Blood culture utilization practices among febrile and/or hypothermic inpatients

BACKGROUND: Predictors associated with the decision of blood culture ordering among hospitalized patients with abnormal body temperature are still underexplored, particularly non-clinical factors. In this study, we evaluated the factors affecting blood culture ordering in febrile and hypothermic inpatients. METHODS: We performed a retrospective study of 15,788 adult inpatients with fever (≥ 38.3℃) or hypothermia (\u3c 36.0℃) from January 2016 to December 2017. We evaluated the proportion of febrile and hypothermic episodes with an associated blood culture performed within 24h. Generalized Estimating Equations were used to determine independent predictors associated with blood culture ordering among febrile and hypothermic inpatients. RESULTS: We identified 21,383 abnormal body temperature episodes among 15,788 inpatients (13,093 febrile and 8,290 hypothermic episodes). Blood cultures were performed in 36.7% (7,850/ 21,383) of these episodes. Predictors for blood culture ordering among inpatients with abnormal body temperature included fever ≥ 39℃ (adjusted odd ratio [aOR] 4.17, 95% confident interval [CI] 3.91-4.46), fever (aOR 3.48, 95% CI 3.27-3.69), presence of a central venous catheter (aOR 1.36, 95% CI 1.30-1.43), systemic inflammatory response (SIRS) plus hypotension (aOR 1.33, 95% CI 1.26-1.40), SIRS (aOR 1.26, 95% CI 1.20-1.31), admission to stem cell transplant / medical oncology services (aOR 1.09, 95% CI 1.04-1.14), and detection of abnormal body temperature during night shift (aOR 1.06, 95% CI 1.03-1.09) or on the weekend (aOR 1.05, 95% CI 1.01-1.08). CONCLUSION: Blood culture ordering for hospitalized patients with fever or hypothermia is multifactorial; both clinical and non-clinical factors. These wide variations and gaps in practices suggest opportunities to improve utilization patterns

A Ten Year Retrospective Follow-Up Of Drug Dependence Career.

This research report presents findings on addiction careers over a ten year period. One of the objectives of this study is to describe the patterns of drug use, criminality, arrest, incarceration and legitimate employment which characterised the addicts, and to relate these configurations to characteristics prior to addiction, during the periods of abstinence and at the point of interview

Effect of superficial air velocity on solidstate fermentation of palm kernel cake in a lab scale fermenter using locally isolated fungal strain

Solid state fermentation (SSF) is emerging as an attractive alternative to submerged fermentation despite the engineering problems such as removal of metabolic heat, transport of oxygen and moisture into the particles and the heterogeneity of the substrate. In the present work, a lab scale fermenter which can be operated as fluidized bed and packed bed was fabricated. Solid state fermentation of palm kernel cake (PKC) using fungal strain TW1 was carried out at three superficial air velocities. PKC particles of mean diameter 855 μm were used and the fluidizing medium was air. Reducing sugar concentration, biomass growth, bed moisture content, substrate pH, and hemicellulose content were measured. The maximum increase in reducing sugar concentration was at 0.17 m/s since an increase in mannose from 14.55 to 18.63 mg mannose/g dry PKC was observed. The hemicellulose content of this fermented PKC was estimated and the result was around 10% in reduction of hemicellulose content in fermented PKC. Further improvement of PKC bioconversion can likely be achieved by selection of a more robust microbe that can withstand the conditions in the fluidized bed during SSF and by creating a system which can maintain the moisture content of PKC during SSF of PKC throughout the packed bed

Incidence and diagnostic yield of repeat urine culture in hospitalized patients: An opportunity for diagnostic stewardship

There is limited knowledge on the incidence, diagnostic yield, and cost associated with inappropriate repeat urine cultures. The factors that affect repeat urine culturing practices are not well understood. We conducted a retrospective study of adult inpatients who had ≥1 urine culture performed during their hospitalization between January 2015 and February 2018. We analyzed the proportion of inappropriate repeat urine cultures performed \u3c48 h after the index culture. We defined an inappropriate repeat urine culture to be a repeat urine culture performed following a negative index culture or a repeat urine specimen obtained from the same urinary catheter. Overall, 28,141 urine cultures were performed on 21,306 patients. There were 2,060 (7.3%) urine cultures repeated in \u3c48 h. Of these, 1,120 (54.4%) urine cultures were inappropriate. Predictors for inappropriate repeat urine cultures included collection of the initial urine sample for culture in the emergency department (adjusted odds ratio [aOR], 5.65; 95% confidence interval [CI], 4.70 to 6.78), male gender (aOR, 1.61; 95% CI, 1.42 to 1.84), congestive heart failure (aOR, 1.20; 95% CI, 1.03 to 1.38), and a longer hospital stay (aOR, 1.01 per day; 95% CI, 1.00 to 1.01). A patient with an index urine culture obtained from an indwelling catheter (aOR, 0.65; 95% CI, 0.53 to 0.80) was less likely to have an inappropriate repeat culture. Among 1,120 negative index urine cultures, only 4.7% of repeat cultures were positive for bacteriuria. The estimated laboratory charges for inappropriate repeat urine cultures were $16,800 over the study period. Among inpatients, over half of all urine cultures repeated in \u3c48 h were inappropriate. This offers an opportunity for diagnostic stewardship and optimization of antimicrobial use