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Prior pediatric blood culture practice at UIHC was to send a single aerobic blood culture bottle with a small inoculum of blood per septic episode, often less than 1 ml. This led to low yield, apparent culture-negative sepsis, and failure to obtain a microbiologic diagnosis that might guide therapy. A multidisciplinary effort was undertaken to promote the adoption of a new pediatric blood culture protocol that emphasizes delivery of higher blood volumes (ideally, a total of 3 ml per year of age, divided across 6 bottles) and inclusion of matched aerobic/anaerobic bottle pairs instead of reliance on only the aerobic bottle.
This effort led to an increase in the overall rate of blood culture positivity from 5% pre-intervention to 7% post-intervention (a 40% increase). Compared to a pre-intervention baseline, this was associated with receipt of twice as many bottles on average, almost half of which were anaerobic culture bottles. The increase in yield was almost entirely due to positive anaerobic bottles: 10% of cultures were positive only in the anaerobic bottles, and where both bottles were positive (30% of total episodes) the anaerobic bottle was most likely positive first and 8.5 hours before its aerobic mate. This has led to more rapid and effective diagnosis of sepsis in our pediatric patients, and in recognition of this effort and its success a poster by Bradley Ford, MD PhD; Mary Beth Davis, RN; and Erik Edens, MD, received a best-in-class award at the UIHC Quality and Patient Safety Symposium.