Drs. Zwemer and Stephens (L-R) at UNC Children’s.

The majority of blood cultures performed on children with common skin and soft tissue infections are unnecessary, according to a new article by researchers in the Department of Pediatrics. The article, “Blood Cultures for Uncomplicated Skin and Soft Tissue Infections of Children” was written as part of the journal’s ongoing series, “Things We Do For No Reason,” which examines practices in hospital care that, while commonplace, may provide little value to patients.

The co-authors, Eric Zwemer, M.D., and John R. Stephens, M.D. of the Division of General Pediatrics and Adolescent Medicine, reviewed several retrospective studies of children who presented with skin and soft tissue infections (SSTIs). They found that blood cultures are commonly ordered in children presenting with uncomplicated skin and soft tissue infections, despite a failure to demonstrate benefits.

According to their review, blood cultures in uncomplicated SSTIs are often associated with unwanted health outcomes, including increased lengths of hospital stays, a higher rate of false-positive results, and increased charges to patients and healthcare systems.

“As physicians we always want the best for our individual patients,” Dr. Stephens said in a joint statement with Dr. Zwemer. “Studies and reviews like these help show that what might seem like a harmless test may have significant costs and harms, not only to our individual patients, but to the healthcare system as a whole. Clearly, as at the system moves towards alternate models of payment, there will be more and more emphasis on only performing examinations and treatments that add value.”

Current guidelines from the Infectious Disease Society of America (IDSA) recommend that blood cultures should not be used as part of routine, uncomplicated SSTI evaluation. Blood cultures are recommended in patients with immunodeficiency, animal bites and immersion injuries, which are soft tissue injuries occurring in fresh or saltwater. Drs. Zwemer and Stephens recommend wound cultures be performed in the place of blood cultures.

The article is available in the July issue of the Journal of Hospital Medicine.