117. Hospitalized Burn Patients with Fever and Leukocytosis: Blood Culture or Not?

BACKGROUND: Fever and leukocytosis are very common in patients with burn injury. Many patients had to do blood cultures frequently during their hospitalization given the concern of bacteremia. We opt to utilize the clinical characters of the patients to evaluate the risk for bacteremia and avoid unnecessary blood culture. METHODS: The adult patients (≥18 years) with burn injury were selected from the Nationwide Inpatient Sample database (2005–2014). Using ICD-9 codes, we further identified bacteremia, total body surface area (TBSA) of burn, inhalation injury, pneumonia, urinary tract infection, wound infection, escharotomy, placement of central venous line, indwelling urinary catheter, gastrostomy tube (G-tube), intubation, and total parenteral nutrition (TPN). The risk factors for bacteremia were evaluated by Logistic regression. A risk-adjusted model to predict the occurrence of bacteremia was developed by discriminant analysis. RESULTS: In total, 241,323 hospitalized patients with burn injury were identified. The incidence of bacteremia was 1.1% (n = 2,634). Comparing with the patients without bacteremia, those with bacteremia were older (51.1 vs. 46.7 year old, P < 0.001), had more severe burn injury (50.7% vs. 12% with burn TBSA over 20%, P < 0.001) and comorbidities (22.7% vs. 14.9% with Charlson index ≥2, P < 0.001), higher in-hospital mortality (5.6% vs. 3.7%, P < 0.001), longer hospital stay (26 vs. 5 days, P < 0.001) and more hospital charges ($206,028 vs. $30,339, P < 0.001). When the age, sex, race, and Charlson index of the patients were adjusted by Logistic regression, it was found that the factors of inhalation injury (OR = 1.25, 95% CI 1.03–1.51), intubation (OR = 1.62, 95% CI 1.44–1.82), TPN (OR = 1.56, 95% CI 1.16–2.11), placement of central venous line (OR = 1.86, 95% 1.57–2.01), and G-tube (OR = 2.04, 95% CI 1.60–2.60) were associated with increased risk for bacteremia. A risk-adjusted model composed of the patient’s age, Charlson index, burn TBSA, inhalation injury, intubation, TPN, placement of central venous line, and G-tube could predict the occurrence of bacteremia with an accurate rate of 85.4% (Table 1). CONCLUSION: The risk factors and risk-adjusted model for bacteremia may assist to decide whether a blood culture is needed in the hospitalized burn patients. [Image: see text] DISCLOSURES: All authors: No reported disclosures.