Blood cultures taken from patients attending emergency departments in South Africa are an important antibiotic stewardship tool, which directly influences patient management

dc.contributor.authorBoyles, Tom H
dc.contributor.authorDavis, Kelly
dc.contributor.authorCrede, Thomas
dc.contributor.authorMalan, Jacques
dc.contributor.authorMendelson, Marc
dc.contributor.authorLesosky, Maia
dc.date.accessioned2015-10-30T14:27:21Z
dc.date.available2015-10-30T14:27:21Z
dc.date.issued2015-10-06
dc.date.updated2015-10-26T17:24:03Z
dc.description.abstractAbstract 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.apacitationBoyles, 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/11427/14582en_ZA
dc.identifier.chicagocitationBoyles, 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/11427/14582en_ZA
dc.identifier.citationBMC 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.urihttp://dx.doi.org/10.1186/s12879-015-1127-1
dc.identifier.urihttp://hdl.handle.net/11427/14582
dc.identifier.urihttp://hdl.handle.net/11427/14582
dc.identifier.urihttp://dx.doi.org/10.1186/s12879-015-1127-1
dc.identifier.vancouvercitationBoyles 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.rfc3066en
dc.publisher.departmentDepartment of Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rights.holderBoyles et al.
dc.sourceBMC Infectious Diseases
dc.source.urihttp://bmcinfectdis.biomedcentral.com/
dc.titleBlood cultures taken from patients attending emergency departments in South Africa are an important antibiotic stewardship tool, which directly influences patient management
dc.typeJournal Article
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
Files
Original bundle
Now showing 1 - 1 of 1
Loading...
Thumbnail Image
Name:
12879_2015_Article_1127.pdf
Size:
665.27 KB
Format:
Adobe Portable Document Format
Description:
License bundle
Now showing 1 - 1 of 1
Loading...
Thumbnail Image
Name:
license.txt
Size:
1.72 KB
Format:
Item-specific license agreed upon to submission
Description:
Collections