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Guidelines on targeted use of blood cultures are needed to avoid wasting resources, according experience in one emergency department in Glasgow, Scotland, UK. Doctors there found only four instances over two years' retrospective review when blood cultures directly influenced patient management, for which empirical costs for consumables alone amounted to just over £3500. Though theirs was not an economic study and in practice more than four patients would need them, the doctors believe that taking blood cultures could be significantly reduced without missing true positive cases.
The patients whose blood cultures were warranted and influenced their management included three whose antibiotic treatment was changed according to the sensitivity profile of the bacteria isolated and one in whom urine culture and renal ultrasonography confirmed pyelonephritis. Theirs were four out of just 30 true positive blood cultures yielding various bacterial spp, most commonly Escherichia coli. In total, 2213 blood cultures were taken, 94% of which showed no growth. The 30 with true positive results represented just 1.4% of the total.
The review of all blood cultures taken in the department during 2003 and 2004 linked the microbiological results and consultant microbiologists' reports with initial diagnosis and eventual management according to patients' case notes. Positive cultures of doubtful significance (skin flora) were discounted from those of significance or uncertain significance (true positives).
Although routinely used in emergency departments, blood cultures seem rarely to influence patient management, according to evidence from Europe, North America, and Australasia—and now, Glasgow.
Munro P, et al.Emergency Medicine Journal 2007;24:213–214.
Please visit the Journal of Clinical Pathology website [www. jclinpath.com] for a link to the full text of this article.