ABSTRACT Background: Blood cultures (BCs) are obtained to identify etiologic organisms, demonstrate antibiotic efficacy, determine duration of treatment, and/or suggest further interventions. Published guidelines do not clearly state indications and timing for obtaining BCs. As a result, clinicians may obtain too many BCs, increasing cost and patient discomfort.Objective: To determine frequency of BCs performed at our hospital as part of a quality improvement project.Design: Retrospective review of all BCs submitted during a randomly selected month.Setting: A New York City 535-bed, university-affiliated community hospital. Measurements: Patient demographics and BC data were obtained from medical and laboratory records.Results: During the selected month, 2280 BCs were performed for 379 patients. Negative BCs were seen in 221 patients (58%) with one-half having multiple BCs performed within 48 hours of admission and prior to obtaining results of initial BCs. Repeat BCs frequently did not reveal further pathogens among patients with either negative or positive initial BCs. Conclusions: Two-thirds of BCs were obtained from less than one-half of patients without added clinical utility. Often, BCs were repeated prior to results of initial BCs or repeated in patients receiving antibiotics in spite of known low yield following antibiotic initiation. Clinical assessment and review of initial BCs prior to obtaining further BCs is necessary. Staff education regarding appropriate clinical setting for BCs and indications for repeat BCs is required to maximize utilization of resources, improve diagnostic yield, and limit patient discomfort.
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J. Maurer, J. Burns, M. Godfrey, C. Urban and S. Segal-Maurer, "Frequency of Blood Cultures Performed in a Community Hospital," Open Journal of Medical Microbiology, Vol. 3 No. 2, 2013, pp. 130-134. doi: 10.4236/ojmm.2013.32019.
 B. Coburn, A. M. Morris, G. Tomlinson and A. S. Detsky, “Does This Adult with Suspected Bacte Remia Require Blood Cultures?” JAMA, Vol. 308, No. 5, 2012, pp. 502-511. doi:10.1001/jama.2012.8262
 N. I. Shapiro, R. E. Wolfe, S. B. Wright, R. Moore and D. W. Bates, “Who Needs a Blood Culture? A Prospectively Derived and Validated Prediction Rule,” Journal of Emergency Medicine, Vol. 35, No. 3, 2008, pp. 255-264.
 C. C. Lee, C. J. Wu, C. H. Chi, N. Y. Lee, P. L. Chen, H. C. Lee, C. M. Chang, N. Y. Ko and W. C. Ko, “Prediction of Community-Onset Bacte Remia among Febrile Adults Visiting an Emergency Department: Rigor Matters,” Diagnostic Microbiology and Infectious Diseases, Vol. 73, No. 2, 2012, pp. 168-173.
 M. P. Weinstein, “Blood Culture Contamination: Persisting Problems and Partial Progress,” Journal of Clinical Microbiology, Vol. 41, No. 6, 2003, pp. 2275-2278.
 R. B. Schifman, C. L. Strand, F. A. Meier and P. J. Howanitz, “Blood Culture Contamination: A College of American Pathologists Q-Probes Study Involving 640 Institutions and 497134 Specimens from Adult Patients,” Archives of Pathology and Laboratory Medicine, Vol. 122, No. 3, 1998, pp. 216-221.
 M. L. Towns, W. R. Jarvis and P. R. Hsueh, “Guidelines on Blood Cultures,” Journal of Microbiology Immunology and Infection, Vol. 43, No. 4, 2010, pp. 347-349.
 K. K. Hall and J. A. Lyman, “Updated Review of Blood Culture Contamination,” Clinical Microbiology Reviews, Vol. 19, No. 4, 2006, pp. 788-802.
 C. J. Grace, J. Lieberman, K. Pierce and B. Littenberg, “Usefulness of Blood Culture for Hospitalized Patients Who Are Receiving Antibiotic Therapy,” Clinical Infectious Diseases, Vol. 32, No. 11, 2001, pp. 1651-1655.
