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Does This Adult Patient With Suspected Bacteremia Require Blood Cultures?

CONTEXT Clinicians 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 cli...

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Bibliographic Details
Published in:JAMA : the journal of the American Medical Association 2012-08, Vol.308 (5), p.502-511
Main Authors: Coburn, Bryan, Morris, Andrew M, Tomlinson, George, Detsky, Allan S
Format: Article
Language:English
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Summary:CONTEXT Clinicians 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 SELECTION A 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 SYNTHESIS The 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 ≥38°C [>100.3°F], LR, 1.9 [95% CI, 1.4-2.4]; for ≥38.5°C [>101.2°F], LR, 1.4 [95% CI, 1.1-2.0]), nor does isolated leukocytosis (LR,
ISSN:0098-7484
1538-3598
DOI:10.1001/jama.2012.8262