IMPACT OF THE RESIN BLOOD CULTURE-MEDIUM ON THE TREATMENT OF CRITICALLY ILL PATIENTS

Objective: To assess the relevance, both clinical and bacteriologic, o f the use of resin containing blood culture media in blood cultures ta ken from critically ill patients receiving antibiotics, Design: A pros pective, open clinical trial, Setting: The mixed medical surgical inte nsive care unit (ICU) of a 550-bed urban hospital, Patients: All ICU p atients admitted during a 3-month period (n = 49) with suspected sepsi s requiring blood cultures as part of their laboratory investigations, Interventions: The use of an aerobic resin containing blood culture m edium, in addition to the regular aerobic and anaerobic media for all blood cultures taken, Measurements and Main Results: Each blood cultur e result was classified as to its clinical significance, Changes in pa tient management were recorded, Culture sets in which the resin-contai ning bottle provided the information central to the change in patient management were identified, Bacteriologically, the results from the re sin-containing medium were compared with the results from the aerobic and anaerobic media, Of 266 blood culture sets, 103 (39%) were positiv e, growing 278 bacterial and fungal isolates, Clinically, the resin co ntaining medium alone provided relevant data leading to changes in pat ient management on three occasions, On two of these occasions, culture s from the regular media provided the same data within 72 hrs. Bacteri ologically, 77 (29%) aerobic bottles, 55 (21%) anaerobic bottles, and 89 (33%) resin-containing bottles were positive (statistical compariso n of percentages: aerobic vs, resin containing bottles, nonsignificant ; aerobic vs, anaerobic bottles, p < .046; anaerobic vs, resin contain ing bottles, p < .0027), A similar proportion of pathogens was isolate d from the resin-containing bottles only (9%) and aerobic bottles only (6%), A higher proportion of contaminants was isolated from the resin -containing bottles only than the aerobic bottles only in the various sets (17% vs, 7%, p < .046), The resin-containing bottle showed a tren d toward increased detection of Staphylococcus aureus and Pseudomonas aeruginosa bacteremia, Conclusions: The resin containing medium offers little clinical benefit to the majority of ICU patients, Bacteriologi cally, it seems to have a similar overall sensitivity as the regular a erobic medium (with the possible exception of a higher sensitivity for the isolation of S. aureus and P. aeruginosa), but a lower specificit y, The wide spread use of the resin containing bottle cannot be recomm ended.