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Pretest probability of bacteremia in common clinical scenarios (percentages as reported in the studies)

Pretest probability of bacteremia in common clinical scenarios (percentages as reported in the studies)
<5%
(very low)		 <10%
(low)		 Between 10% and <20%
(low-moderate)		 Between 20% and <50%
(moderate)		 ≥50%
(high)
  • Fever within first 48 hours of surgery[1-5]
  • Isolated fever[6, 7]
  • Uncomplicated cellulitis[6-12], including periorbital cellulitis[13, 14]
  • Lower urinary tract infection[15, 16]
  • CAP[6, 17-21]
  • HCAP[17, 20, 22, 23]
  • Cellulitis in patients with severe comorbidities[24-26]
  • VAP[27, 28]

  • Acute pyelonephritis[29-32]

  • Cholangitis[33, 34]

  • Pyogenic liver abscess[35]
  • Severe CAP[36]
  • Nonvascular shunt infections[37]
  • Severe sepsis[38, 39]
  • Shaking chills in febrile patient[6]
  • Discitis and VO[40-42]
  • Epidural abscesses[41, 43]
  • Acute nontraumatic native septic joints[44]
  • Meningitis[6]
  • Ventriculoatrial shunt infections[37]
  • Septic shock[6]
  • Catheter-related bloodstream infections
CAP: community-acquired pneumonia; HCAP: health care-associated pneumonia; VAP: ventilator-associated pneumonia; VO: vertebral osteomyelitis.
Reproduced from: Fabre V, Sharara SL, Salinas AB, et al. Does This Patient Need Blood Cultures? A Scoping Review of Indications for Blood Cultures in Adult Non-Neutropenic Inpatients. Clin Infect Dis 2020; pii:ciaa039. By permission of Oxford University Press. Copyright © 2020.
References:
  1. Copeland-Halperin LR, Stodghill J, Emery E, et al. Clinical predictors of positive postoperative blood cultures. Ann Surg 2018; 267:297.
  2. Lee JJ, Martin DR. The efficacy of blood culture in postoperative patients. Am Surg 2010; 76:1172.
  3. Lesperance R, Lehman R, Lesperance K, et al. Early postoperative fever and the "routine" fever work-up: results of a prospective study. J Surg Res 2011; 171:245.
  4. Copeland-Halperin LR, Emery E, Collins D, Liu C, Dort J. Dogma without data: a clinical decision-making tool for postoperative blood cultures. Am Surg 2018; 84:1339.
  5. Nakamura T, Daimon T, Mouri N, et al. Staphylococcus aureus and repeat bacteremia in febrile patients as early signs of sternal wound infection after cardiac surgery. J Cardiothorac Surg 2014; 9:80.
  6. Coburn B, Morris AM, Tomlinson G, Detsky AS. Does this adult patient with suspected bacteremia require blood cultures? JAMA 2012; 308:502.
  7. Linsenmeyer K, Gupta K, Strymish JM, et al. Culture if spikes? Indications and yield of blood cultures in hospitalized medical patients. J Hosp Med 2016; 11:336.
  8. Torres J, Avalos N, Echols L, et al. Low yield of blood and wound cultures in patients with skin and soft-tissue infections. Am J Emerg Med 2017; 35:1159.
  9. Tay EY, Thirumoorthy T, Pang SM, Lee HY. Clinical outcomes of bacteraemia in cellulitis of the leg. Clin Exp Dermatol 2014; 39:683.
  10. Paolo WF, Poreda AR, Grant W, et al. Blood culture results do not affect treatment in complicated cellulitis. J Emerg Med 2013; 45:163.
  11. Bauer S, Aubert CE, Richli M, Chuard C. Blood cultures in the evaluation of uncomplicated cellulitis. Eur J Intern Med 2016; 36:50.
  12. Mills AM, Chen EH. Are blood cultures necessary in adults with cellulitis? Ann Emerg Med 2005; 45:548.
  13. Chaudhry IA, Shamsi FA, Elzaridi E, et al. Inpatient preseptal cellulitis: experience from a tertiary eye care centre. Br J Ophthalmol 2008; 92:1337.
  14. Liu IT, Kao SC, Wang AG, et al. Preseptal and orbital cellulitis: a 10-year review of hospitalized patients. J Chin Med Assoc 2006; 69:415.
  15. Lalueza A, Sanz-Trepiana L, Bermejo N, et al. Risk factors for bacteremia in urinary tract infections attended in the emergency department. Intern Emerg Med 2018; 13:41.
  16. Etienne M, Pestel-Caron M, Chapuzet C, et al. Should blood cultures be performed for patients with acute prostatitis? J Clin Microbiol 2010; 48:1935.
  17. Zhang D, Yang D, Makam AN. Utility of blood cultures in pneumonia. Am J Med 2019; 132:1233.
  18. Bordón J, Peyrani P, Brock GN, et al. The presence of pneumococcal bacteremia does not influence clinical outcomes in patients with community-acquired pneumonia: results from the Community-Acquired Pneumonia Organization (CAPO) International Cohort study. Chest 2008; 133:618.
  19. Abe T, Tokuda Y, Ishimatsu S, Birrer RB. Usefulness of initial blood cultures in patients admitted with pneumonia from an emergency department in Japan. J Infect Chemother 2009; 15:180.
