{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T01:48:44Z","timestamp":1790387324140,"version":"4.1.0"},"reference-count":24,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"<jats:sec id=\"ab-zoi250994-4\"><jats:title>Importance<\/jats:title><jats:p>A national shortage of blood culture bottles affected approximately half of US hospitals, necessitating changes in blood culture practices.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi250994-5\"><jats:title>Objective<\/jats:title><jats:p>To determine the association between restrictive blood culture stewardship measures and patient outcomes at a pediatric hospital.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi250994-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>A retrospective cohort study was performed to determine the association between new restrictive stewardship measures and blood culture practices in a quaternary care pediatric medical center from July 1, 2023, to January 31, 2025. All children with blood cultures collected were included.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi250994-7\"><jats:title>Exposures<\/jats:title><jats:p>The following restrictive measures were enacted: (1) a 48-hour restriction on all aerobic blood cultures, (2) a 7-day restriction on all anaerobic blood cultures, (3) authorization to order an additional aerobic blood culture every 7 days, and (4) pooling of all central vein catheter lumens in 1 blood culture bottle.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi250994-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>The primary outcome was the monthly blood culture positivity rate, stratified and normalized per 100 emergency department (ED) visits and per 100 patient-days.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi250994-9\"><jats:title>Results<\/jats:title><jats:p>During the study period, a total of 18\u202f132 blood cultures from 5063 patient visits (median [IQR] age, 5.6 [1.1-12.4] years; 2744 [54.2%] male; 358 [7.15%] Black, 3013 [58.5%] Latino\/a\/x\/Hispanic, and 720 [14.2%] White patients) were collected from August 1, 2023, to July 31, 2024 (preintervention period), and 6449 blood cultures from 2495 patient visits (1391 [55.8%] male, median [IQR] age; 5.5 [1.1-12.5] years; 191 [7.7%] Black, 1452 [58.2%] Latino\/a\/x\/Hispanic, and 375 [15.0%] White patients) were collected from August 1, 2024, to January 31, 2025 (postintervention period). Restrictive stewardship measures were associated with a significant decrease in the blood culture collection rate per 100 ED visits (cumulative change, \u221224.1%; 95% CI, \u221238.4% to \u22128.9%; <jats:italic>P<\/jats:italic>\u2009=\u2009.01) and per 100 patient-days (cumulative change, \u221245.8%; 95% CI, \u221264.7% to \u221226.9%; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001). In the ED and inpatient units, the blood culture positivity rate remained stable, with a 14.4% (95% CI, \u221223.1% to 52.0%) and 27.8% (95% CI, \u221213.7% to 69.3%) cumulative increase, respectively. There was no significant change in hospital mortality due to septic shock (0.13% vs 0.15%) or mean length of stay (5.4 days vs 6.4 days), but there was a significant decrease in readmissions (3.3 vs 2.7; cumulative change, \u221227.5%; 95% CI, \u22127.6% to \u221247.6%; <jats:italic>P<\/jats:italic>\u2009=\u2009.02).<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi250994-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>The implementation of restrictive blood culture measures, including pooling lumens and decreasing testing cadence, successfully reduced blood cultures collected without decreasing blood culture positivity rates and without an increase in mortality secondary to septic shock, readmission rates, or length of stay.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.35580","type":"journal-article","created":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T15:00:53Z","timestamp":1759762853000},"page":"e2535580","source":"Crossref","is-referenced-by-count":4,"title":["Rapid Diagnostic Stewardship and Blood Culture Use in a Pediatric Medical Center"],"prefix":"10.1001","volume":"8","author":[{"given":"Esther","family":"Vaugon","sequence":"first","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Children\u2019s Hospital Los Angeles, Los Angeles, California"},{"name":"Department of Laboratory Medicine, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Qu\u00e9bec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Costales","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Children\u2019s Hospital Los Angeles, Los Angeles, California"},{"name":"Keck School of Medicine, University of Southern California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zein","family":"Assad","sequence":"additional","affiliation":[{"name":"Infection, Antimicrobials, Modelling, Evolution (IAME) Research Unit, INSERM UMR 1137, Paris Cit\u00e9 University, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Barter","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Children\u2019s Hospital Los Angeles, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leila C.","family":"Posch","sequence":"additional","affiliation":[{"name":"Keck School of Medicine, University of Southern California, Los Angeles"},{"name":"Department of Pediatrics, Division of Infectious Diseases, Children\u2019s Hospital Los Angeles, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Etan","family":"Orgel","sequence":"additional","affiliation":[{"name":"Keck School of Medicine, University of Southern California, Los Angeles"},{"name":"Department of Pediatrics, Division of Hematology-Oncology, Children\u2019s Hospital Los Angeles, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah R.","family":"Liu","sequence":"additional","affiliation":[{"name":"Keck School of Medicine, University of Southern California, Los Angeles"},{"name":"Department of Pediatrics, Division of Emergency Medicine, Children\u2019s Hospital Los Angeles, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Dien Bard","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Children\u2019s Hospital Los Angeles, Los Angeles, California"},{"name":"Keck School of Medicine, University of Southern California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,10,6]]},"reference":[{"issue":"9","key":"zoi250994r3","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofae479","article-title":"Every Crisis Is an Opportunity: Advancing Blood Culture Stewardship During a Blood Culture Bottle Shortage.","volume":"11","author":"Ryder","year":"2024","journal-title":"Open Forum Infect Dis"},{"issue":"10","key":"zoi250994r6","doi-asserted-by":"publisher","first-page":"e354","DOI":"10.1097\/INF.0000000000004453","article-title":"Blood cultures in children: maximizing their usefulness.","volume":"43","author":"Truong","year":"2024","journal-title":"Pediatr Infect Dis J"},{"issue":"9","key":"zoi250994r8","doi-asserted-by":"publisher","first-page":"964","DOI":"10.1016\/j.cmi.2018.03.030","article-title":"Contaminants in blood cultures: importance, implications, interpretation and 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