Characterization of Community-Acquired Staphylococcus aureus Infections in Children

2007 ◽  
Vol 41 (9) ◽  
pp. 1361-1367 ◽  
Author(s):  
Peter N Johnson ◽  
Robert P Rapp ◽  
Christopher T Nelson ◽  
JS Butler ◽  
Sue Overman ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Length Of Stay ◽  
Antibiotic Therapy ◽  
Treatment Success ◽  
Eastern Kentucky ◽  
Disk Diffusion Test ◽  
Noticeable Increase ◽  
Significant Difference ◽  
Control And Prevention ◽  
The Impact

Background: Limited data exist concerning characteristics of community-acquired Staphylococcus aureus infections (CA-SAI) in central and eastern Kentucky. Objective: To describe the incidence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections from January 1, 2004 through December 31, 2005, compare the number of CA-MRSA infections between years, and contrast treatment interventions and antibiotic susceptibility patterns of CA-SAI. Methods: A concurrent and retrospective study was conducted in 125 patients less than 18 years of age with CA-SAI admitted to the hospital/clinic based on criteria from the Centers for Disease Control and Prevention. Data on demographics, length of stay, antibiotic therapy, and antibiotic susceptibilities were collected. Results: Seventy patients were included for analysis (CA-MRSA, n = 51; community-acquired methicillin-susceptible S. aureus [CA-MSSA], n = 19). No statistically significant differences were noted between the number of CA-MRSA infections and the total CA-SAI (9/15 in 2004 vs 42/55 in 2005; p = 0.15). Approximately 75% of patients with CA-SAI were admitted to the hospital with no significant difference in length of stay. Ninety percent of CA-SAI were skin and soft tissue infections. There was a significant difference between groups with cutaneous abscesses (CA-MRSA, n = 37 vs CA-MSSA, n = 6; p = 0.002). Greater than 95% of all isolates were susceptible to vancomycin and trimethoprim/sulfamethoxazole. Half of CA-MRSA patients received inappropriate antibiotic therapy with β-lactam antibiotics or clindamycin without confirmatory disk diffusion test. Twenty-five (49%) patients with CA-MRSA received surgical debridement (S/D) and/or incision and drainage (I/D) with concomitant antibiotic therapy. Four patients with CA-MRSA were rehospitalized for subsequent infections; all 4 received appropriate antibiotic therapy. Conclusions: A noticeable increase in CA-MRSA infections with cutaneous abscess between 2004 and 2005 was noted. In patients receiving inappropriate antibiotic therapy, treatment success was attributed to concomitant S/D and I/D. Further analysis should focus on the impact of antibiotic therapy alone or in combination with S/D and I/D on the incidence of subsequent CA-MRSA infections.

scholarly journals Staphylococcus Aureus: Selective Reporting of Antibiogram Results and Its Impact on Antibiotic Use. Interventional Study with a Reference Group on the Effect of Switching from Non-Selective to Selective Antibiotic Reporting

2020 ◽  
Author(s):  
Franka Lestin-Bernstein ◽  
Ramona Harberg ◽  
Ingo Schumacher ◽  
Lutz Briedigkeit ◽  
Oliver Heese ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Antibiotic Therapy ◽  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
Selective Reporting ◽  
Care Hospital ◽  
Beta Lactams ◽  
Interventional Study ◽  
Narrow Spectrum ◽  
The Impact

