Introduction: Fever commonly occurs in patients with spontaneous intracerebral hemorrhage (sICH). However, it is non-infectious in the majority of cases. Blood cultures (BCx) are often obtained as part of a fever work-up, yet their utility may be limited and false-positive results may potentially compromise patient care. We hypothesized blood cultures in the first 48 hours would more likely be false-positive.
Methods: We performed a retrospective chart review of patients admitted to a tertiary medical center with a diagnosis of spontaneous intracerebral hemorrhage. Patients with secondary causes of ICH as well as institution of comfort measures only were excluded. Data obtained included demographics, clinical parameters of ICH and blood culture results. Blood culture results and charts were reviewed for adjudication of false-positive and true-positive cultures.
Results: Of 654 included patients with sICH, 226 patients (34%) had 1065 blood cultures obtained. 52 cultures were positive, of which 23 were classified as false-positive and 29 as true positive. False positive results were more common in the first 2 days (17 vs. 6), while true positive results were more common after the first 48 hours (12 vs. 17) (p= 0.018).
Conclusion: Early blood cultures in patients with sICH are more commonly non-infectious. In line with prior published data, our results demonstrate the high cost and limited yield for blood cultures within the first 48 hours.