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The value of outpatient blood cultures in the emergency department
Insights
Outpatient blood cultures in the emergency department are rarely positive for bacteremia. However, they are valuable for diagnosing endocarditis and other bloodstream infections before symptoms become apparent.
Area of Science:
- Infectious Diseases
- Internal Medicine
- Emergency Medicine
Background:
- Assessing the utility of blood cultures for adult patients seen in the emergency department.
- Evaluating the diagnostic yield of blood cultures in non-admitted patients presenting with febrile illness.
Observation:
- A retrospective chart review was conducted on 411 adult patients who had blood cultures drawn in the emergency department.
- Eighty-six patients were discharged without admission, and five of these individuals subsequently showed positive blood culture results.
- Three of the five bacteremic patients were diagnosed with endocarditis, all possessing identifiable risk factors.
Findings:
- Positive blood cultures were identified in 5.8% (5/86) of non-admitted emergency department patients.
- Endocarditis was diagnosed in 3 out of 5 bacteremic patients, highlighting the importance of blood cultures in specific cases.
- Blood cultures are not generally recommended for most discharged febrile patients but are crucial for detecting early bacteremic conditions.
Implications:
- Blood cultures can be a critical diagnostic tool for identifying serious infections like endocarditis in select outpatient emergency department populations.
- The findings suggest a targeted approach to blood culture utilization in the emergency department may be warranted.
- Early detection of bacteremia through blood cultures can lead to timely intervention and improved patient outcomes, particularly in high-risk individuals.
Abstract:
The value of adult outpatient blood cultures was assessed by a retrospective chart review of all patients for whom cultures were obtained in an emergency department. Eighty-six of 411 patients for whom cultures were obtained were not admitted. Five of these 86 patients were identified as being bacteremic by positive blood culture growth the next day, and three of the five had endocarditis. All endocarditis patients had identifiable risk factors for this disease. Although blood cultures cannot be recommended for most patients discharged from the emergency department with a febrile illness, they are helpful in detecting endocarditis and other bacteremic conditions before obvious signs develop.
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