Abstract Background:Antimicrobial stewardship (AMS) strategies worldwide focus on optimised antibiotic use. Selective susceptibility reporting is recommended as an effective AMS tool, although there is a lack of representative studies investigating the impact of selective susceptibility reporting on antibiotic use.The aim of this study was to investigate the impact of selective susceptibility reporting of Staphylococcus aureus (S. aureus) on antibiotic consumption. Enhancing the use of narrow-spectrum beta-lactam antibiotics such as flucloxacillin/cefazolin/cefalexin is one of the main goals in optimising antibiotic therapy of S. aureus infections.Methods:This interventional study with control group was conducted at a tertiary care hospital in Germany. During the one-year interventional period, susceptibility reports for all methicillin-sensitive S. aureus (MSSA) were restricted to flucloxacillin/cefazolin/oral cefalexin, trimethoprim-sulfamethoxazole, clindamycin, gentamicin and rifampin/fosfomycin; instead of reporting all tested antibiotics during the year before the intervention and in the reference clinic. The impact of the intervention was analysed by monitoring antibiotic consumption (recommended daily dose/100 occupied bed days: RDD/100 BD).Results:MSSA-antibiograms were reported for 2836 patients. Total use of narrow-spectrum beta-lactams more than doubled during the intervention (from 1.2 to 2.8 RDD/100 BD, P<0.001; P<0.001 compared to the reference clinic); the percentage of total antibiotic use increased from 2.6% to 6.2%. A slight, but significant increase in the use of trimethoprim-sulfamethoxazole was also observed (+ 0.37 RDD/100 BD).There was no decrease in antibiotics withdrawn from the antibiogram, probably as a consequence of their wide use for indications other than S. aureus infections.Conclusions:As narrow-spectrum beta-lactams are not widely used for other infections, there is a strong indication that selective reporting guided clinicians to optimised antibiotic therapy of S. aureus infections.As useful AMS tool, we recommend implementing selective reporting rules into the national/international standards for susceptibility reporting.

scholarly journals 1005. The Antibiotic Optimization DOOR: Refining Assessment of Antibiotic Therapy with Desirability of Outcome Ranking

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S354-S354
Author(s):  
Steven Smoke ◽  
Vishal Patel ◽  
Nicole Leonida ◽  
Maria DeVivo
Keyword(s):  
Retrospective Study ◽  
Antibiotic Therapy ◽  
Medical Center ◽  
Academic Medical Center ◽  
Treatment Success ◽  
Molecular Diagnostic ◽  
Single Measure ◽  
Optimal Therapy ◽  
Desirable Outcome ◽  
The Impact

Abstract Background Desirability of outcome ranking (DOOR) is a novel methodology for incorporating multiple outcomes into a single value to more comprehensively compare therapeutic strategies. Its primary application has been limited to antibiotic clinical trials, incorporating treatment success and antibiotic toxicity into a single measure. We describe the application of DOOR methodology to a retrospective study evaluating antibiotic optimization. Methods This was a single-center, retrospective quasi-experimental study conducted at an academic medical center evaluating the impact of prospective pharmacist review of rapid molecular diagnostic testing (RDT) of blood cultures on antibiotic optimization. Two 8-week time periods were evaluated, corresponding to RDT implementation prior to prospective pharmacist review (RDT-only) and RDT with prospective pharmacist review (RDT-PPR). Patients with a positive blood culture who were not on optimal therapy at the time of gram stain were included in the study. Outcomes included the percentage of patients who received optimal therapy, time to optimal antibiotic therapy, and percentage of patients who had therapy de-escalated. An antibiotic optimization DOOR was created with 3 ordinal ranks. The most desirable outcome, rank one, was patients receiving optimal therapy with no missed de-escalation opportunities. Rank two was patients receiving optimal therapy with a missed de-escalation opportunity. The least desirable outcome, rank three, consisted of patients not receiving optimal antibiotic therapy. Time to optimal therapy was used as a tiebreaker for patients in ranks one and two. Results A total of 19 and 29 patients were included in the pre and post-intervention periods, respectively. The percentage of patients reaching optimal therapy was 84% (16/19) and 97% ([28/29], P = 0.16). Median time to optimal therapy was 30:28:26 and 22:40:17 (P = 0.32), respectively. DOOR analysis indicated that the probability of a better outcome for the RDT-PPR group than the RDT-only group was 58% (95% CI 54–62). Conclusion In this small retrospective study, the use of a novel composite methodology identified the benefit of an intervention that was not detected by standard comparison of individual outcomes. Disclosures All authors: No reported disclosures.

