{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T04:29:01Z","timestamp":1787891341308,"version":"build-2784847793"},"reference-count":19,"publisher":"American Medical Association (AMA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Blood culture (BC) use benchmarks in US hospitals have not been defined.<\/jats:p><\/jats:sec>Objective<\/jats:title>To characterize BC use in adult intensive care units (ICUs) and wards in US hospitals.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>A retrospective cross-sectional study of BC use in adult medical ICUs, medical-surgical ICUs, medical wards, and medical-surgical wards from acute care hospitals from the 4 US geographic regions was conducted. Critical access hospitals, less than 6 months of BC data, and non-US hospitals were excluded. The study included BC use data from September 1, 2019, to August 31, 2021. Data were analyzed from February 23 to July 14, 2024.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcome was BC use per 1000 patient-days. Adjusted means with 95% CIs were calculated using mixed-effects negative binomial regression models adjusted for unit type, hospital bed size, geographic region, seasonality, and state COVID-19 case load, with random intercepts accounting for clustering at unit and hospital levels. Secondary outcomes included blood culture positivity, single BCs, BC contamination, and minimum threshold for BC use where blood culture positivity would be optimized.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 362\u202f327 blood cultures were analyzed from 27 medical ICUs, 35 medical-surgical ICUs, 121 medical wards, and 109 medical-surgical wards from 48 hospitals in 19 states and the District of Columbia. The adjusted mean BC use per 1000 patient-days was 273.1 (95% CI, 270.2-275.9) for medical ICUs, 146.0 (95% CI, 144.5-147.5) for medical-surgical ICUs, 80.3 (95% CI, 79.8-80.7) for medical wards, and 65.1 for medical-surgical wards. Blood culture use was significantly higher across all 4 unit types in hospitals with more than 500 beds compared with 500 or less beds and in the West-Midwest compared with other regions. Single blood culture and positive blood culture rates were below 10% across all 4 unit types. Of the 292 units, 97% had a mean BC contamination rate within 3% of the recommended threshold, and 51% were within 1%. The minimum BC use thresholds (ie, BC use below this number may represent undertesting) were 120 BCs per 1000 patient-days for medical ICUs, 80 BCs per 1000 patient-days for medical-surgical ICUs, and 30 BCs per 1000 patient-days for medical-surgical wards.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>The findings of this study suggest that blood culture positivity may help determine appropriate BC use for individual unit types.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.54738","type":"journal-article","created":{"date-parts":[[2025,1,15]],"date-time":"2025-01-15T16:00:48Z","timestamp":1736956848000},"page":"e2454738","source":"Crossref","is-referenced-by-count":16,"title":["Blood Culture Use in Medical and Surgical Intensive Care Units and Wards"],"prefix":"10.1001","volume":"8","author":[{"given":"Valeria","family":"Fabre","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yea-Jen","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Johns Hopkins Bloomberg of School of Public Health, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen C.","family":"Carroll","sequence":"additional","affiliation":[{"name":"Department of Pathology, Division of Medical Microbiology, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandra B.","family":"Salinas","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avinash","family":"Gadala","sequence":"additional","affiliation":[{"name":"Department of Hospital Epidemiology and Infection Control, The Johns Hopkins Hospital, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Bower","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Boyd","sequence":"additional","affiliation":[{"name":"Saint Luke\u2019s Health System, Kansas City, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen O.","family":"Degnan","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pragya","family":"Dhaubhadel","sequence":"additional","affiliation":[{"name":"Geisinger Medical Center, Danville, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel J.","family":"Diekema","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, University of Iowa Hospitals and Clinics, Iowa City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marci","family":"Drees","sequence":"additional","affiliation":[{"name":"ChristianaCare, Wilmington, Delaware"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baevin","family":"Feeser","sequence":"additional","affiliation":[{"name":"Division of Infection Control\/Hospital Epidemiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark A.","family":"Fisher","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Utah School of