Do Positive Anaerobic Culture Results Affect Physicians’ Clinical Management Decisions?
Often routine aerobic and anaerobic cultures from body fluids, abscesses and wounds are ordered. We seek to determine whether results of anaerobic tissue and fluid cultures, with the exception of blood, affect physicians' treatment approaches.
Retrospective chart review of all adult inpatients (age ≥ 18 yrs) with positive anaerobic body tissue/fluid cultures between January 1, 2012 and December 31, 2012.
Data collected included subjects' ages, co-morbidities, hospital service, initial antibiotic regimen, acknowledgement in the chart of positive anaerobic culture results, and whether or not ID consultation was obtained. Culture data included specimen source, organism identification, and time to growth of anaerobic culture.
205 of 3,234 (6.34%) anaerobic body fluid/tissue cultures, from 180 patient visits, were positive. Of these 180 visits, 26 were excluded based on exclusion criteria, therefore 154 charts were reviewed.
The majority of cases with positive anaerobic cultures were surgical specimens. Only 20% (n=31) of patient charts with positive cultures had documented physician acknowledgement, 90.3% by ID physicians. Only 8% (n=15) had antibiotic regimens changed based on results (Fig 1). In about 25% of cases, results were reported after the patient was discharged, so no assessment of response was possible.
Nearly 70% of all patients were on appropriate initial empiric antibiotic coverage (Fig 2). Of the remaining 30% (inappropriate, unknown, or no empiric coverage), 1 regimen change was documented after culture results were known. There were no changes in cases without physician result acknowledgment.
Conclusion: Our study suggests that positive anaerobic body fluid culture results infrequently affect physicians' treatment decisions. There may be significant opportunities for cost saving if anaerobic cultures are not routinely processed.
1. Use of progress notes as evidence of physician acknowledgement of culture results likely misses many cases in which results were reviewed and considered in physician assessments.
2. Since only patients with positive culture results were reviewed, we cannot assess the impact of a negative result on decisions regarding need for continued antimicrobial therapy.
S. Boruchoff, None
T. Bhowmick, None