Swisher E D, Kahleifeh B, Pohl J F
Department of Obstetrics and Gynecology, Walter Reed Army Medical Center, Washington, DC, USA.
J Reprod Med. 1997 Sep;42(9):547-50.
To determine the impact and cost-effectiveness of blood cultures in patients with febrile morbidity following vaginal or abdominal hysterectomy.
The charts of 192 abdominal and 150 vaginal hysterectomy cases performed at Walter Reed Army Medical Center for benign disease between June 1992 and June 1995 were retrospectively analyzed for postoperative febrile morbidity, fever evaluation, blood culture results, management and clinical course.
Of the 342 hysterectomy cases reviewed, 46 (24%) abdominal and 16 (10.7%) vaginal hysterectomies had fever evaluations that included aerobic and anaerobic blood cultures. There were no blood cultures documenting bacteremia in the abdominal or vaginal hysterectomy patients evaluated for postoperative febrile morbidity. Two patients with positive blood cultures had preoperative infections and were eliminated from statistical analysis. Adherence to the definition of febrile morbidity eliminated another 19 (30.6%) of the 62 febrile patients phlebotomized for blood cultures.
Blood cultures in the routine patient following vaginal or abdominal hysterectomy did not alter management and were not cost-effective. Blood cultures may be appropriate for febrile patients with preoperative, intraoperative and postoperative risk factors for bacteremia.
确定血培养对阴道或腹部子宫切除术后发热患者的影响及成本效益。
回顾性分析1992年6月至1995年6月在沃尔特·里德陆军医疗中心因良性疾病行192例腹部子宫切除术和150例阴道子宫切除术患者的病历，以了解术后发热情况、发热评估、血培养结果、治疗及临床病程。
在回顾的342例子宫切除术病例中，46例（24%）腹部子宫切除术和16例（10.7%）阴道子宫切除术的发热评估包括需氧和厌氧血培养。在接受术后发热评估的腹部或阴道子宫切除术患者中，没有血培养记录到菌血症。两名血培养阳性的患者术前有感染，被排除在统计分析之外。按照发热的定义，在62例因血培养而采血的发热患者中，又有19例（30.6%）被排除。
阴道或腹部子宫切除术后的常规患者进行血培养不会改变治疗方案，且不具有成本效益。对于有术前、术中和术后菌血症危险因素的发热患者，血培养可能是合适的。
