Optimizing The Use of Blood Cultures in The Febrile Postoperative Patient
| Autor: | Babak Sarani, Stephen R.T. Evans, Andrea T Badillo |
|---|---|
| Rok vydání: | 2002 |
| Předmět: |
education.field_of_study
medicine.medical_specialty Fever medicine.diagnostic_test business.industry Mortality rate Population Colony Count Microbial Bacteremia medicine.disease Sensitivity and Specificity Postoperative fever Postoperative Complications medicine.anatomical_structure White blood cell Intensive care Etiology Humans Medicine Surgery Blood culture business education Intensive care medicine |
| Zdroj: | Journal of the American College of Surgeons. 194:477-487 |
| ISSN: | 1072-7515 |
| Popis: | Fever in the postoperative period is a common occurrence with potentially serious implications. Postoperative fever can indicate the presence of an infective focus or a serious surgical complication, but in the majority of cases, these fevers are the result of a noninfectious etiology. The current practice pattern is to evaluate postoperative fevers for the presence of associated infections with a routine battery of laboratory tests. The primary diagnostic workup often includes a white blood cell count, urine culture, blood cultures, and a chest x-ray. The majority of these tests, however, when ordered routinely for all fevers are often negative and constitute a significant cost expenditure. Blood cultures are considered the gold standard test for the diagnosis of bacteremia. Mortality rates for bacteremic patients range from 20% to 35% in studies of hospitalized adults to as high as 60% in studies of intensive care populations. It is because of the potential clinical severity of bacteremia that many clinicians have a low threshold for ordering blood cultures, but the incidence of bacteremia in postoperative febrile patients is extremely low. Many authors speculate that routinely obtaining blood cultures with each temperature elevation is an inefficient use of resources and that the impact of blood culture results on treatment is low. This article describes the physiologic mechanism of the febrile response, the significance of the febrile response in the postoperative period, and reviews the existing literature on the use of blood cultures in the postoperative period. Recommendations for the use of blood cultures in the postoperative febrile population are also discussed. Studies were identified for review by a series of Medline searches (1966-2000) using the key words postoperative fever, blood culture utilization, and bacteremia and by scanning the bibliographies of relevant articles retrieved. |
| Databáze: | OpenAIRE |
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