Inova Fairfax Medical Campus, Falls Church, VA.
Ann Surg. 2018 Feb;267(2):297-302. doi: 10.1097/SLA.0000000000002077.
To define clinical features of surgical patients in whom postoperative blood cultures are likely to identify pathogens.
Bacteremia is a worrisome postoperative complication and blood cultures (BCx) are routinely used for evaluation of postoperative bacteremia, but are costly and not always diagnostic. Better methods are needed to select patients in whom BCx identify pathogens.
We reviewed records of patients ≥18 years old with BCx drawn ≤10 days after surgery in 2013 seeking independent predictors of positive cultures by simple and multiple logistic regression models with statistical significance at α = 0.05.
Of 1804 BCx, excluding contaminants yielded 1780 cultures among 746 patients for analysis. The yield was low, with only 4% identifying potential pathogens. Positive BCx were most common after cardiac, ear/nose/throat, obstetric, and urologic procedures [odds ratio (OR) =10.3, P < 0.001 vs low-yield procedures: eg, gynecologic, neurosurgical, plastic surgical, podiatric, transplant]. Cultures more often grew pathogens when drawn in association with higher peak temperature (Tmax, P = 0.001) and longer interval from procedure to Tmax (P = 0.001). Antibiotic therapy at time of culture reduced yield (2.9% with vs 5.5% without antibiotics, P = 0.007). Multivariable logistic regression analysis found antibiotics at culture, procedure specialty, Tmax, and postoperative timing of Tmax were associated with blood culture results.
Ordering blood cultures based on fever or another single predictor inconsistently identifies pathogens. Our dataset, the largest available, identify clinical predictors in the first 10 postoperative days to guide identification of patients with bacteremia.
确定术后血培养可能鉴定病原体的手术患者的临床特征。
菌血症是一种令人担忧的术后并发症，血培养（BCx）通常用于评估术后菌血症，但成本高且并非总是具有诊断意义。需要更好的方法来选择 BCx 能鉴定病原体的患者。
我们回顾了 2013 年在术后 10 天内采集 BCx 的≥18 岁患者的记录，通过简单和多变量逻辑回归模型寻找阳性培养物的独立预测因子，统计显著性为α=0.05。
在排除污染后，1804 次 BCx 中，746 例患者的 1780 次培养物可用于分析。阳性 BCx 的检出率较低，仅 4%可鉴定潜在病原体。阳性 BCx 最常见于心脏、耳鼻喉、产科和泌尿科手术[比值比（OR）=10.3，P < 0.001 与低产率手术相比：例如，妇科、神经外科、整形手术、足科、移植]。当与较高的峰值温度（Tmax，P=0.001）和从手术到 Tmax 的较长时间间隔（P=0.001）相关时，培养物更常生长病原体。培养时使用抗生素治疗会降低产量（有抗生素与无抗生素的比例分别为 2.9%和 5.5%，P=0.007）。多变量逻辑回归分析发现，培养时使用抗生素、手术专业、Tmax 和术后 Tmax 的时间与血培养结果相关。
基于发热或其他单一预测因子进行血培养检查不能一致地鉴定病原体。我们的数据集是目前可用的最大数据集，确定了术后 10 天内的临床预测因子，以指导菌血症患者的识别。
