Resource utilization and contaminated blood cultures in children at risk for occult bacteremia

Objective: To measure the increases in resource utilization and hospital charges associated with the evaluation of contaminated blood cultures obtained from emergency department patients at risk for occult bacteremia. Design: Retrospective medical record review. Setting: Emergency department of an urban, university-affiliated pediatric referral center. Patients: Children aged 3 to 36 months with blood cultures positive for bacterial growth obtained between January 1994 and October 1996. Main Outcome Measures: Increased resource utilization related to contaminated blood culture follow-up, including telephone contact, return emergency department visits, additional diagnostic tests and therapies performed at reevaluation, and hospital admissions. Hospital charges for these additional services were tabulated. Results: Of 8306 children who had blood cultures drawn, 491 (5.9%) had positive findings. Four hundred eighty five (98.8%) of these were available for review. Two hundred seventy-six (57%) of 485 were excluded from final analysis. Of the remaining 209 patients at risk for occult bacteremia, 85 (41%) had cultures that grew contaminants only. Follow-up of these 85 patients generated 106 telephone calls, 49 return visits to the emergency department, 102 additional diagnostic tests, 18 doses of parenteral antibiotics, and 12 hospital admissions with a combined length of stay of 24 days. This resulted in additional charges of $78 904, or an additional $642 per true pathogen recovered. Conclusions: Contaminated blood cultures obtained from children at risk for occult bacteremia lead to substantial increases in resource utilization and hospital charges. These untoward effects should be accounted for in formal decision analyses regarding the management of occult bacteremia.