Pediatric Doctors Create Guidelines to Safely Cut Unneeded Blood Cultures

Blood infections can be particularly dangerous in children, a fact that was tragically highlighted recently when a young girl in Canada died of a rare blood infection. Although the source of her infection is not yet known, one of the risk factors for pediatric blood infections and sepsis is blood draws. In a new study, a team led by Johns Hopkins University researchers found a way to reduce unnecessary blood draws in hospitalized children to determine if this would have an impact on pediatric blood infections.

Previous studies have highlighted the risk factors for blood infections in hospitalized children and the importance of central line safety, as central lines are a source of infection. In this new study, a team of researchers from Johns Hopkins and The Children’s Hospital of Philadelphia investigated the use of new clinical practice guidelines developed to reduce the number of total blood cultures and cultures taken from central venous catheters in pediatric patients. Their study was recently published in the journal JAMA Pediatrics. In the study, the researchers note that blood cultures, used to test for pathogens and infections in the bloodstream, can cause stress and pain in young children and have a high rate of false positives. Those incorrect diagnoses, say the researchers, lead to unnecessary antibiotic prescriptions, longer hospital stays, high risk of hospital-acquired infections, and antibiotic-resistant infections from misuse of medications.

“It is common for children in the ICU to have a fever and get a blood culture. Sometimes, the culture is positive, but before the clinician can order treatment, the child clears the fever on his or her own,” explained study author Charlotte Woods-Hill, MD, in a recent press release. The researchers note that doctors often order blood cultures in pediatric patients with fevers because of a fear of sepsis. “The clinicians are left with the decision of what to do with that information, so to be safe, they choose to treat them. We have had a number of kids who are ready to go home and the next thing you know they are spending two more weeks in the hospital getting IV antibiotics because a blood culture was positive.”

Between April 1, 2013 and March 31, 2015, the researchers studied the use of education and decision support tools developed as a checklist-style set of procedures. The documents were used by pediatric clinicians as guidance when considering whether or not to order blood cultures. Before the study, a total of 2,204 children under evaluation received a total of 1,807 blood cultures over the course of 11,196 patient days. During the study period, a total of 2,356 children under evaluation received a total of 984 blood cultures over the course of 11,204 days, which was nearly half the number of blood cultures performed prior to the study. The researchers noted that the patients in the study group did not show an increased risk of a missed sepsis diagnosis, nor a difference in the occurrence of septic shock, hospital mortality, or readmission.

The study’s findings support the limitation of unnecessary blood culture draws in critically-ill children without impacting the treatment of blood infections in these children. Still, clinicians may be uneasy about paring down on the tests. “While our study was promising, there are limitations,” said study author James Fackler, MD. “Primarily, clinicians are uneasy when asked to do less, especially when facing an acute condition like sepsis. We hope that the tools developed by our team will ease these concerns by offering guidelines for a clear and effective path to diagnosis.”