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. 2025 Jan 2;8(1):e2454738.
doi: 10.1001/jamanetworkopen.2024.54738.

Blood Culture Use in Medical and Surgical Intensive Care Units and Wards

Valeria Fabre  1 , Yea-Jen Hsu  2 , Karen C Carroll  3 , Alejandra B Salinas  1 , Avinash Gadala  4 , Chris Bower  5 , Sarah Boyd  6 , Kathleen O Degnan  7 , Pragya Dhaubhadel  8 , Daniel J Diekema  9 , Marci Drees  10 , Baevin Feeser  11 , Mark A Fisher  12 , Cynthia Flynn  10 , Bradley Ford  13 , Erin B Gettler  14 , Laurel J Glaser  15 , Jessica Howard-Anderson  5 , J Kristie Johnson  16 , Justin J Kim  17 , Marvin Martinez  18 , Amy J Mathers  19 , Leonard A Mermel  18   20 , Rebekah W Moehring  14 , George E Nelson  21 , John C O'Horo  22 , Dana E Pepe  23 , Evan D Robinson  19 , Guillermo Rodríguez-Nava  24 , Jonathan H Ryder  25 , Jorge L Salinas  24 , Gregory M Schrank  26 , Aditya Shah  22 , Mark Shelly  8 , Emily S Spivak  27 , Kathleen O Stewart  28 , Thomas R Talbot  21 , Trevor C Van Schooneveld  25 , Anastasia Wasylyshyn  29 , Sara E Cosgrove  1 ; Centers for Disease Control and Prevention (CDC) Prevention Epicenters Program
Affiliations

Blood Culture Use in Medical and Surgical Intensive Care Units and Wards

Valeria Fabre et al. JAMA Netw Open. .

Abstract

Importance: Blood culture (BC) use benchmarks in US hospitals have not been defined.

Objective: To characterize BC use in adult intensive care units (ICUs) and wards in US hospitals.

Design, setting, and participants: A retrospective cross-sectional study of BC use in adult medical ICUs, medical-surgical ICUs, medical wards, and medical-surgical wards from acute care hospitals from the 4 US geographic regions was conducted. Critical access hospitals, less than 6 months of BC data, and non-US hospitals were excluded. The study included BC use data from September 1, 2019, to August 31, 2021. Data were analyzed from February 23 to July 14, 2024.

Main outcomes and measures: The primary outcome was BC use per 1000 patient-days. Adjusted means with 95% CIs were calculated using mixed-effects negative binomial regression models adjusted for unit type, hospital bed size, geographic region, seasonality, and state COVID-19 case load, with random intercepts accounting for clustering at unit and hospital levels. Secondary outcomes included blood culture positivity, single BCs, BC contamination, and minimum threshold for BC use where blood culture positivity would be optimized.

Results: A total of 362 327 blood cultures were analyzed from 27 medical ICUs, 35 medical-surgical ICUs, 121 medical wards, and 109 medical-surgical wards from 48 hospitals in 19 states and the District of Columbia. The adjusted mean BC use per 1000 patient-days was 273.1 (95% CI, 270.2-275.9) for medical ICUs, 146.0 (95% CI, 144.5-147.5) for medical-surgical ICUs, 80.3 (95% CI, 79.8-80.7) for medical wards, and 65.1 for medical-surgical wards. Blood culture use was significantly higher across all 4 unit types in hospitals with more than 500 beds compared with 500 or less beds and in the West-Midwest compared with other regions. Single blood culture and positive blood culture rates were below 10% across all 4 unit types. Of the 292 units, 97% had a mean BC contamination rate within 3% of the recommended threshold, and 51% were within 1%. The minimum BC use thresholds (ie, BC use below this number may represent undertesting) were 120 BCs per 1000 patient-days for medical ICUs, 80 BCs per 1000 patient-days for medical-surgical ICUs, and 30 BCs per 1000 patient-days for medical-surgical wards.

Conclusions and relevance: The findings of this study suggest that blood culture positivity may help determine appropriate BC use for individual unit types.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Carroll reported receiving consulting fees from BD Diagnostics Inc, Co-Diagnostics Inc scientific advisory board, Melio scientific advisory board, Abbott Inc scientific advisory board, Applied BioCode scientific advisory board, and American Society for Microbiology; and grants from Meridian Bioscience and Qiagen Inc outside the submitted work. Dr Diekema reported receiving grants from bioMerieux Inc outside the submitted work. Dr Feeser reported receiving grants from Johns Hopkins University during the conduct of the study. Dr Fisher reported receiving grants from Paratek Pharmaceuticals and nonfinancial support from Copan Diagnostics outside the submitted work. Dr Howard-Anderson reported receiving grants from the Centers for Disease Control and Prevention (CDC) outside the submitted work. Dr Johnson reported receiving grants from Johns Hopkins University during the conduct of the study. Dr Kim reported receiving personal fees from Johns Hopkins University School of Medicine in the form of an honorarium to the Department of Quality Assurance and Safety of Dartmouth Hitchcock Medical Center during the conduct of the study. Dr Mermel reported receiving personal fees from Citius Pharma and Destiny Pharma as a member of the scientific advisory board and consultant fees from Pristine Access Technologies outside the submitted work. Dr Moehring reported receiving funds from CDC to the institution for the current work. Outside of this work, she has received royalties from UpToDate, Inc and travel/meeting support as board member of the Society for Healthcare Epidemiology of America (SHEA). Dr Spivak reported receiving consulting and speaker fees from Prime Education LLC outside the submitted work and serving as a member of the board of scientific counselors to the Office of Infectious Diseases at the CDC. Dr Van Schooneveld reported receiving grants from BioMerieux outside the submitted work. Dr Wasylyshyn reported receiving grants from Johns Hopkins Prevention Epicenter during the conduct of the study. Dr Cosgrove reported receiving personal fees from the Duke Clinical Research Institute and grants from the Duke Clinical Research Institute, Agency for Healthcare Research and Quality, and the Food and Drug Administration outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Quarterly Mean Blood Culture (BC) Use Per 1000 Patient-Days
ICU indicates intensive care unit.
Figure 2.
Figure 2.. Association Between Blood Culture (BC) Use and BC Positivity
Associations for medical intensive care units (A), medical-surgical ICUs (B), medical wards (C), and medical-surgical wards using nonparametric weighted regression based on the BC data without making any assumptions about the underlying distribution. Each dot in the x-axis represents a unit quarter. The y-axis represents BC positivity (10 increment). The orange line represents the conditional mean. Regression models were adjusted for unit type, hospital bed size, geographic region, seasonality, and monthly COVID-19 hospitalization rates at the state level.
See this image and copyright information in PMC

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