  20. Cham G, Yan S, Heng BH, Seow E. Predicting positive blood cultures in patients presenting with pneumonia at an emergency department in Singapore. Ann Acad Med Singapore 2009; 38:508.
  21. Lee J, Hwang SS, Kim K, et al. Bacteremia prediction model using a common clinical test in patients with community-acquired pneumonia. Am J Emerg Med 2014; 32:700.
  22. Yamazoe M, Tomioka H, Yamashita S, et al. Significance of blood cultures in nursing home-acquired pneumonia. J Infect Chemother 2018; 24:272.
  23. van Werkhoven CH, Huijts SM, Postma DF, et al. Predictors of bacteraemia in patients with suspected community-acquired pneumonia. PLoS One 2015; 10:e0143817.
  24. van Daalen FV, Kallen MC, van den Bosch CMA, et al. Clinical condition and comorbidity as determinants for blood culture positivity in patients with skin and soft-tissue infections. Eur J Clin Microbiol Infect Dis 2017; 36:1853.
  25. Collazos J, de la Fuente B, García A, et al. Cellulitis in adult patients: a large, multicenter, observational, prospective study of 606 episodes and analysis of the factors related to the response to treatment. PLoS One 2018; 13:e0204036.
  26. Peralta G, Padrón E, Roiz MP, et al. Risk factors for bacteremia in patients with limb cellulitis. Eur J Clin Microbiol Infect Dis 2006; 25:619.
  27. Kunac A, Sifri ZC, Mohr AM, et al. Bacteremia and ventilator-associated pneumonia: a marker for contemporaneous extrapulmonic infection. Surg Infect (Larchmt) 2014; 15:77.
  28. Agbaht K, Diaz E, Muñoz E, et al. Bacteremia in patients with ventilator-associated pneumonia is associated with increased mortality: a study comparing bacteremic vs. nonbacteremic ventilator-associated pneumonia. Crit Care Med 2007; 35:2064.
  29. Velasco M, Martínez JA, Moreno-Martínez A, et al. Blood cultures for women with uncomplicated acute pyelonephritis: are they necessary? Clin Infect Dis 2003; 37:1127.
  30. Ledochowski S, Abraham PS, Jacob X, et al. Relevance of blood cultures in acute pyelonephritis in a single-center retrospective study. Intern Emerg Med 2015; 10:607.
  31. Chen Y, Nitzan O, Saliba W, et al. Are blood cultures necessary in the management of women with complicated pyelonephritis? J Infect 2006; 53:235.
  32. Kim KS, Kim K, Jo YH, et al. A simple model to predict bacteremia in women with acute pyelonephritis. J Infect 2011; 63:124.
  33. Chandra S, Klair JS, Soota K, et al. Endoscopic retrograde cholangio-pancreatography-obtained bile culture can guide antibiotic therapy in acute cholangitis. Dig Dis 2019; 37:155.
  34. Sahu MK, Chacko A, Dutta AK, Prakash JA. Microbial profile and antibiotic sensitivity pattern in acute bacterial cholangitis. Indian J Gastroenterol 2011; 30:204.
  35. Du ZQ, Zhang LN, Lu Q, et al. Clinical characteristics and outcome of pyogenic liver abscess with different size: 15-year experience from a single center. Sci Rep 2016; 6:35890.
  36. Sanyal S, Smith PR, Saha AC, et al. Initial microbiologic studies did not affect outcome in adults hospitalized with community-acquired pneumonia. Am J Respir Crit Care Med 1999; 160:346.
  37. Forward KR, Fewer HD, Stiver HG. Cerebrospinal fluid shunt infections. A review of 35 infections in 32 patients. J Neurosurg 1983; 59:389.
  38. Bates DW, Sands K, Miller E, et al. Predicting bacteremia in patients with sepsis syndrome. Academic Medical Center Consortium Sepsis Project Working Group. J Infect Dis 1997; 176:1538.
  39. Rhee C, Filbin MR, Massaro AF. Compliance with the national SEP-1 quality measure and association with sepsis outcomes: A multicenter retrospective cohort study. Crit Care Med 2018; 46:1585.
  40. Nolla JM, Lora-Tamayo J, Gómez Vaquero C, et al. Pyogenic arthritis of native joints in non-intravenous drug users: a detailed analysis of 268 cases attended in a tertiary hospital over a 22-year period. Semin Arthritis Rheum 2015; 45:94.
  41. Aagaard T, Roed C, Dragsted C, Skinhoj P. Microbiological and therapeutic challenges in infectious spondylodiscitis: a cohort study of 100 cases, 2006–2011. Scand J Infect Dis 2013; 45:417.
  42. Roger PM, Cua E, Courjon J, et al. The impact of bacteremia on the outcome of bone infections. Med Mal Infect 2014; 44:380.
  43. Connor DE Jr, Chittiboina P, Caldito G, Nanda A. Comparison of operative and nonoperative management of spinal epidural abscess: a retrospective review of clinical and laboratory predictors of neurological outcome. J Neurosurg Spine 2013; 19:119.
  44. Daynes J, Roth MF, Zekaj M, et al. Adult native septic arthritis in an inner city hospital: effects on length of stay. Orthopedics 2016; 39:e674.
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