A single-center qualitative study evaluating the safety and efficacy of a pharmacist-driven protocol for high-dose methotrexate management

2020 ◽  
pp. 107815522092745
Author(s):  
Stephanie F Matta ◽  
Leslie A Gieselman ◽  
Robert S Mancini
Keyword(s):  
Length Of Stay ◽  
Kidney Injury ◽  
High Dose ◽  
High Dose Methotrexate ◽  
Improvement Project ◽  
Treatment Delays ◽  
Dose Methotrexate ◽  
Significant Difference ◽  
The Impact ◽  
Inpatient Length Of Stay

Introduction Delayed methotrexate clearance in several patients admitted to the oncology unit at a regional medical center necessitated the development of a pharmacist-driven protocol for supportive therapy with high-dose methotrexate. This performance improvement project evaluated the impact of the protocol on inpatient length of stay, patient safety, and clinical outcomes. Methods Retrospective data were collected over 14 months pre-implementation and prospective data were collected over 19 months post-implementation. Primary outcomes included mean length of stay and incidence of kidney injury. Secondary outcomes included myelosuppression, treatment delays, mucositis, protocol adherence, and pharmacist interventions. Chi-squared and unpaired two sample t-test were used for data analysis. Intervention A literature review of consensus recommendations for supportive care post high-dose methotrexate administration was conducted to develop the protocol. Education on implementation was provided to involved disciplines. Results One-hundred ten high-dose methotrexate admissions for 23 patients were analyzed: 24 pre-protocol and 86 post-protocol. Mean length of stay was 5.17 nights pre-protocol and 3.91 nights post-protocol ( p = 0.026). Incidence of kidney injury significantly decreased (16.7% pre-protocol versus 3.5% post-protocol; p = 0.0394). Lower incidences of all-grade anemia (83.3% versus 58.1%), neutropenia (62.5% versus 29.1%), and thrombocytopenia (58.3% versus 33.7%) as well as treatment delays (29.2% versus 11.6%; p = 0.036) were reported post protocol. No statistically significant difference in mucositis was detected. Pharmacist adherence to protocol was ≥80% resulting in 348 interventions with 99.4% provider acceptance. Conclusion The implementation of a pharmacist-driven high-dose methotrexate management protocol resulted in a statistically significant decrease in inpatient length of stay and kidney injury. Further studies are needed to assess the impact on additional outcomes.

Does MIS Surgery Allow for Shorter Constructs in the Surgical Treatment of Adult Spinal Deformity?

Neurosurgery ◽  
2017 ◽  
Vol 80 (3) ◽  
pp. 489-497 ◽  
Author(s):  
Juan S. Uribe ◽  
Joshua Beckman ◽  
Praveen V. Mummaneni ◽  
David Okonkwo ◽  
Pierce Nunley ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Blood Loss ◽  
Clinical Outcomes ◽  
Spinal Deformity ◽  
Lumbar Lordosis ◽  
Adult Spinal Deformity ◽  
Radiographic Parameters ◽  
Estimated Blood Loss ◽  
Significant Difference ◽  
The Impact

Abstract BACKGROUND: The length of construct can potentially influence perioperative risks in adult spinal deformity (ASD) surgery. A head-to-head comparison between open and minimally invasive surgery (MIS) techniques for treatment of ASD has yet to be performed. OBJECTIVE: To examine the impact of MIS approaches on construct length and clinical outcomes in comparison to traditional open approaches when treating similar ASD profiles. METHODS: Two multicenter databases for ASD, 1 involving MIS procedures and the other open procedures, were propensity matched for clinical and radiographic parameters in this observational study. Inclusion criteria were ASD and minimum 2-year follow-up. Independent t-test and chi-square test were used to evaluate and compare outcomes. RESULTS: A total of 1215 patients were identified, with 84 patients matched in each group. Statistical significance was found for mean levels fused (4.8 for circumferential MIS [cMIS] and 10.1 for open), mean interbody fusion levels (3.6 cMIS and 2.4 open), blood loss (estimated blood loss 488 mL cMIS and 1762 mL open), and hospital length of stay (6.7 days cMIS and 9.7 days open). There was no significant difference in preoperative radiographic parameters or postoperative clinical outcomes (Owestry Disability Index and visual analog scale) between groups. There was a significant difference in postoperative lumbar lordosis (43.3° cMIS and 49.8° open) and pelvic incidence-lumbar lordosis correction (10.6° cMIS and 5.2° open) in the open group. There was no significant difference in reoperation rate between the 2 groups. CONCLUSION: MIS techniques for ASD may reduce construct length, reoperation rates, blood loss, and length of stay without affecting clinical and radiographic outcomes when compared to a similar group of patients treated with open techniques.

