Cost-effectiveness of blood cultures for adult patients with cellulitis.
To assess the cost-effectiveness of blood cultures for patients with cellulitis, a retrospective review was conducted of clinical and microbiological data for all 757 patients admitted to a medical center because of community-acquired cellulitis during a 41-month period. Blood cultures were performed for 553 patients (73%); there were a total of 710 blood samples (i.e., a mean of 1.3 cultures were performed per patient). In only 11 cases (2.0%) was a significant patient-specific microbial strain isolated, mainly beta-hemolytic streptococci (8 patients [73%]). An organism that was considered a contaminant was isolated from an additional 20 culture bottles (3. 6%). The cost of laboratory workup of the 710 culture sets was $36, 050. Isolation of streptococci led to a change from empirical treatment with cefazolin to penicillin therapy for 8 patients. All patients recovered. In conclusion, the yield of blood cultures is very low, has a marginal impact on clinical management, and does not appear to be cost-effective for most patients with cellulitis.
Perl
B
B
Infectious Diseases Unit, Shaare Zedek Medical Center, Jerusalem 91031, Israel.
Gottehrer
N P
NP
Raveh
D
D
Schlesinger
Y
Y
Rudensky
B
B
Yinnon
A M
AM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000191:economics / Q000382:microbiology; D001419:Bacteria / Q000302:isolation & purification; D001424:Bacterial Infections / Q000097:blood / Q000191:economics / Q000382:microbiology*; D001431:Bacteriological Techniques; D002481:Cellulitis / Q000097:blood / Q000191:economics / Q000382:microbiology*; D019411:Clinical Laboratory Techniques / Q000191:economics / Q000379:methods; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013291:Streptococcus / Q000302:isolation & purification