THE RATIONAL CLINICIAN’S CORNER CLINICAL EXAMINATION Does This Adult Patient With Suspected Bacteremia Require Blood Cultures? Bryan Coburn, MD, PhD Context Clinicians order blood cultures liberally among patients in whom bacter- emia is suspected, though a small proportion of blood cultures yield true-positive re- Andrew M. Morris, MD, SM sults. Ordering blood cultures inappropriately may be both wasteful and harmful. George Tomlinson, PhD Objective To review the accuracy of easily obtained clinical and laboratory findings Allan S. Detsky, MD, PhD to inform the decision to obtain blood cultures in suspected bacteremia. Data Sources and Study Selection A MEDLINE and EMBASE search (inception CLINICAL SCENARIOS to April 2012) yielded 35 studies that met inclusion criteria for evaluating the accu- Case 1 racy of clinical variables for bacteremia in adult immunocompetent patients, repre- A 62-year-old woman presents to the senting 4566 bacteremia and 25 946 negative blood culture episodes. emergency department with worsen- Data Extraction Data were extracted to determine the prevalence and likelihood ing cough, shortness of breath, and fe- ratios (LRs) of findings for bacteremia. ver. Her temperature on presentation Data Synthesis The pretest probability of bacteremia varies depending on the clini- is 38.4C (101.1F). She is alert, ori-
JAMA – American Medical Association
Published: Aug 1, 2012
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