title: Blood cultures in acute surgical admissions.
abstract: BACKGROUND
  Obtaining blood cultures prior to the administration of antimicrobial therapy was a key recommendation of the 2012 UK Surviving Sepsis Campaign. Few studies have examined the effect blood cultures have on clinical management and there have been none on acute surgical admissions. This retrospective study sought to evaluate the effect of blood cultures on clinical management in acute surgical admissions.
  
  
  METHODS
  Data on acute surgical patients admitted between 1 January and 31 December 2012 were extracted from hospital records. Patients given intravenous antibiotics within 24 hours of admission were identified. Data collected included antibiotics administered, blood culture results, admission observations and white blood cell count. Case notes were reviewed for patients with positive cultures to establish whether the result led to a change in management.
  
  
  RESULTS
  Of 5,887 acute surgical admissions, 1,346 received intravenous antibiotics within 24 hours and 978 sets of blood cultures were taken in 690 patients. The recommended two sets of cultures were obtained in 246 patients (18%). Patients who had blood cultures taken had the same in-hospital mortality as those who had none taken (3.6% vs 3.5%, p=0.97). Blood cultures were positive in 80 cases (11.6%). The presence of systemic inflammatory response syndrome did not increase positivity rates (12.9% vs 10.3%, p=0.28). Overall, cultures altered management in two patients (0.3%).
  
  
  CONCLUSIONS
  Blood cultures rarely affect clinical management. In order to assess the additional value that blood cultures bring to sepsis management in acute surgical admissions, a prospective randomised trial focusing on outcome is needed.
authors.affiliation: Aintree University Hospital NHS Foundation Trust, UK.
authors.forename: D F J
authors.initials: DF
authors.lastname: Dunne
authors.forename: R
authors.initials: R
authors.lastname: McDonald
authors.forename: R
authors.initials: R
authors.lastname: Ratnayake
authors.forename: H Z
authors.initials: HZ
authors.lastname: Malik
authors.forename: R
authors.initials: R
authors.lastname: Ward
authors.forename: G J
authors.initials: GJ
authors.lastname: Poston
authors.forename: S W
authors.initials: SW
authors.lastname: Fenwick
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D001419:Bacteria / Q000187:drug effects / Q000302:isolation & purification; D001431:Bacteriological Techniques / Q000706:statistics & numerical data*; D001769:Blood / Q000382:microbiology*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012189:Retrospective Studies; D018805:Sepsis / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D013514:Surgical Procedures, Operative
chemical_list: D000900:Anti-Bacterial Agents