Are blood cultures effective in the evaluation of fever in perioperative patients?

doi:10.1016/0002-9610(91)90121-S

The American Journal of Surgery

Volume 162, Issue 6, December 1991, Pages 615-619

https://doi.org/10.1016/0002-9610(91)90121-S Get rights and content

Abstract

Blood cultures are routinely performed as part of the evaluation of fever in the perioperative period. Results of 364 blood culture vials representing 108 consecutive febrile events (temperature greater than or equal to 101.5 °F) in 72 patients on adult surgical services without evidence of sepsis in a metropolitan hospital were prospectively studied. Eighty-nine percent of patients had undergone an operation prior to the febrile episode. Microorganisms were isolated in blood culture vials from 9 of 108 patient febrile events. Of these blood cultures, five were positive (contained pathogens), and four represented contaminants. Two of five positive blood cultures occurred in patients with an identifiable source of bacteremia. The cost of processing all blood culture vials was $13,992, which amounted to $2,798 spent to identify each of the five patients with positive blood cultures. Blood culture vials were more likely to be positive if blood was drawn during postoperative days 4 through 10, as opposed to days 1 through 3, or if it was drawn from patients with factors depressing immune function or who had indwelling devices. Neither the magnitude of the absolute leukocyte count nor the maximum temperature at the time of phlebotomy predicted a positive blood culture. The use of resin vials produced sterile cultures in the 10 vials submitted. In no case did a positive blood culture have a measurable effect on reducing patient morbidity or mortality.