scholarly journals Catheter-Related Staphylococcus aureus Bacteremia and Septic Thrombosis: The Role of Anticoagulation Therapy and Duration of Intravenous Antibiotic Therapy

2018 ◽  
Vol 5 (10) ◽  
Author(s):  
Rita Wilson Dib ◽  
Anne-Marie Chaftari ◽  
Ray Y Hachem ◽  
Ying Yuan ◽  
Dima Dandachi ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Antibiotic Therapy ◽  
Antimicrobial Therapy ◽  
Management Strategies ◽  
Anticoagulation Therapy ◽  
Multivariate Logistic Regression Analysis ◽  
Central Line ◽  
Pulmonary Complications ◽  
Significant Difference ◽  
Septic Thrombosis

Abstract Background Catheter-related septic thrombosis is suspected in patients with persistent central line–associated bloodstream infection (CLABSI) after 72 hours of appropriate antimicrobial therapy. The clinical diagnosis and management of this entity can be challenging as limited data are available. We retrospectively studied the clinical characteristics of patients with Staphylococcus aureus catheter-related septic thrombosis and the outcomes related to different management strategies. Methods This retrospective study included patients with CLABSI due to S. aureus who had concomitant radiographic evidence of catheter site thrombosis treated at our institution between the years 2005 and 2016. We collected data pertaining to patients’ medical history, clinical presentation, management, and outcome within 3 months of bacteremia onset. Results A total of 128 patients were included. We found no significant difference in overall outcome between patients who had deep vs superficial thrombosis. Patients with superficial thrombosis were found to have a higher rate of pulmonary complications (25% vs 6%; P = .01) compared with those with deep thrombosis. Patients who received less than 28 days of intravascular antibiotic therapy had higher all-cause mortality (31 vs 5%; P = .001). A multivariate logistic regression analysis identified 2 predictors of treatment failure: ICU admission during their illness (odds ratio [OR], 2.74; 95% confidence interval [CI], 1.08–6.99; P = .034) and not receiving anticoagulation therapy (OR, 0.24; 95% CI, 0.11–0.54; P &lt; .001). Conclusions Our findings suggest that the presence of S. aureus CLABSI in the setting of catheter-related thrombosis may warrant prolonged intravascular antimicrobial therapy and administration of anticoagulation therapy in critically ill cancer patients.

Impact of Contaminated Blood Cultures on Children, Families, and the Health Care System

2020 ◽  
Vol 10 (10) ◽  
pp. 836-843
Author(s):  
Megan Farrell ◽  
Sarah Bram ◽  
Hongjie Gu ◽  
Shakila Mathew ◽  
Elizabeth Messer ◽  
...  
Keyword(s):  
Health Care ◽  
Length Of Stay ◽  
Health Care System ◽  
Peripheral Blood ◽  
Blood Cultures ◽  
Hospital Charges ◽  
Significant Difference ◽  
Contaminated Blood ◽  
The Impact ◽  
Care System

BACKGROUND: Contaminated blood cultures pose a significant burden. We sought to determine the impact of contaminated peripheral blood cultures on patients, families, and the health care system. METHODS: In this retrospective case-control study from January 1, 2014, to December 31, 2017, we compared the hospital course, return visits and/or admissions, charges, and length of stay of patients with contaminated peripheral blood cultures (case patients) with those of patients with negative cultures (controls). Patients were categorized into those evaluated and discharged from the emergency department (ED) (ED patients) and those who were hospitalized (inpatients). RESULTS: A total of 104 ED case patients were matched with 208 ED control patients. A total of 343 case inpatients were matched with 686 inpatient controls. There was no significant difference between case and control patient demographics, ED, or hospital course at presentation. Fifty-five percent of discharged ED patients returned to the hospital for evaluation and/or admission versus 4% of controls. There was a significant (P &lt; .0001) increase in repeat blood cultures (43% vs 1%), consultations obtained (21% vs 2%), cerebrospinal fluid studies (10% vs 0%), and antibiotic administration (27% vs 1%) in ED patients compared with controls. Each ED patient requiring revisit to the hospital incurred, on average, $4660 in additional charges. There was a significant (P &lt; .04) increase in repeat blood cultures (57% vs 7%), consultations obtained (35% vs 28%), broadening of antibiotic coverage (18% vs 11%), median length of stay (75 vs 64 hours), and median laboratory charges ($3723 vs $3296) in case inpatients compared with controls. CONCLUSIONS: Contaminated blood cultures result in increased readmissions, testing and/or procedures, length of stay, and hospital charges in children.

