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Is the blood culture useful in febrile immunocompetent patients in the Emergency Department?

Introduction

Blood culture was commonly performed, without any specific indication, at the Emergency Department. However, the true positive rate was found to be very low (1.8–5%) and patients with true bacteremia usually had such risk factors as an indwelling catheter, severe underlying disease or an immunocompromised state. This study was performed to determine the usefulness of performing blood culture for managing febrile immunocompetent patients who present to the Emergency Department.

Method

We prospectively analyzed the medical characteristic and the results of blood culture of febrile immunocompetent patients who were more than 18 years old and who presented to the Chonnam National University Hospital Emergency Center from April 2005 to October 2005. Fever was defined as a single axillary temperature higher than 38.0°C. The two sets of blood for culture were drawn at the antecubital area by the emergency physician who knew well how to obtain blood for culture. The bacteremia was classified as true bacteremia or contamination, based on the presence of clinical signs and symptoms and also on the criteria of MacGregor. For the true bacteremia group, we further investigated the changes that occurred with the previously administered antibiotic therapy according to the results of blood culture.

Results

This study included 182 patients: of the 182 cultures, only 36 were positive with 10 contaminants (5.5%) and 26 true positives (14.3%). The most common disease that required blood culture in the Emergency Department was respiratory infection (57/182) and the most common disease with true bacteremia was urinary infection (41.9%). A low initial level of albumin was the characteristic associated with a positive blood culture result on multivariate analysis. Management of only five patients was influenced by the blood culture results (2.7%).

Conclusion

The blood cultures, as were usually ordered for febrile immunocompetent patients in the Emergency Department, rarely altered patient management and the results had limited usefulness. The emergency physician who initially treats these patients has to consider this limitation of blood culture. Also, eliminating blood cultures for immunocompetent patients may hold down unnecessary medical expenses.

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Moon, J. Is the blood culture useful in febrile immunocompetent patients in the Emergency Department?. Crit Care 11, P82 (2007). https://doi.org/10.1186/cc5242

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Keywords

  • Emergency Department
  • Blood Culture
  • True Positive Rate
  • Positive Blood Culture
  • Emergency Physician