To evaluate the usefulness of blood cultures in patients admitted with
pyelonephritis, a retrospective chart review was conducted of inpatie
nts at a 594-bed urban, academic medical center from 1990 through 1992
with a primary discharge diagnosis of pyelonephritis. A total of 338
patients had this primary discharge diagnosis. One or more sets of blo
od cultures were obtained in 307 patients (91%), Fifty-six (18%) patie
nts had a positive blood culture; 24 (32%) positive blood cultures gre
w coagulase negative Staphylococcus species, in all but two instances
considered a skin contaminant, Of the blood cultures drawn, only 1 (0.
2%) grew a pathogenic organism not found in the urine culture, with no
impact on clinical management, These results support the conclusion t
hat blood cultures are rarely clinically useful and seldom vary from u
rine culture results. Potential annual cost savings of between $10 mil
lion and $20 million in the United States could result from eliminatin
g routine blood cultures in the setting of uncomplicated acute pyelone
phritis. Copyright (C) 1997 by W.B. Saunders Company.