Utility of Blood Cultures in Febrile Patients in a BCSH Level 4 Centre

To describe the epidemiology of bacterial organisms in a level 4 haematology centre and to investigate the prevalence of positive blood cultures at various time points in a febrile patient

A retrospective review was performed on 138 haematology patients who had blood cultures taken on ward 19 for febrile episodes at Heartlands Hospital, a BCSH Level 4 centre over a 6 month period from 1/5/2009 until 30/11/2009.

There were 704 blood cultures performed on 138 patients for 246 ‘febrile’ episodes. There were 59 positive blood cultures.

Patients with AML and DLBCL are most likely to require blood cultures as a result of febrile neutropenia.

Coagulase Negative Staphylococcus is the most common organism isolated from blood cultures in neutropenic patients during ‘febrile’ episodes.

There was only one pathogen cultured that was resistant to the first line antibiotic (Pipercillin/Tazobactam) that was used at this Trust.

The incidence of positive blood cultures at onset of fever is 15% is comparable to that seen in other institutions of similar patient populations. This decreased to 1.5 % at 24 hours, 1.7% at 48 hours and 6.3% at 72 hours.

Based on the results above, it appears reasonable in stable patients to reduce the number of blood cultures done to 72 hours after the initial culture.

At the time of this review, the antibiotic policy in place at HOE NHS trust is appropriate for the pathogens that normally affect this patient population.

There should be regular audits to observe the epidemiology of microbials that affect haematology patients in this region and also to monitor their antimicrobial resistance to ensure appropriate first line antibiotics are in use.

No relevant conflicts of interest to declare.