The impact of blood cultures obtained in the emergency department on clinical management

8. ABSTRACT The Impact of Blood Cultures Obtained in the Emergency Department on Clinical Management Objectives: Although blood cultures (BCs) are considered the most sensitive method for detecting bacteremia, there are still controversy about the benefits of BCs obtained in the emergency department (ED). The aim of this study was to identify the patients whom BCs were obtained in the ED and to evaluate the impact of BC results on clinical management. Materials and Methods: A retrospective analysis of peripheral BC results obtained from patients aged 18 years and over who presented to the Akdeniz University Hospital ED between July 01, 2022 and June 30, 2023 was performed. Data were collectd concerning patient demographics, indications of BC sampling, BC results, and changes in clinical management. Results: During the study period, 646 BC samples were obtained from 461 ED visits of 439 patients and 43 BCs taken in 28 visits of 26 patients were excluded from the analysis. Of the 603 BC samples, 400 (66.3%) had no growth, 93 (15.4%) had true positive growth, and 110 (18.2%) were assessed as being contaminated. It was determined that BCs were obtained most frequently for the diagnoses of fever of unknown origin, pneumonia, and complicated urinary tract infection; the true positive BC results were 14%, 10%, and 33%, respectively. The growth rate was high in BCs obtained for the diagnoses of cholangitis (50%), catheter infection (50%), infective endocarditis (50%), and peritonitis (40%). The ratio of treatment changes made as a result of positive culture to all patient visits was 6.7%. The most frequent treatment changes were in the diagnoses of catheter infection, cholangitis, infective endocarditis and complicated urinary tract infection, between 15% and 25%. Resistance to empirical antibiotics was observed in more than 40% of complicated urinary tract infection, pneumonia, cholangitis, central nervous system infection, cellulitis, and fistula site infections. Conclusion: Although BCs obtained in our ED have resulted in more treatment changes than in other studies, they rarely produced clinically significant results and appeared to have minimal impact on the subsequent patient management. Keywords: Emergency department, BC, Sepsis, Clinical impact, Contamination