Unnecessary Blood Culture Testing Persists in Pediatrics

Rates of routine blood culture (BC) testing for uncomplicated infections in children had no significant effect on length of stay, costs, return emergency department visits, or hospital readmissions, according to data from nearly 95,000 hospitalizations presented at the Pediatric Hospital Medicine (PHM) 2025.

Routine BC testing has shown minimal value in the clinical management of uncomplicated community-acquired pneumonia (CAP), skin and soft tissue infections (SSTI), and urinary tract infections (UTI), according to Smit K. Shah, MD, a clinical assistant professor of pediatrics at the University of Missouri-Kansas City School of Medicine, who presented the findings at the meeting.

While such BC testing in an otherwise healthy pediatric population has low clinical benefit, said Shah in an interview, “downstream harms of such testing may be leading to not just healthcare waste but patient harm.”

To review the effect of BC testing patterns on outcomes, Shah and colleagues identified hospitalizations for patients aged 3 months to 18 years admitted with CAP, SSTI, or UTI from 2016 to 2023. The data on 94,524 hospitalizations across 31 hospitals came from the Pediatric Health Information System database. The researchers excluded patients with complicated infections, ICU admission, or hospital stays longer than 1 week.

Hospitals were characterized as low-, moderate-, or high-BC testers (13, 10, and 8 hospitals, respectively). The primary outcomes were rates of blood culture testing by infection and hospital, annual rates of testing over 8 years, and clinical outcomes including length of hospital stay, costs, emergency department return visits, and hospital readmissions.

The researchers reviewed data for 41% of CAP, 45% of SSTI, and 55% of UTI cases. BC testing rates varied widely; the widest range was from 16% to 77% for low-testing and high-testing hospitals for CAP, respectively. BC testing ranged from approximately 38% to 77% for SSTI and from approximately 22% to 77% for UTI for the low-testing and high-testing hospitals.

Over the study period, seven hospitals showed significant increases, 17 showed no changes, and seven showed decreases in annual BC testing.

Overall, no significant differences appeared between the high- and low-testing groups in outcome measures of adjusted length of stay, costs, emergency department return visits, hospital readmissions at 7 days, or bacteremia.

The findings were limited by several factors including the use of administrative data and potential lack of generalizability to nonacademic hospitals, Shah noted.

Many hospitals showed no reduction in BC testing over time, despite growing evidence of no change in outcomes, Shah said in his presentation. The results of the current study suggest that the reassessment of BC use and reduction of unnecessary testing is needed to optimize resources and improve healthcare value, Shah concluded.

What Drives Disregard for Guidelines

Despite guidelines from the American Academy of Pediatrics on the futility of BC testing in uncomplicated SSTIs, the proportion of hospitalized children with this infection undergoing testing is alarming and continues to remain high over time, Shah told Medscape Medical News.

“We need to understand drivers of unnecessary testing,” said Shah. Identifying whether unnecessary testing stems from institutional factors or lack of education about futility and downstream effects of unnecessary testing would help direct national stewardship efforts to reduce testing overuse, he said. “The recent blood culture vial shortage could act as a natural experiment in reducing testing,” Shah noted

“Diagnostic stewardship in regard to blood cultures is important as overuse of blood cultures when not clinically indicated has the potential to lead to false-positive results, antibiotic overuse, antibiotic resistance, and can potentially increase healthcare costs,” said Shirin Mazumder, MD, an infectious diseases specialist in Memphis, Tennessee, in an interview. “Evaluating scenarios where blood cultures may not be clinically indicated can help to address these issues,” said Mazumder, who was not involved in the study.

The fear of missing an invasive infection and changing long-standing practice habits are some barriers to reducing unnecessary BC culture testing, but they can be overcome in part by sharing available study data, said Mazumder. In addition, the development of guidelines to determine which candidates would or would not benefit from BCs would help guide clinicians in best practices, she said.

This study was supported in part by grants from the Agency for Healthcare Research and Quality to two of the coauthors. Shah reported no financial conflicts of interest.

Mazumder reported no financial conflicts of interest.