Cost and Utility of Microbiological Cultures Early After Intensive Care Unit Admission for Intracerebral Hemorrhage.
Cost and Utility of Microbiological Cultures Early After Intensive Care Unit Admission for Intracerebral Hemorrhage.
复制标题
DOI：
10.1007/s12028-016-0285-3
复制
发表时间：
2017-03
影响因子：
3.5
通讯作者：
Takhar SS
中科院分区：
文献类型：
--
作者：
Elmer J;Yamane D;Hou PC;Wilcox SR;Bajwa EK;Hess DR;Camargo CA Jr;Greenberg SM;Rosand J;Pallin DJ;Goldstein JN;Takhar SS
发热在重症监护室（ICU）患者中很常见。临床医生可以使用微生物培养来区分感染性和无菌性发热。然而，它们的效用取决于感染的流行程度，假阳性结果可能会对患者护理产生不利影响。我们试图量化ICU自发性脑出血（ICH）患者队列中微生物培养的成本和效用。我们对需要机械通气的自发性ICH队列进行了二次分析。我们收集了基线数据、全身炎症指标、前48小时的微生物培养结果和每日抗生素使用情况。两名医生使用标准标准判定真阳性和假阳性培养结果。我们计算了每个真阳性结果的成本，并使用逻辑回归来检验假阳性结果与随后的抗生素暴露之间的关联。共纳入697例受试者。共有233名受试者获得了432次血培养，其中1次为真阳性（诊断率为0.1%，每例真阳性花费22，200美元），11次为假阳性。真阳性尿培养（5%）和痰培养（13%）更常见，但假阳性也更常见（分别为6%和17%）。在校正分析中，假阳性血液和痰结果与抗生素暴露增加相关。自发性脑出血后早期血培养的产量非常低。假阳性结果显著增加了抗生素暴露的几率。我们的研究结果支持在自发性ICH入住ICU后的第一天限制使用血培养。
Fever is common among intensive care unit (ICU) patients. Clinicians may use microbiological cultures to differentiate infectious and aseptic fever. However, their utility depends on the prevalence of infection and false positive results might adversely affect patient care. We sought to quantify the cost and utility of microbiological cultures in a cohort of ICU patients with spontaneous intracerebral hemorrhage (ICH). We performed a secondary analysis of a cohort with spontaneous ICH requiring mechanical ventilation. We collected baseline data, measures of systemic inflammation, microbiological culture results for the first 48h, and daily antibiotic usage. Two physicians adjudicated true positive and false positive culture results using standard criteria. We calculated the cost per true positive result, and used logistic regression to test the association between false positive results with subsequent antibiotic exposure. Overall, 697 subjects were included. A total of 233 subjects had 432 blood cultures obtained, with one true positive (diagnostic yield 0.1%, $22,200 per true positive), and 11 false positives. True positive urine cultures (5%) and sputum cultures (13%) were more common, but so were false positives (6% and 17%, respectively). In adjusted analysis, false positive blood and sputum results were associated with increased antibiotic exposure. The yield of blood cultures early after spontaneous ICH was very low. False positive results significantly increased odds of antibiotic exposure. Our results support limiting use of blood cultures in the first days after ICU admission for spontaneous ICH.
登录
查看更多内容
影响因子：
8.3
作者：
Hemphill, JC;Bonovich, DC;Johnston, SC
通讯作者：
Johnston, SC
影响因子：
8.3
作者：
Meretoja, Atte;Strbian, Daniel;Tatlisumak, Turgut
通讯作者：
Tatlisumak, Turgut
影响因子：
8.3
作者：
Lord AS;Langefeld CD;Sekar P;Moomaw CJ;Badjatia N;Vashkevich A;Rosand J;Osborne J;Woo D;Elkind MS
通讯作者：
Elkind MS
影响因子：
158.5
作者：
STAMM, WE;COUNTS, GW;HOLMES, KK
通讯作者：
HOLMES, KK
影响因子：
3.5
作者：
Maramattom, Boby Varkey;Weigand, Stephen;Manno, Edward M.
通讯作者：
Manno, Edward M.