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Blood culturing practices in a trauma intensive care unit: does concurrent antibiotic use make a difference?
Carol R Schermer1, Damion P Sanchez, Clifford R Qualls
1Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico 87131, USA. cschermer@salud.unm.edu
The Journal of Trauma
|March 20, 2002
Summary
Blood cultures in febrile trauma patients on antibiotics show similar diagnostic yield. Prophylactic antibiotics alter cultured organisms, and repetitive culturing provides little new information, suggesting optimization is possible.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Trauma Critical Care
Background:
- Febrile trauma patients often undergo repeated blood cultures during extended hospital stays.
- The diagnostic utility of blood cultures in severely injured patients requires examination, particularly concerning antimicrobial therapy's impact.
Purpose of the Study:
- To assess the diagnostic yield of blood cultures in trauma patients.
- To determine if concurrent or prophylactic antibiotic administration affects blood culture results.
- To evaluate if the frequency of blood cultures can be reduced.
Main Methods:
- Retrospective chart review of trauma patients with Injury Severity Score ≥15 and ICU stay ≥5 days.
- Analysis of blood culture dates and results alongside antibiotic administration records.
- Comparison of positive blood culture rates and organism sensitivity using Fisher's exact test.
Main Results:
- No significant difference in positive blood culture rates between patients on and off antibiotics (13.9% vs. 10.8%).
- Prophylactic antibiotics, often beta-lactams, were associated with lower sensitivity in positive blood cultures (18% vs. 59%).
- Repetitive culturing yielded minimal new information, with only three patients showing a second, different organism after initial positive results.
Conclusions:
- Concurrent antibiotic use does not significantly impact overall blood culture diagnostic yield.
- Prophylactic antibiotic administration can alter the types of organisms detected in blood cultures.
- Repetitive blood culturing in trauma patients offers limited additional diagnostic value.