Interventions to optimize blood culture (BCx) practices in adult inpatients are limited. We conducted a before-after study evaluating the impact of a diagnostic stewardship program that aimed to optimize BCx use in a medical intensive care unit (MICU) and five medicine units at a large academic center. The program included implementation of an evidence-based algorithm detailing indications for BCx use and education and feedback to providers about BCx rates and indication inappropriateness. Neutropenic patients were excluded. BCx rates from contemporary control units were obtained for comparison. The primary outcome was the change in BCxs ordered with the intervention. Secondary outcomes included proportion of inappropriate BCx, solitary BCx, and positive BCx. Balancing metrics included compliance with the Centers for Medicare and Medicaid Services (CMS) SEP-1 BCx component, 30-day readmission, and all-cause in-hospital and 30-day mortality. After the intervention, BCx rates decreased from 27.7 to 22.8 BCx/100 patient-days (PDs) in the MICU (P = 0.001) and from 10.9 to 7.7 BCx/100 PD for the 5 medicine units combined (P < 0.001). BCx rates in the control units did not decrease significantly (surgical intensive care unit [ICU], P = 0.06; surgical units, P = 0.15). The proportion of inappropriate BCxs did not significantly change with the intervention (30% in the MICU and 50% in medicine units). BCx positivity increased in the MICU (from 8% to 11%, P < 0.001). Solitary BCxs decreased by 21% in the medicine units (P < 0.001). Balancing metrics were similar before and after the intervention. BCx use can be optimized with clinician education and practice guidance without affecting sepsis quality metrics or mortality.

中文翻译：

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诊断性管理干预以改善成年非中性粒细胞减少症患者的血液培养使用：DISTRIBUTE研究。

在成年住院患者中优化血液培养（BCx）方法的干预措施是有限的。我们进行了一项前后研究，评估了诊断管理计划的影响，该计划旨在优化医疗重症监护病房（MICU）和大型学术中心的五个药房的BCx使用量。该计划包括实施基于证据的算法，详细说明BCx使用和教育的适应症，以及向提供者反馈有关BCx率和适应症的信息。中性粒细胞减少症患者被排除在外。从当代控制单元获得BCx率进行比较。主要结果是干预后BCx的变化。次要结果包括不适当的BCx，孤立的BCx和阳性BCx的​​比例。平衡指标包括对医疗保险和医疗补助中心（CMS）SEP-1 BCx成分的遵守情况，30天的再入院率以及全因住院和30天死亡率。干预后，MICU的BCx发生率从27.7 BCx / 100患者天（PDs）降低至22.8（PDs）（P = 0.001）和5个药物单位的从10.9到7.7 BCx / 100 PD（P < 0.001）。对照组的BCx率没有显着降低（外科重症监护病房[ICU]，P = 0.06；外科病房，P = 0.15）。干预后不适当的BCx比例没有显着变化（MICU中为30％，药物单位中为50％）。MICU的BCx阳性率增加（从8％增至11％，P < 0.001）。在药物单位中，单独的BCxs降低了21％（P < 0.001）。干预前后的平衡指标相似。可以通过临床医生的教育和实践指导来优化BCx的使用，而不会影响败血症的质量指标或死亡率。