Editor’s Note: Blood culture is one of the most important tests in the clinical microbiology laboratory. Blood culture is the gold standard for diagnosing bloodstream infection and bacteremia. However, in the United States, blood cultures are still performed even for emergency patients with a low probability of bacteremia, which may result in a large waste of resources. At IDWeek 2023, a study reported the implementation of a blood culture algorithm in emergency department patients as a diagnostic stewardship intervention.
Infectious Diseases Associate Professor at Duke University Hospital
co-director of the infection prevention program and an associate hospital epidemiologist
co-director for the Duke Infection Control Outbreak Network (DICON)
Infectious Disease Frontline: Could you elaborate on the current challenges in ID diagnostic and how do your practical approaches address those issues?
- Dr. Jessica Seidelman: Sure. What we did is we implemented a blood culture algorithm in our emergency department to see what the effects of it were on blood culture rates in the emergency room on those patients. So currently, I think how a lot of people practice is patients have a fever or a high white blood cell count and they automatically get every single test. They get blood, they get urine, they get sputum, they kind of get chest x -rays. And really, I think what we’re trying to do, what is the pre-test probability that the patient has back, yeah, if the patient’s presenting with something like simple cellulitis or cystitis or even isolated fever without any concern for sepsis, how likely is it that patient is going to be back to remake? And the answer is that in those clinical scenarios, it’s quite low, less than 5%, 10%. And what is your true yield of getting that blood culture? A lot of times, you’re more likely to get a contaminant, which is going to cause more harm arguably to the patient than getting any meaningful use information. So what we really are asking is, think about the pre-test probability by using the algorithm and then ordering it based on that probability of factor.
Infectious Disease Frontline: Thank you. Looking forward, what advancements or innovations do you anticipate in the field of ID diagnostic? And how can professions prepare to adapt those changes?
- Dr. Jessica Seidelman: Yeah. I really like that the group put out an entire guideline on diagnostic stewardship. This is where a lot of us are going. We see that there is a lot of harm by just sending a lot of tests out. I’m really not knowing what to do with them or why we’re doing it. And so I’m really happy that this is an area of active research and innovation. And I think for us, we’ve used this algorithm, but I think for future studies, what we want to do is kind of build this into the EMR or the electronic medical record. We don’t want it to be someone using a piece of paper having to think about it. We want this to be more hardwired, if you will, into those order sets.
