Impact of Filmarray® Blood Culture Identification Panel on Management of Patients with a Contaminated Blood Culture Discharged from a Pediatric Emergency Department

Background: Up to 10% of blood cultures are contaminated by non-pathogenic skin flora. These contaminated blood cultures lead to additional healthcare costs due to unnecessary antibiotic use, repeat lab draws, and even hospital admissions.

In August 2014, the Nemours/Alfred I. duPont Hospital for Children (N/AIDHC) microbiology laboratory implemented the blood culture identification (BCID) Panel. The BCID is a PCR-based system that tests for 24 bacteria and yeast and three antibiotic resistance genes which provides results within two hours.

The objective of this study was to evaluate the impact of BCID implementation on management of patients with contaminated blood cultures who were discharged from the pediatric emergency department (PED).

Methods: A retrospective cohort study was conducted on patients who had contaminated blood cultures drawn in the N/AIDHC PED pre- (2010-2013) and post-implementation (2015-March 2021) of the BCID panel. Patients whose blood cultures were drawn from an indwelling central venous catheter or admitted on the initial PED visit were excluded.
Frequency of call backs to the PED, repeat blood culture, antibiotic(s) administration, and hospital admission were compared pre and post BCID implementation periods.

Results: A total of 134 patients were evaluated in the pre (n=63) and post (n=71) implementation periods. Patient demographics including age, sex, and race were similar between the two groups. There was a 26% reduction in antibiotic administration post BCID implementation period (95% CI, 16.1%-33.2%; P = 0.003) and 18% reduction in repeat blood culture (95% CI, 21.8%-93.2%; P = 0.031). While there were fewer returns to the ED (pre 74% vs post 70%, P = 0.589) and fewer admissions to the hospital (pre 43% vs post 30%, P = 0.11, these were not statistically significant.

Conclusion: BCID implementation resulted in a significant decrease in antibiotic administration and repeat blood culture. However, the BCID did not significantly affect the frequency of patients returning to the ED and hospital admissions. Additional stewardship interventions may further improve management of patients with contaminated blood cultures in the PED.