissions over 10 months, 348 (31%) had BCs taken. 34 patients had proven BSI. 53% were community-acquired and 47% healthcare-acquired infections (HCAI). Half of HCAIs resulted from Gram negative infections and half from either methicillin sensitive Staphylococcus aureus or coagulase negative staphylococcus (CNS). Central venous catheter-related BSIs were the commonest HCAI (64% of HCAIs).
40 patients had a false positive culture, most commonly CNS (>95%).
116 patients who were cultured were audited. The commonest indication was pyrexia followed by sepsis/systemic inflammatory response.
The majority of patients had ≤2 sites cultured. 12% of cultures had been repeated within 24 hours. 72% of cultures were taken when already on antibiotics.
Following guideline introduction, BC sampling rates fell by 25%, primarily with reductions in multi-site sampling and repeat cultures within 24 hours. Proportion of positive BCs due to contaminants remains 50%.
Conclusions: Formalised BC sampling guidelines can reduce duplicate sampling with associated cost improvements and no evidence of delayed infection diagnosis. Ongoing high contamination rates remain a problem with potential inappropriate antibiotic administration.