Cost and Utility of Microbiological Cultures Early After Intensive Care Unit Admission for Intracerebral Hemorrhage.
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 48 h, 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 the odds of antibiotic exposure. Our results support limiting the use of blood cultures in the first two days after ICU admission for spontaneous ICH.
Departments of Emergency Medicine and Critical Care Medicine, University of Pittsburgh, Iroquois Building, Suite 400A, 3600 Forbes Avenue, Pittsburgh, PA, 15213, USA. elmerp@upmc.edu.
Jonathan
J
Elmer
Department of Anesthesiology and Critical Care Medicine, George Washington University Hospital, Washington, DC, USA.
David
D
Yamane
Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.|Surgical Intensive Care Unit, Brigham and Women's Hospital, Boston, MA, USA.
Peter C
PC
Hou
Divisions of Emergency Medicine and Pulmonary, Critical Care and Sleep Medicine, Medical University of South Carolina, Charleston, SC, USA.
Susan R
SR
Wilcox
Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.|Pulmonary and Critical Care Unit, Massachusetts General Hospital, Boston, MA, USA.
Ednan K
EK
Bajwa
Pulmonary and Critical Care Unit, Massachusetts General Hospital, Boston, MA, USA.|Department of Respiratory Care, Massachusetts General Hospital, Boston, MA, USA.
Dean R
DR
Hess
Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
Carlos A
CA
Camargo
Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.|Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Boston, MA, USA.
Steven M
SM
Greenberg
Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.|Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Boston, MA, USA.
Jonathan
J
Rosand
Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Daniel J
DJ
Pallin
Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.|Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Boston, MA, USA.
Joshua N
JN
Goldstein
Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.|Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA.
Sukhjit S
SS
Takhar
D000368:Aged; D001769:Blood / Q000382:microbiology*; D002543:Cerebral Hemorrhage / Q000097:blood / Q000175:diagnosis* / Q000191:economics / Q000382:microbiology; D003422:Critical Care / Q000191:economics / Q000592:standards*; D016638:Critical Illness / Q000191:economics; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000175:diagnosis* / Q000191:economics / Q000382:microbiology; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D013183:Sputum / Q000382:microbiology*; D019564:Unnecessary Procedures / Q000191:economics / Q000592:standards*; D014556:Urine / Q000382:microbiology*
Antimicrobial; Critical illness; Culture; Intracerebral hemorrhage; Microbiology