scholarly journals No additional protection against ventriculitis with prolonged systemic antibiotic prophylaxis for patients treated with antibiotic-coated external ventricular drains

2015 ◽  
Vol 122 (5) ◽  
pp. 1120-1126 ◽  
Author(s):  
Rory K. J. Murphy ◽  
Betty Liu ◽  
Abhinav Srinath ◽  
Matthew R. Reynolds ◽  
Jingxia Liu ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Antibiotic Prophylaxis ◽  
Nosocomial Infections ◽  
Cost Savings ◽  
Systemic Antibiotic ◽  
Period 2 ◽  
Systemic Antibiotic Therapy ◽  
Control And Prevention ◽  
The Impact ◽  
Systemic Antibiotic Prophylaxis

OBJECT External ventricular drains (EVDs) are commonly used for CSF diversion but pose a risk of ventriculitis, with rates varying in frequency from 2% to 45%. Results of studies examining the utility of prolonged systemic antibiotic therapy for the prevention of EVD-related infection have been contradictory, and no study to date has examined whether this approach confers additional benefit in preventing ventriculitis when used in conjunction with antibiotic-coated EVDs (ac-EVDs). METHODS A prospective performance analysis was conducted over 4 years to examine the impact of discontinuing systemic antibiotic prophylaxis after insertion of an ac-EVD on rates of catheter-related ventriculitis. Ventriculitis and other nosocomial infections were ascertained by a qualified infection disease nurse using definitions based on published standards from the Centers for Disease Control and Prevention, comparing the period when patients received systemic antibiotic therapy for the duration of EVD treatment (Period 1) compared with only for the peri-insertion period (Period 2). Costs were analyzed and compared across the 2 time periods. RESULTS Over the 4-year study period, 866 patients were treated with ac-EVDs for a total of 7016 catheter days. There were 8 cases of ventriculitis, for an overall incidence of 0.92%. Rates of ventriculitis did not differ significantly between Period 1 and Period 2 (1.1% vs 0.4%, p = 0.22). The rate of nosocomial infections, however, was significantly higher in Period 1 (2.0% vs 0.0% in Period 2, p = 0.026). Cost savings of $162,516 were realized in Period 2 due to decreased drug costs and savings associated with the reduction in nosocomial infections. CONCLUSIONS Prolonged systemic antibiotic therapy following placement of ac-EVDs does not seem to reduce the incidence of catheter-related ventriculitis and was associated with a higher rate of nosocomial infections and increased cost.

8: IMPACT OF LATE USE MAGNESIUM SULFATE IN INNER CITY CHILDREN HOSPITALIZED FOR ASTHMA EXACERBATION

2016 ◽  
Vol 64 (3) ◽  
pp. 802.1-802
Author(s):  
P Shukla ◽  
E Aragona ◽  
J Wang ◽  
D Pillai
Keyword(s):  
Length Of Stay ◽  
Magnesium Sulfate ◽  
Severe Asthma ◽  
Asthma Exacerbation ◽  
Status Asthmaticus ◽  
Asthma Severity ◽  
Day Length ◽  
Multiple Doses ◽  
Significant Difference ◽  
The Impact