Medicine, Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia","family":"Flynn","sequence":"additional","affiliation":[{"name":"ChristianaCare, Wilmington, Delaware"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley","family":"Ford","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Iowa Carver College of Medicine and University of Iowa Hospitals and Clinics, Iowa City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin B.","family":"Gettler","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Duke University, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurel J.","family":"Glaser","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Howard-Anderson","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Kristie","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of Maryland School of Medicine, Baltimore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin J.","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marvin","family":"Martinez","sequence":"additional","affiliation":[{"name":"Lifespan Hospital System, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy J.","family":"Mathers","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health, Charlottesville"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonard A.","family":"Mermel","sequence":"additional","affiliation":[{"name":"Lifespan Hospital System, Providence, Rhode Island"},{"name":"Warren Alpert Medical School of Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebekah W.","family":"Moehring","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Duke University, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George E.","family":"Nelson","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John C.","family":"O\u2019Horo","sequence":"additional","affiliation":[{"name":"Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana E.","family":"Pepe","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evan D.","family":"Robinson","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health, Charlottesville"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guillermo","family":"Rodr\u00edguez-Nava","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Stanford University School of Medicine, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan H.","family":"Ryder","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge L.","family":"Salinas","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Stanford University School of Medicine, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory M.","family":"Schrank","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Maryland School of Medicine, Baltimore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aditya","family":"Shah","sequence":"additional","affiliation":[{"name":"Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Shelly","sequence":"additional","affiliation":[{"name":"Geisinger Medical Center, Danville, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily S.","family":"Spivak","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen O.","family":"Stewart","sequence":"additional","affiliation":[{"name":"Department of Quality Assurance and Safety, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas R.","family":"Talbot","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trevor C.","family":"Van Schooneveld","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anastasia","family":"Wasylyshyn","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Disease, University of Michigan Health, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara E.","family":"Cosgrove","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Centers for Disease Control and Prevention (CDC) Prevention Epicenters Program","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,1,15]]},"reference":[{"issue":"10","key":"zoi241538r1","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.01053-20","article-title":"A diagnostic stewardship intervention to improve blood culture use among adult nonneutropenic inpatients: the DISTRIBUTE Study.","volume":"58","author":"Fabre","year":"2020","journal-title":"J Clin Microbiol"},{"key":"zoi241538r2","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1016\/j.ejim.2022.04.028","article-title":"Do we need blood culture stewardship programs? a quality control study and survey to assess the appropriateness of blood culture collection and the knowledge and attitudes among physicians in Swiss hospitals.","volume":"103","author":"Dr\u00e4ger","year":"2022","journal-title":"Eur J Intern Med"},{"key":"zoi241538r3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2023.154255","article-title":"Assessing a standardized decision-making algorithm for blood culture collection in the intensive care unit.","volume":"75","author":"Siev","year":"2023","journal-title":"J Crit Care"},{"issue":"2","key":"zoi241538r4","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofad644","article-title":"Impact of blood culture contamination on antibiotic use, resource utilization, and clinical outcomes: a retrospective cohort study in Dutch and US