A cost-benefit analysis of initial burn cultures in the management of acute burns

It is common practice to obtain cultures in the first 24 hours after burn i njuries. However, little evidence exists that these tests change clinical p ractice or clinical outcome. We conducted a retrospective chart review to d etermine how often the results of wound and other cultures lead to changes in the clinical treatment of patients. A total of 598 charts were reviewed. Pour hundred forty-seven patients had a length of stay in the hospital of 1 day or less and were primarily treated in the emergency department and th en discharged from the hospital. Wound cultures were obtained for 42 (10%) of these patients. Thirty cultures (71%) had no significant growth. Twelve cultures (29%) grew mixed common skin flora. No patients in this group were "pan-cultured." No patients in this group required antibiotic treatment on the basis of culture results. A total of 151 patients were admitted to the burn center, with an average length of stay of 3.9 days (range, 2-125 days ). In this group, 45 patients (30%) had wound cultures and 24 patients (16% ) were pan-cultured in the first 24 hours after admission to the hospital. Enterococcus species grew in the initial wound culture of 1 patient, and th e patient was treated with antibiotics. Antibiotics were not ordered for an y other patients on the basis of cultures. The collection of routine cultur es during the first 24 hours after admission to the hospital is not cost-ef fective and rarely alters or provides therapeutic direction. An estimated $ 14,000 per year decrease in charges could be achieved by the elimination of cultures taken during the first 24 hours of admission to the hospital.