Impact of Mandatory Public Reporting of Central Line-Associated Bloodstream Infections on Blood Culture and Antibiotic Utilization in Pediatric and Neonatal Intensive Care Units.
BACKGROUND
As mandatory public reporting of healthcare-associated infections increases, there is concern that clinicians could attempt to decrease rates by avoiding the diagnosis of reportable infections.


OBJECTIVE
To determine whether blood culture and antibiotic utilization changed after mandatory public reporting of central line-associated bloodstream infection (CLABSI).


METHODS
Interrupted time-series of blood culture and antibiotic rates before and after state-specific implementation of mandatory public reporting. We analyzed data from pediatric and neonatal intensive care units (ICUs) at 17 children's hospitals that contributed to the Pediatric Health Information System administrative database. We used multivariable regression with generalized linear mixed-effects models to determine adjusted rate ratios (ARRs) after implementation of mandatory public reporting. We conducted subgroup analysis on patients with central venous catheters. To assess temporal trends, we separately analyzed data from 4 pediatric hospitals in states without mandatory public reporting.


RESULTS
There was no significant effect of mandatory public reporting on rates of blood culture (pediatric ICU ARR, 1.03 [95% CI, 0.82-1.28]; neonatal ICU ARR, 1.06 [0.85-1.33]) or antibiotic utilization (pediatric ICU ARR, 0.86 [0.72-1.04]; neonatal ICU ARR, 1.09 [0.87-1.35]). Results were similar in the subgroup of patients with central venous catheter codes. Hospitals with and without mandatory public reporting experienced small decreases in blood culture and antibiotic use across the study period.


CONCLUSIONS
Mandatory public reporting of central line-associated bloodstream infection did not impact blood culture and antibiotic utilization, suggesting that clinicians have not shifted their practice in an attempt to detect fewer infections.
1Division of Infectious Diseases,Department of Medicine,Boston Children's Hospital,Boston,Massachusetts.
Kelly B
KB
Flett
2Harvard Medical School,Boston,Massachusetts.
Al
A
Ozonoff
2Harvard Medical School,Boston,Massachusetts.
Dionne A
DA
Graham
1Division of Infectious Diseases,Department of Medicine,Boston Children's Hospital,Boston,Massachusetts.
Thomas J
TJ
Sandora
1Division of Infectious Diseases,Department of Medicine,Boston Children's Hospital,Boston,Massachusetts.
Gregory P
GP
Priebe
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology; D001769:Blood / Q000382:microbiology; D055499:Catheter-Related Infections / Q000188:drug therapy / Q000382:microbiology; D062905:Central Venous Catheters / Q000009:adverse effects*; D015169:Colony Count, Microbial / Q000706:statistics & numerical data*; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D007223:Infant; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D065186:Interrupted Time Series Analysis; D019221:Mandatory Reporting; D014481:United States
D000900:Anti-Bacterial Agents