Abstract Details

Title The Utility of Frequent Blood Culture for Fever Workup in Critically Ill Neurological Patients

Topic Critical Care/Emergency Neurology/Trauma

Presentation(s) P05 - (-)

Poster/Presentation
Number 208

Objective

Background BACKGROUND: Persistent fever is very common in patients with severe traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), or intracerebral hemorrhage (ICH), possibly due to brain injury or hematoma-related inflammation. However, frequent blood culture is widely used in ruling out sepsis. The aim of this study was to evaluate the utility of blood culture in patients with critically ill neurological disorders.

Design/Methods DESIGN/METHODS: Prospective data collection of consecutive patients admitted to our Neuroscience Critical Care Unit was carried out. Fever was defined as body temperature ?101[deg]F (38.3[deg]C) documented on at least one measurement for 2 consecutive days. Patients with severe TBI, ICH, or SAH were included for this study.

Results RESULTS: From April to August of 2012, 18 patients with severe TBI (5), ICH (6), or SAH (7) were found to have fever. There were 8 male and 10 female with average ages 47.7 ±18.3. Their ICU length of stay was 21.5 ±16.3. There were 220 blood cultures for fever workup, averaging 12.1 blood cultures per patient. There were 5 (2.3%) positive blood cultures (3 Staphylococcus epidermidis, 1 Staphylococcus saprophyticus in [frac12] bottles, and 1 viridans streptococcus in 2/2 bottles). Among them, only the patient with viridans streptococcus had sudden high fever (40.1[deg]C) and chills. The other 4 positive cultures likely represented contamination. The yield of blood culture for the diagnosis of sepsis in critically ill neurological patients was therefore 0.45% (1/220).

Conclusions CONCLUSIONS: Persistent inflammatory fever is common in critically ill neurological patients. The yield of frequent blood culture is extremely low. Blood culture should only be ordered for critically ill neurological patients with sudden fever spike, leukocytosis, and/or hypotension.

Authors/Disclosures
Wengui Yu, MD, PhD (UC Irvine, Neurology Dept) PRESENTER	Dr. Yu has nothing to disclose.
Asma Moheet, MD (Riverside Methodist Hospital - OhioHealth)	No disclosure on file
David Palestrant, MD	No disclosure on file
	No disclosure on file

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