McMurray B R, Wrenn K D, Wright S W
Department of Emergency Medicine, Vanderbilt University, Nashville, TN 37232-4700, USA.
Am J Emerg Med. 1997 Mar;15(2):137-40. doi: 10.1016/s0735-6757(97)90084-x.
To evaluate the usefulness of blood cultures in patients admitted with pyelonephritis, a retrospective chart review was-conducted of inpatients at a 594-bed urban, academic medical center from 1990 through 1992 with a primary discharge diagnosis of pyelonephritis. A total of 338 patients had this primary discharge diagnosis. One or more sets of blood cultures were obtained in 307 patients (91%). Fifty-six (18%) patients had a positive blood culture; 24 (32%) positive blood cultures grew coagulase-negative Staphylococcus species, in all but two instances considered a skin contaminant. Of the blood cultures drawn, only 1 (0.2%) grew a pathogenic organism not found in the urine culture, with no impact on clinical management. These results support the conclusion that blood cultures are rarely clinically useful and seldom vary from urine culture results. Potential annual cost savings of between $10 million and $20 million in the United States could result from eliminating routine blood cultures in the setting of uncomplicated acute pyelonephritis.
为评估血培养在肾盂肾炎住院患者中的作用，对一家拥有594张床位的城市学术医疗中心1990年至1992年期间以肾盂肾炎为主要出院诊断的住院患者进行了回顾性病历审查。共有338例患者有此主要出院诊断。307例患者（91%）进行了一组或多组血培养。56例（18%）患者血培养阳性；24例（32%）血培养阳性培养出凝固酶阴性葡萄球菌，除两例情况外，均被认为是皮肤污染物。在采集的血培养中，只有1例（0.2%）培养出尿培养中未发现的致病微生物，且对临床管理无影响。这些结果支持以下结论：血培养在临床上很少有用，且很少与尿培养结果不同。在美国，通过在单纯性急性肾盂肾炎患者中取消常规血培养，每年可能节省1000万至2000万美元的费用。