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Early postoperative fever workup in children: utilization and utility
2018, Journal of Pediatric Surgery
Citation Excerpt :
Kiragu et al. reported similar results in their retrospective review of postoperative patients in the PICU, where only 1 of 177 cases were found to have clinically significant bacteremia [14]. Similar findings are reported in the adult literature, with 15–45% of patients with early postoperative fever having blood cultures drawn, but only 0–3% of patients having positive results [15,16]. Other concerns related to blood cultures include the high incidence of specimen contamination as well as inadequate specimen volume resulting in decreased testing sensitivity.
Early postoperative fever is common. Adult data indicate that workup is unnecessary in the early postoperative period, but comparable data in children is limited. The objectives are to determine the incidence of fever and the utilization and yield of tests ordered in children.
Single-institution, retrospective analysis of surgical patients undergoing an elective inpatient/observational surgery between 2011 and 2015 was performed. Early fever was defined > 38.0 °C within two days post-procedure. Encounters were queried for all blood cultures (BC), urinalysis (UA), urine cultures (UC), chest radiographs (CXR), and respiratory viral panels (RVP) obtained.
We identified 6943 patients, of whom 30.6% developed fever. UA was positive in 19.8% of patients tested. UC was positive in 15.7% of patients and 92.0% had a urinary catheter during surgery. BC was positive in 0.69% of patients, all with a central venous catheter. CXRs were considered infectious in 3.0% of patients tested. Patients with PICU stay and/or fever ≥ 38.9 °C were more likely to undergo BC and UC, but no more likely to have a positive result compared those without PICU stay and/or fever < 38.9°.
Early postoperative fever is common in pediatric surgical populations and rarely associated with an infectious source. Workup should be applied selectively.
Level IV.
Fever is common postoperatively following posterior spinal fusion: Infection is an uncommon cause
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To determine the frequency and clinical significance of postoperative fever in pediatric patients undergoing posterior spinal fusion (PSF).
A retrospective chart review was performed for consecutive patients undergoing PSF at a single institution between June 2005 and April 2011, with a minimum of 2-year follow up. Exclusion criteria were previous spine surgery, a combined anterior-posterior approach, and delayed wound closure at the time of surgery.
Two hundred and seventy-eight patients with an average age of 13 years (1-22 years) met inclusion criteria, with the following diagnoses: adolescent idiopathic scoliosis 43%, neuromuscular/syndromic scoliosis 39%, congenital scoliosis 11%, spondylolisthesis 4%, and Scheuermann kyphosis 3%. Seventy-two percent (201/278) of patients had a maximum temperature (T_max) >38^° postoperatively, and 9% (27/278) T_max >39^°. The percentage of febrile patients trended down following the first postoperative day. Infection rate was 4% (12/278). There was no correlation between T_max >38^° or T_max >39^°, and timing of fever, positive blood or urine cultures, pneumonia, or surgical site infection.
Seventy-two percent of pediatric patients undergoing PSF experienced postoperative fever, and 9% of patients had T_max>39^°. There was no significant correlation between fever and positive blood culture, urine culture, pneumonia, or surgical site infection. This information may help relieve stress for families and healthcare providers, and obviate routine laboratory evaluation for fever alone.
Early postoperative fever and the "routine" fever work-up: Results of a prospective study
2011, Journal of Surgical Research
Citation Excerpt :
Blood cultures have similarly been found unhelpful during the early postoperative period. Theuer and colleagues [16] evaluated 108 sets of blood cultures from 72 febrile patients, and found five positive results, but none of them in patients febrile during the first 72 h postop. In the other studies described previously, blood cultures were positive 0%–5% of the time, and only one study [6] reported a positive blood culture in a patient febrile during the first 3 d postop.
Fever in the postoperative period frequently results in a battery of diagnostic tests in search of an etiology. We sought to evaluate the incidence and utility of extensive postoperative fever evaluations in a teaching hospital setting.
Prospective observational study of all adult patients undergoing in-patient general surgical procedures during a 13-mo period. Patients experiencing an early postoperative fever (>100.4° F in the first 72 h) had data collected on their evaluation, the yield of the diagnostic studies, and whether an infectious diagnosis was made.
Of 1032 surgical procedures, 245 (23.7%) patients experienced an early postoperative fever. One hundred patients (9.7%) underwent documented fever evaluation. Thirty-five (35%) had blood cultures with no positive results among elective surgery patients. Forty-six patients (46%) had urine cultures sent, of which four infections were diagnosed (8.9%). Fifty chest radiographs were performed, but the diagnosis of pneumonia was made by only three (6.0%). Ultimately, 18 febrile patients (18%) were diagnosed with an infectious source, in nine of these patients the physical exam and clinical picture accurately diagnosed the infection without need for further testing.
Early postoperative fever is a common event and rarely caused by an infection. A brief bedside evaluation has the highest yield for determining the fever etiology, and extensive evaluations with cultures and chest imaging have little to no benefit in patients admitted for elective surgery.
Fever during anaesthesia
2003, Best Practice and Research: Clinical Anaesthesiology
Fever occurs when pyrogenic stimulation activates thermal control centres. Fever is common during the perioperative period, but rare during anaesthesia. Although only a limited number of studies are available to explain how anaesthesia affects fever, general anaesthesia seems to inhibit fever by decreasing the thermoregulatory-response thresholds to cold. Opioids also inhibit fever; however, the effect is slightly less than that of general anaesthesia. In contrast, epidural anaesthesia does not affect fever. This suggests that hyperthermia, which is often associated with epidural infusions during labour or in the post-operative period, may be a true fever caused by inflammatory activation. Accordingly, this fever might be diminished in patients who receive opioids for pain treatment. Post-operative fever is a normal thermoregulatory response usually of non-infectious aetiology. Fever may be important in the host defence mechanisms and should not be routinely treated lest the associated risks exceed the benefits.
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2002, Journal of the American College of Surgeons
50 years of general surgery at the Southwestern Surgical Congress
1998, American Journal of Surgery

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^☆: Presented at the 43rd Annual Meeting of the Southwestern Surgical Congress, Las Vegas, Nevada, April 21–24, 1991.

¹: From the Department of Surgery, Harbor-UCLA Medical Center, Torrance, California.

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Scientific paperAre blood cultures effective in the evaluation of fever in perioperative patients?☆

Abstract

J Thorac Cardiovasc Surg

Blood culture phlebotomy: switching needles does not prevent contamination

Ann Intern Med

Blood cultures

Ann Intern Med

Should blood cultures be obtained in the evaluation of young children without an evident focus of bacterial infection?

Pediatrics

The value of postoperative fever evaluation

Surgery

House officer's use of blood cultures

J Gen Intern Med

Scientific paper
Are blood cultures effective in the evaluation of fever in perioperative patients?☆