Blood cultures taken from patients attending emergency departments in South Africa are an important antibiotic stewardship tool, which directly influences patient management
dc.contributor.author | Boyles, Tom H | |
dc.contributor.author | Davis, Kelly | |
dc.contributor.author | Crede, Thomas | |
dc.contributor.author | Malan, Jacques | |
dc.contributor.author | Mendelson, Marc | |
dc.contributor.author | Lesosky, Maia | |
dc.date.accessioned | 2015-10-30T14:27:21Z | |
dc.date.available | 2015-10-30T14:27:21Z | |
dc.date.issued | 2015-10-06 | |
dc.date.updated | 2015-10-26T17:24:03Z | |
dc.description.abstract | Abstract Background Febrile illness with suspected blood stream infection (BSI) is a common reason for admission to hospital in Africa and blood cultures are therefore an important investigation. Data on the prevalence and causes of community acquired BSI in Africa are scarce and there are no studies from South Africa. There are no validated clinical prediction rules for use of blood cultures in Africa. Methods A prospective observational cohort study of patients attending 2 urban emergency departments in Cape Town, South Africa. The decision to take a blood culture was made by the attending clinician and information available at the time of blood draw was collected. Bottles were weighed to measure volume of blood inoculated. Results 500 blood culture sets were obtained from 489 patients. 39 (7.8 %) were positive for pathogens and 13 (2.6 %) for contaminants. Significant independent predictors of positive cultures were diastolic blood pressure <60 mmHg, pulse >120 bpm, diabetes and a suspected biliary source of infection, but not HIV infection. Positive results influenced patient management in 36 of 38 (95 %) cases with the organism being resistant to the chosen empiric antibiotic in 9 of 38 (24 %). Taking <8 ml of blood was predictive of a negative culture. The best clinical prediction rule had a negative predictive value (NPV) of 92 % which is unlikely to be high enough to be clinically useful. Discussion Blood cultures taken from patients attending emergency departments in a high HIV prevalent city in South Africa are frequently positive and almost always influence patient management. At least 8 ml of blood should be inoculated into each bottle. Conclusion Blood cultures should be taken from all patients attending EDs in South Africa suspected of having BSI particularly if diabetic, with hypotension, tachycardia or if biliary sepsis is suspected. | |
dc.identifier.apacitation | Boyles, T. H., Davis, K., Crede, T., Malan, J., Mendelson, M., & Lesosky, M. (2015). Blood cultures taken from patients attending emergency departments in South Africa are an important antibiotic stewardship tool, which directly influences patient management. <i>BMC Infectious Diseases</i>, http://hdl.handle.net/11427/14582 | en_ZA |
dc.identifier.chicagocitation | Boyles, Tom H, Kelly Davis, Thomas Crede, Jacques Malan, Marc Mendelson, and Maia Lesosky "Blood cultures taken from patients attending emergency departments in South Africa are an important antibiotic stewardship tool, which directly influences patient management." <i>BMC Infectious Diseases</i> (2015) http://hdl.handle.net/11427/14582 | en_ZA |
dc.identifier.citation | BMC Infectious Diseases. 2015 Oct 06;15(1):410 | |
dc.identifier.ris | TY - Journal Article AU - Boyles, Tom H AU - Davis, Kelly AU - Crede, Thomas AU - Malan, Jacques AU - Mendelson, Marc AU - Lesosky, Maia AB - Abstract Background Febrile illness with suspected blood stream infection (BSI) is a common reason for admission to hospital in Africa and blood cultures are therefore an important investigation. Data on the prevalence and causes of community acquired BSI in Africa are scarce and there are no studies from South Africa. There are no validated clinical prediction rules for use of blood cultures in Africa. Methods A prospective observational cohort study of patients attending 2 urban emergency departments in Cape Town, South Africa. The decision to take a blood culture was made by the attending clinician and information available at the time of blood draw was collected. Bottles were weighed to measure volume of blood inoculated. Results 500 blood culture sets were obtained from 489 patients. 39 (7.8 %) were positive for pathogens and 13 (2.6 %) for contaminants. Significant independent predictors of positive cultures were diastolic blood pressure <60 mmHg, pulse >120 bpm, diabetes and a suspected biliary source of infection, but not HIV infection. Positive results influenced patient management in 36 of 38 (95 %) cases with the organism being resistant to the chosen empiric antibiotic in 9 of 38 (24 %). Taking <8 ml of blood was predictive of a negative culture. The best clinical prediction rule had a negative predictive value (NPV) of 92 % which is unlikely to be high enough to be clinically useful. Discussion Blood cultures taken from patients attending emergency departments in a high HIV prevalent city in South Africa are frequently positive and almost always influence patient management. At least 8 ml of blood should be inoculated into each bottle. Conclusion Blood cultures should be taken from all patients attending EDs in South Africa suspected of having BSI particularly if diabetic, with hypotension, tachycardia or if biliary sepsis is suspected. DA - 2015-10-06 DB - OpenUCT DO - 10.1186/s12879-015-1127-1 DP - University of Cape Town J1 - BMC Infectious Diseases LK - https://open.uct.ac.za PB - University of Cape Town PY - 2015 T1 - Blood cultures taken from patients attending emergency departments in South Africa are an important antibiotic stewardship tool, which directly influences patient management TI - Blood cultures taken from patients attending emergency departments in South Africa are an important antibiotic stewardship tool, which directly influences patient management UR - http://hdl.handle.net/11427/14582 ER - | en_ZA |
dc.identifier.uri | http://dx.doi.org/10.1186/s12879-015-1127-1 | |
dc.identifier.uri | http://hdl.handle.net/11427/14582 | |
dc.identifier.uri | http://hdl.handle.net/11427/14582 | |
dc.identifier.uri | http://dx.doi.org/10.1186/s12879-015-1127-1 | |
dc.identifier.vancouvercitation | Boyles TH, Davis K, Crede T, Malan J, Mendelson M, Lesosky M. Blood cultures taken from patients attending emergency departments in South Africa are an important antibiotic stewardship tool, which directly influences patient management. BMC Infectious Diseases. 2015; http://hdl.handle.net/11427/14582. | en_ZA |
dc.language.rfc3066 | en | |
dc.publisher.department | Department of Medicine | en_ZA |
dc.publisher.faculty | Faculty of Health Sciences | en_ZA |
dc.publisher.institution | University of Cape Town | |
dc.rights.holder | Boyles et al. | |
dc.source | BMC Infectious Diseases | |
dc.source.uri | http://bmcinfectdis.biomedcentral.com/ | |
dc.title | Blood cultures taken from patients attending emergency departments in South Africa are an important antibiotic stewardship tool, which directly influences patient management | |
dc.type | Journal Article | |
uct.type.filetype | Text | |
uct.type.filetype | Image | |
uct.type.publication | Research | en_ZA |
uct.type.resource | Article | en_ZA |