POSTCESAREAN ENDOMETRITIS - CLINICAL RISK-FACTORS PREDICTIVE OF POSITIVE BLOOD CULTURES

OBJECTIVE: To identify peripartum risk factors that are predictive of positive blood cultures in patients with postcesarean endometritis. ST UDY DESIGN: A retrospective review of 179 patients diagnosed with post cesarean endometritis was conducted. Patients with positive and negati ve blood cultures obtained at the time of diagnosis were compared. Pat ient's charts were reviewed for intrapartum, intraoperative and postpa rtum factors. Chi-square and nonpaired Student's t tests were used whe n appropriate, with P < .05 considered significant. RESULTS: During th is period, 179 (20%) postcesarean patients developed endometritis. One hundred sixty-eight (94%) of those patients had blood cultures. Eleve n (6.5%) were positive; however, one of these grew a skin contaminant and was disregarded. When patients with positive blood cultures were c ompared to those with negative blood cultures, length gf labor, number df vaginal examinations, postoperative day when the diagnosis was est ablished, estimated blood loss at the time of cesarean delivery, prese nce of intrapartum chorioamnionitis, number of hours of ruptured membr anes, white blood cell count at the time of diagnosis, use of prophyla ctic antibiotics, development of wound infection or other infectious e tiologies were not shown to be predictive. There were no positive bloo d cultures among patients with a temperature < 38.5 degrees C. At a te mperature < 38.8 degrees C, 1/226 (0.79%) had a positive blood culture . At a temperature greater than or equal to 38.8 degrees C, 9/42 (21.4 %) had a positive blood culture (P < .001). Approximately $5,890 was s pent on obtaining positive blood cultures in patients with temperature s < 38.8 degrees C. In contrast, $218 was spent per positive blood cul ture obtained from patients with a temperature greater than or equal t o 38.8 degrees C. CONCLUSION: The traditional practice of obtaining bl ood cultures at a temperature greater than or equal to 38.0 degrees C is not justified, but elevating the threshold to 38.8 degrees C is equ ally effective and less costly.