1918. Is It Time to Assess the Role of Blood Cultures in the Current Practice of Medicine?

BACKGROUND: Today’s physician must deal with data from traditional tests, as well from new sources like smart phones and texting, the electronic medical record (EMR), septic shock and sepsis “bundles,” and the availability of PCR for the rapid identification of organisms, all in an environment of antibiotic stewardship programs. We need to assess which methods of data collection are meaningful and efficient, and which can be modified. METHODS: We reviewed a handwritten log of the preliminary demographics of patients with positive blood cultures from a 6-year study period, then confirmed this number with the financial department, as well as the locations where blood cultures were drawn, and the charges generated. Our data identify those who died, but do not identify the cause of death nor the causative nature of the patient’s bacteremia for mortality. RESULTS: We found that the majority of orders were for “two sets of blood cultures 30 minutes apart,” but there were multiple orders for one or more additional sets; in many cases, additional cultures were ordered because of temperature elevation or leukocytosis; in other instances, the indication for the blood culture was not clear. The number and volume of blood cultures ordered for individual patient encounters came at the discretion of the individual physician. The percentage of positive blood cultures was approximately 5%, of an average 17,000 cultures done per year, with total charges of more than $60 M over a 6-year period. Thus, we have a common test with low sensitivity resulting in a high financial expenditure CONCLUSION: Since data sharing among medical teams is now easier because of new tests and electronic data gathering advances in medicine, it is also easier to assess which traditional patterns of data collection are most effective and which should be reviewed. All blood culture order guidelines for local hospital systems should be reviewed and assessed for efficacy and efficiency by the appropriate personnel. National organizations should consolidate and codify one set of clinically relevant and case-based guidelines from those which are available. DISCLOSURES: All authors: No reported disclosures.