Assessment of the Value of Routine Blood Cultures in the Evaluation and Treatment of Patients WithChorioamnionitis

[摘要] Objective:The objective of this investigation was to determine the usefulness of blood cultures inevaluating patients with chorioamnionitis who were treated in accordance with a specific antibiotic protocol.Methods:We reviewed the records of 539 patients with chorioamnionitis who delivered at ourfacility over a 3 year period (July 1, 1989–June 30, 1992). Patients had one set of aerobic and anaerobic blood culturesat the time of their initial assessment. They were treated initially with ampicillin or vancomycin plus gentamicin. Thosewho required cesarean delivery also received clindamycin postoperatively. Patients who had a poor initial response to therapy were treated empirically with selected antibiotics targeted against likely resistant organisms until the results ofbacteriologic cultures were available. Bacteremic patients had repeat blood cultures while on therapy. We analyzed themedical records to determine the frequency with which blood culture results led to meaningful changes in patientmanagement. We also compared the duration of febrile morbidity in bacteremic vs. nonbacteremic patients.Results:Thirty-nine of 538 patients (7.2%, 95% confidence interval [CI] 5.2–9.2%) hadpositive blood cultures. In only one patient did the result of the blood culture definitively alter therapy. This patient hada fever of unknown origin, and the finding of a positive blood culture ultimately led to the diagnosis of chorioamnionitis.The mean duration of febrile morbidity was not significantly different in bacteremic vs. nonbacteremic patients (2.03 vs. 1.74 days). None of the repeat blood cultures was positive. The cost of blood cultures in the study population was $72,759.00.Conclusions:The routine use of blood Cultures in the assessment of patients with chorioamnionitisrarely provides information that justifies a change in clinical management when patients are treated in accordance withthe specific antibiotic protocol outlined in this investigation.

[学科分类] 妇产科学