Purpose of StudyAsthma is typically treated acutely with β2-agonists and systemic steroids. Adjunctive therapies such as magnesium sulfate (MgSO4) have proven useful with early addition potentially improving clinical outcomes in asthma (reduced hospital admission rates, length of stay and intubation rates). Exact administration time and impact on outcomes in children are not fully understood. We sought to identify the impact of timing of initiating MgSO4 therapy in innercity children admitted for status asthmaticus.Methods UsedWe performed a retrospective chart review of children (age 2–21 yrs) admitted to a children's hospital over a 12 month period with asthma exacerbation and administered MgSO4. Data collected included ethnicity, gender, medications, timing of interventions, length of stay, BMI percentile, comorbidities and NAEPP asthma severity. Statistical analysis performed with SPSS 22.Summary of Results150 innercity children were admitted for asthma exacerbation and received MgSO4 during the study period. 85% were African American, 36% female, 39% had moderate/severe asthma and mean time to initial MgSO4 was 3.8 hours from triage. Those receiving initial MgSO4 after 4 hours were more likely to receive multiple doses of MgSO4 (OR2.8 [95%CI:1.4–5.6]). Time of initial MgSO4 dose (<4 vs. >4 hrs) showed no significant difference in other parameters including age, obesity, asthma severity, and comorbidities. A sub-analysis of children that received 1 dose vs. >1 MgSO4 dose demonstrated that those receiving >1 MgSO4 doses were more likely to be obese (OR2.7 [1.3–5.7]), have moderate/severe asthma (OR3.2 [1.6–6.8]) and have increased length of stay (p=0.005) and charges (p=0.042). Additionally, obese children (OR8.9 [2.2–35.2]), and intermittent/mild asthmatic children (OR6.4 [1.2–31.2]) receiving >1 MgSO4 dose were more likely to have >2 day length of stay.ConclusionsDelay in administration of MgSO4 in children hospitalized for status asthmaticus may be associated with poor outcomes including multiple doses of MgSO4 which in turn is associated with longer length of stay and increased charges. Obesity and asthma severity are important factors associated with these outcomes. A prospective analysis in a larger cohort is recommended to further evaluate these findings.

scholarly journals Different Aminoglycoside-Resistant Phenotypes in a Rabbit Staphylococcus aureus Endocarditis Infection Model

2002 ◽  
Vol 46 (5) ◽  
pp. 1591-1593 ◽  
Author(s):  
N. Asseray ◽  
J. Caillon ◽  
N. Roux ◽  
C. Jacqueline ◽  
R. Bismuth ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Infection Model ◽  
Diffusion Test ◽  
Disk Diffusion Test ◽  
Human Dose ◽  
Different Types ◽  
Resistant Strains ◽  
The Impact ◽  
Apparent Susceptibility

ABSTRACT The impact of different types of enzymatic resistance on the in vivo antibacterial activity of aminoglycosides (amikacin, gentamicin, and netilmicin) was studied in the rabbit endocarditis model with four strains of Staphylococcus aureus. Animals were treated in a manner simulating the administration of a single daily human dose. Amikacin had no effect on the three kanamycin-resistant strains despite apparent susceptibility in the disk diffusion test. Gentamicin appears to be the preferable aminoglycoside for treatment of staphylococcal infections.

scholarly journals Evaluation of an Initial Specimen Diversion Device (ISDD) on Rates of Blood Culture Contamination in the Emergency Department

2021 ◽  
Vol 14 ◽  
pp. 73-76
Author(s):  
Blake Buzard ◽  
Patrick Evans ◽  
Todd Schroeder
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Blood Culture ◽  
Blood Cultures ◽  
Contamination Rate ◽  
Total Hospital Cost ◽  
Initial Specimen ◽  
Significant Difference ◽  
Secondary Outcomes ◽  
The Impact

Introduction: Blood cultures are the gold standard for identifying bloodstream infections. The Clinical and Laboratory Standards Institute recommends a blood culture contamination rate of <3%. Contamination can lead to misdiagnosis, increased length of stay and hospital costs, unnecessary testing and antibiotic use. These reasons led to the development of initial specimen diversion devices (ISDD). The purpose of this study is to evaluate the impact of an initial specimen diversion device on rates of blood culture contamination in the emergency department.  Methods: This was a retrospective, multi-site study including patients who had blood cultures drawn in an emergency department. February 2018 to April 2018, when an ISDD was not utilized, was compared with June 2019 to August 2019, a period where an ISDD was being used. The primary outcome was total blood culture contamination. Secondary outcomes were total hospital cost, hospital and intensive care unit length of stay, vancomycin days of use, vancomycin serum concentrations obtained, and repeat blood cultures obtained.  Results: A statistically significant difference was found in blood culture contamination rates in the Pre-ISDD group vs the ISDD group (7.47% vs 2.59%, p<0.001). None of the secondary endpoints showed a statistically significant difference. Conclusions: Implementation of an ISDD reduces blood culture contamination in a statistically significant manner. However, we were unable to capture any statistically significant differences in the secondary outcomes.

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