The utility of routine wound surveillance cultures in the management of burn injury
© The Author(s) 2001
Received: 15 January 2001
Published: 2 March 2001
The objectives of this study are to establish the proportion and cost of surveillance cultures that yield a positive microbiological culture and to determine the influence of surveillance cultures in the ordering of antimicrobials.
Retrospective, computer-assisted chart review.
University-based burn center.
The records of all burn injuries admitted to the Burn Service between Jan 1997 and Jan 1998 were retrospectively identified by ICD-9 release codes. Patients with length of stay less than 1 day, or who had a bed assignment other than in the burn center were excluded. Patients with at least one surveillance culture were included. Surveillance cultures were defined as cultures obtained on Wednesdays and Saturdays per Burn Center protocol. Data collected included: length of stay, extent of burn injury, documentation of surveillance culture results, documentation of signs and/or symptoms of cellulitis and intervention and treatment. A P value < 0.05 was considered statistically significant.
151 patients were identified. Eighty patients met the inclusion criteria. A total of 179 surveillance cultures were collected. 89% (71/80) of study patients received antimicrobials during their hospital course and 82% (58/71) had clinical signs of cellulitis. 91% (53/58) of patients with clinical signs of cellulitis were treated with antimicrobials. Most of these patients (86%) received empirical antimicrobials for cellulitis, based solely on clinical judgment not on culture results. In only three cases (1.6%) were orders for antimicrobials initiated or changed on the basis of wound surveillance cultures. Patients with surveillance culture were significantly more likely to receive antimicrobials than those who were not cultured (39.6% vs 1.7% P = 0.001). However, among those patients with surveillance cultures (n = 179), there were significantly more patients who did not receive any antimicrobials (60.3% vs 39.7% P = 0.001) There was no significant relationship between a positive or negative surveillance culture and orders for antimicrobials (P = 0.097).
The clinical management of burn wounds is not significantly altered by the results of routine surveillance wound cultures. The diagnosis of cellulitis is based on clinical judgment and treatment is initiated empirically. Omitting twice-weekly routine surveillance cultures would result in potential savings of $25,550.00 (US) and would not compromise the quality of patient care.