Does This Adult Patient With Suspected Bacteremia Require Blood Cultures?

Abstract

ContextClinicians order blood cultures liberally among patients in whom bacteremia is suspected, though a small proportion of blood cultures yield true-positive results. Ordering blood cultures inappropriately may be both wasteful and harmful.Objective To review the accuracy of easily obtained clinical and laboratory findings to inform the decision to obtain blood cultures in suspected bacteremia. Data Sources and Study SelectionA MEDLINE and EMBASE search (inception to April 2012) yielded 35 studies that met inclusion criteria for evaluating the accuracy of clinical variables for bacteremia in adult immunocompetent patients, representing 4566 bacteremia and 25 946 negative blood culture episodes.Data Extraction Data were extracted to determine the prevalence and likelihood ratios (LRs) of findings for bacteremia. Data SynthesisThe pretest probability of bacteremia varies depending on the clinical context, from low (eg, cellulitis: 2%) to high (eg, septic shock: 69%). Elevated temperatures alone do not accurately predict bacteremia (for Ն38°C [Ͼ100.3°F], LR, 1.9 [95% CI, 1.4-2.4]; for Ն38.5°C [Ͼ101.2°F], LR, 1.4 [95% CI, 1.1-2.0]), nor does isolated leukocytosis (LR, Ͻ1.7). The severity of chills graded on an ordinal scale (shaking chills, LR, 4.7; 95% CI, 3.0-7.2) may be more useful. Both the systemic inflammatory response syndrome (SIRS) and a multivariable decision rule with major and minor criteria are sensitive (but not specific) predictors of bacteremia (SIRS, negative LR, 0.09 [95% CI, 0.03-0.26]; decision rule, negative LR, 0.08 [95% CI, 0.04-0.17]).Conclusions Blood cultures should not be ordered for adult patients with isolated fever or leukocytosis without considering the pretest probability. SIRS and the decision rule may be helpful in identifying patients who do not need blood cultures. These conclusions do not apply to immunocompromised patients or when endocarditis is suspected.

Blood Culture Sampling Practices among Internal Medicine Inpatients

“…Other prediction rules based on clinical features and laboratory abnormalities have been found to be predictive of bacteremia, and could reduce the inappropriate use of blood cultures by approximately 27% [21,24]. It has been suggested that blood cultures should not be ordered for adult patients with isolated fever or leukocytosis without considering the pretest probability [25]. The pretest probability is in turn influenced by the clinical syndrome; where conditions such as cellulitis have a low pretest probability of BSI, and bacterial meningitis would have a high pretest probability of BSI [25].…”

“…It has been suggested that blood cultures should not be ordered for adult patients with isolated fever or leukocytosis without considering the pretest probability [25]. The pretest probability is in turn influenced by the clinical syndrome; where conditions such as cellulitis have a low pretest probability of BSI, and bacterial meningitis would have a high pretest probability of BSI [25].…”

Mortality in intensive care: The impact of bacteremia and the utility of systemic inflammatory response syndrome

“…We also investigated the relationship between SIRS status and blood culture result, as prior work in the non-ICU [3,9,10] setting has suggested that the presence of SIRS is closely linked with bacteraemia and as such might be utilised to be used to predict the presence of bacteraemia and thus avoid unnecessary blood cultures in patients who are unlikely to be bacteraemic [6].…”

“…Collection of diagnostic information from blood cultures must be balanced with appropriate testing intervals and frequency to maximize the accuracy and usefulness of the procedure [6]. Obtaining and processing blood cultures that are frequently negative increases the risk of false-positive results, which may lead to increased patient length of stay, exposure to inappropriate antimicrobials and increased laboratory time and costs [6,7].…”

Indications of Collecting Blood Culture and Necessity of Educations [Kan Kulturu Alma Nedenleri ve Egitimin Gerekliligi]

“…Artmış vücut ısısı ve beyaz küre yüksekliği tek başına kuvvetli bakteriyemi şüphesi uyandırmamaktadır [7].…”