Dentofacial infection comprises a major component of admissions for oral and maxillofacial departments. Whilst there is a body of evidence supporting the assimilation of culture and sensitivities from immunocompromised patients or those with atypical infections, there is relative paucity of evidence to suggest its need in the ‘fit and well’ patient. Processing wound swabs/aspirates takes an average of ten days and costs up to £30 per sample. Whilst cost should not dictate provision of care, the current economic climate does impose some constraints to healthcare.
Method: A 6 month retrospective audit over the period of May to November 2012 was performed identifying those fit and well patients from whom swabs/aspirates were obtained. We investigated the cause of infection, choice of empirical antimicrobial administered, any need for surgical intervention and most pertinent, whether results of culture and sensitivity were followed up and/or influenced the outcome of treatment.
Results: Out of a total of 108 patients presenting to University Hospital of Wales/University Dental Hospital, 24 of whom required admission alongside incision and drainage, only 60 were followed up. 14 of those were only reviewed prior to the definitive culture results. In the entire cohort of patients, only one had their antibiotic regimen changed in keeping with the culture and sensitivity results.
Conclusion: The use of culture and sensitivity assays may have a role in treating aggressive or atypical infections, in the immunocompromised and in the identification of notifiable disease. Despite this, our audit demonstrates its limited contribution to advancing delivery of care with significant cost implications in fit and well patients.