hospitals.","volume":"11","author":"Schinkel","year":"2023","journal-title":"Open Forum Infect Dis"},{"issue":"1","key":"zoi241538r5","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00009-19","article-title":"Practical guidance for clinical microbiology laboratories: a comprehensive update on the problem of blood culture contamination and a discussion of methods for addressing the problem.","volume":"33","author":"Doern","year":"2019","journal-title":"Clin Microbiol Rev"},{"issue":"11","key":"zoi241538r6","doi-asserted-by":"publisher","first-page":"1353","DOI":"10.1017\/ice.2018.231","article-title":"Blood culture utilization at an academic hospital: addressing a gap in benchmarking.","volume":"39","author":"Chen","year":"2018","journal-title":"Infect Control Hosp Epidemiol"},{"issue":"7","key":"zoi241538r7","doi-asserted-by":"publisher","first-page":"690","DOI":"10.1001\/jamapediatrics.2022.1024","article-title":"Association of diagnostic stewardship for blood cultures in critically ill children with culture rates, antibiotic use, and patient outcomes: results of the Bright STAR Collaborative.","volume":"176","author":"Woods-Hill","year":"2022","journal-title":"JAMA Pediatr"},{"issue":"2","key":"zoi241538r8","doi-asserted-by":"publisher","first-page":"648","DOI":"10.1128\/JCM.02944-14","article-title":"Proposing an empirically justified reference threshold for blood culture sampling rates in intensive care units.","volume":"53","author":"Karch","year":"2015","journal-title":"J Clin Microbiol"},{"issue":"4","key":"zoi241538r11","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.","volume":"61","author":"von Elm","year":"2008","journal-title":"J Clin Epidemiol"},{"issue":"11","key":"zoi241538r14","doi-asserted-by":"publisher","first-page":"1394","DOI":"10.1017\/ice.2018.224","article-title":"Prescribers\u2019 knowledge, attitudes and perceptions about blood culturing practices for adult hospitalized patients: a call for action.","volume":"39","author":"Fabre","year":"2018","journal-title":"Infect Control Hosp Epidemiol"},{"key":"zoi241538r15","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciae104","article-title":"Guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2024 update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM).","author":"Miller","year":"2024","journal-title":"Clin Infect Dis"},{"issue":"11","key":"zoi241538r16","doi-asserted-by":"publisher","first-page":"3546","DOI":"10.1128\/JCM.01555-07","article-title":"Detection of bloodstream infections in adults: how many blood cultures are needed?","volume":"45","author":"Lee","year":"2007","journal-title":"J Clin Microbiol"},{"issue":"10","key":"zoi241538r17","doi-asserted-by":"publisher","first-page":"1290","DOI":"10.5858\/2001-125-1290-SBC","article-title":"Solitary blood cultures: a College of American Pathologists Q-probes study of 132,778 blood culture sets in 333 small hospitals.","volume":"125","author":"Novis","year":"2001","journal-title":"Arch Pathol Lab Med"},{"issue":"9","key":"zoi241538r18","doi-asserted-by":"publisher","first-page":"956","DOI":"10.1016\/j.cmi.2018.01.011","article-title":"How to: accreditation of blood cultures\u2019 proceedings: a clinical microbiology approach for adding value to patient care.","volume":"24","author":"Lamy","year":"2018","journal-title":"Clin Microbiol Infect"},{"key":"zoi241538r19","volume-title":"Principles and Procedures for Blood Cultures","author":"CLSI","year":"2022","edition":"2nd ed"},{"key":"zoi241538r9","unstructured":"Centers for Disease Control and Prevention-Prevention Epicenters Program. Accessed April 16, 2024. https:\/\/www.cdc.gov\/healthcare-associated-infections\/php\/prevention-epicenters\/?CDC_AAref_Val=https:\/\/www.cdc.gov\/hai\/epicenters\/index.html"},{"key":"zoi241538r10","unstructured":"The Society for Healthcare Epidemiology of America Reserach Network. Accessed July 7, 2024. https:\/\/shea-foundation.org\/research-network\/about-the-srn\/"},{"key":"zoi241538r12","unstructured":"US Dept of Health & Human Services. COVID-19 reported patient impact and hospital capacity by state (RAW). Accessed January 31, 2023. https:\/\/healthdata.gov\/dataset\/COVID-19-Reported-Patient-Impact-and-Hospital-Capa\/6xf2-c3ie\/about_data"},{"key":"zoi241538r13","unstructured":"CDC\/National Center for Health Statistics\/Division of Analysis and Epidemiology. Geographic division or region. Accessed March 7, 2024. https:\/\/www.cdc.gov\/nchs\/hus\/sources-definitions\/geographic-region.htm"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2829228\/fabre_2025_oi_241538_1736277615.47039.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,15]],"date-time":"2025-01-15T16:00:53Z","timestamp":1736956853000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2829228"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,15]]},"references-count":19,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,1,2]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2024.54738","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,15]]}}}