 C. W. Stratton, “The Use and Abuse of Blood Cultures,” Infectious Disease Newsletter, Vol. 10, No. 4, 1991, pp. 28-31.
 Y. F. Van der Heijden, G. Miller, P. W. Wright, B. E. Shepherd, T. L. Daniels and T. R. Talbot, “Clinical Impact of Blood Cultures Contaminated With Coagulase-Negative Staphylococci at an Academic Center,” Infection Control Hospital Epidemiology, Vol. 32, No. 6, 2011, pp. 623-625. doi:10.1086/660096
 J. M. Darby, P. Linden, W. Pasculle and M. Saul, “Utilization and Diagnostic Yield of Blood Cultures in a Surgical Intensive Care Unit,” Critical Care Medicine, Vol. 25, No. 6, 1997, pp. 989-994.
 B. P. Ehrenstein, T. Jarry, H. J. Linde, J. Scholmerich and T. Gluck, “Low Rate of Clinical Consequences Derived from Results of Blood Cultures Obtained in an Internal Medicine Emergency Department,” Infection, Vol. 33, No. 5-6, 2005, pp. 314-319. doi:10.1007/s15010-005-5065-5
 B. P. Ehrenstein, V. Ehrenstein, C. Henke, H. J. Linde, B. Salzberger, J. Scholmerich and T. Glück, “Risk Factors for Negative Blood Cultures in Adult Medical Inpatients—A Retro Spective Analysis,” BMC Infectious Diseases, Vol. 8, 2008, pp. 148-152.
 M. Aronson and D. Bor, “Blood Cultures,” Annals of Internal Medicine, Vol. 106, No. 2, 1987, pp. 246-253.
 N. Bartlett and M. Naughton, “Assessing the Utility of Repeat Blood Cultures Obtained during Neutropenic Fever,” American Society of Clinical Oncology Annual Meeting, 1999, Abstract No. 2269.
 M. S. Tabriz, K. Riederer, J. Baran and R. Khatib, “Repeating Blood Cultures during Hospital Stay: Practice Pattern at a Teaching Hospital and a Proposal for Guidelines,” Clinical Microbiology and Infection, Vol. 10, No. 7, 2004, pp. 624-627.
 F. J. Roberts, “The Value of the Second Blood Culture,” Journal of Infectious Diseases, Vol. 168, No. 3, 1993, pp. 795-796. doi:10.1093/infdis/168.3.795
 S. Shafazand and A. B. Weinacker, “Blood Cultures in the Critical Care Unit: Improving Utilization and Yield,” Chest, Vol. 122, No. 5, 2002, pp. 1727-1736.
 P. H. Chandrasekar and W. J. Brown, “Clinical Issues of Blood Cultures,” Archives of Internal Medicine, Vol. 154, No. 8, 1994, pp. 841-849.
 J. M. Mylotte and A. Tayara, “Blood Cultures: Clinical Aspects and Controversies,” European Journal of Clinical Microbiology and Infectious Disease, Vol. 19, No. 3, 2000, pp. 157-163. doi:10.1007/s100960050453
 F. Y. Chang, B. B. MacDonald, J. E. Peacock Jr., D. M. Musher, P. Triplett, J. M. Mylotte, A. O’Donnell, M. M. Wagener and V. Yu, “A Prospective Multicenter Study of Staphylococcus Aureus Bacteremia: Incidence of Endocarditis, Risk Factors for Mortality, and Clinical Impact of Methicillin Resistance,” Medicine, Vol. 82, No. 5, 2003, pp. 322-332.
 F. L. Weinbaum, S. Lavie, M. Danek, D. Sixsmith, G. F. Heinrich and S. S. Mills, “Doing It Right the First Time: Quality Improvement and the Contaminant Blood Culture,” Journal of Clinical Microbiology, Vol. 35, No. 3, 1997, pp. 563-565.
 L. G. Bekeris, J. A. Tworek, M. K. Walsh and P. N. Valenstein, “Trends in Blood Culture Cotamination: A College of American Pathologists Q-Tracks Study of 356 Institutions,” Archives of Pathology and Laboratory Medicine, Vol. 129, No. 10, 2005, pp. 1222-1225.