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Diagnostic Utility of Blood Cultures in the Post Solid Organ Transplant Patient
Description
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A3282 - Diagnostic Utility of Blood Cultures in the Post Solid Organ Transplant Patient
Author Block: A. S. Greenwald1, M. R. Pereira2, V. K. Moitra1; 1Anesthesiology, Columbia University Medical Center, New York, NY, United States, 2Infectious Diseases, Columbia University Medical Center, New York, NY, United States.
Background
Infection after transplant is a major cause of death among immunosuppressed patients. Pancultures are routinely performed for febrile patients to identify pathogens or the location of infection. Obtaining these cultures, however, can be problematic because of patient discomfort, lab utilization, false positive cultures, decreased satisfaction, hospital acquired anemia, time to obtain the culture, and cost.1
Methods
The objective of this study was to investigate the yield of blood cultures drawn within 48 hours of ICU admission in patients who had a history of solid organ transplant. After IRB approval, we evaluated all patients who were transplanted a primary heart, single or double lung, or liver transplant and were admitted to the either the surgical ICU or cardiothoracic ICU from 2011-2015. We then examined blood cultures drawn within 48 hours of admission to the ICU following transplantation surgery. Cultures from 956 patients were reviewed.
Results
Of 956 patients, 165 (17.26%) patients had blood cultures drawn within 48 hours of ICU admission. 7 patients (4.24% of all cultures drawn) yielded a positive result. One patient grew Pseudomonas (colonized preoperatively); one patient grew E. coli; and the remaining cultures were likely false positives. Following primary organ transplantation, only 1.21% of blood cultures drawn yielded a positive result.
Conclusion
We found that cultures rarely returned positive. Only one patient within 48 hours of a transplant had a de novo positive culture that warranted antibiotic treatment. In the immediate postoperative period after solid organ transplantation, despite a clinical deterioration warranting investigation including a panculture, it may be cost-saving and efficient to exclude blood cultures because the yield is vanishingly low.
1.
Vaughn VM, Chopra V. BMJ Qual Saf 2017; 26: 236-239.
Author Block: A. S. Greenwald1, M. R. Pereira2, V. K. Moitra1; 1Anesthesiology, Columbia University Medical Center, New York, NY, United States, 2Infectious Diseases, Columbia University Medical Center, New York, NY, United States.
Background
Infection after transplant is a major cause of death among immunosuppressed patients. Pancultures are routinely performed for febrile patients to identify pathogens or the location of infection. Obtaining these cultures, however, can be problematic because of patient discomfort, lab utilization, false positive cultures, decreased satisfaction, hospital acquired anemia, time to obtain the culture, and cost.1
Methods
The objective of this study was to investigate the yield of blood cultures drawn within 48 hours of ICU admission in patients who had a history of solid organ transplant. After IRB approval, we evaluated all patients who were transplanted a primary heart, single or double lung, or liver transplant and were admitted to the either the surgical ICU or cardiothoracic ICU from 2011-2015. We then examined blood cultures drawn within 48 hours of admission to the ICU following transplantation surgery. Cultures from 956 patients were reviewed.
Results
Of 956 patients, 165 (17.26%) patients had blood cultures drawn within 48 hours of ICU admission. 7 patients (4.24% of all cultures drawn) yielded a positive result. One patient grew Pseudomonas (colonized preoperatively); one patient grew E. coli; and the remaining cultures were likely false positives. Following primary organ transplantation, only 1.21% of blood cultures drawn yielded a positive result.
Conclusion
We found that cultures rarely returned positive. Only one patient within 48 hours of a transplant had a de novo positive culture that warranted antibiotic treatment. In the immediate postoperative period after solid organ transplantation, despite a clinical deterioration warranting investigation including a panculture, it may be cost-saving and efficient to exclude blood cultures because the yield is vanishingly low.
1.
Vaughn VM, Chopra V. BMJ Qual Saf 2017; 26: 236-239.
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