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Predicting bacteremia.

The presence of leukocytosis, neutrophilia, and/or bandemia is predictive of blood culture positivity, and could be used to identify patients at high risk of bacteremia, reported Dr. Hobart W. Walling and Dr. Farrin A. Manian of St. John's Mercy Medical Center, St. Louis.

In a comparison of laboratory data from patients with positive blood cultures (278 cultures) and patients with negative cultures (395 cultures), white blood cell count was significantly higher in those with bacteremia (15,160 [micro]L vs. 10,300 [micro]L), as was percent neutrophils (polymorphonuclear neutrophils: 84.5% vs. 77.9%) and absolute neutrophil count (12,950 [micro]L vs. 8,200 [micro]L). A white cell count of at least 12,000 [micro]L, neutrophilia of at least 80%, and bandemia of at least 5% are the best cutoffs for discriminating between positive and negative cultures, the investigators found (Infect. Dis. Clin. Pract. 12[1]:2-6, 2004).

In the absence of all of these criteria, deferment of blood culture in favor of observation is reasonable and may be cost effective; when all three are present, the likelihood of bacteremia is raised 50-fold, and empiric antibiotic therapy is warranted pending the availability of microbiologic data. When one or two of these criteria are present, clinical judgment is required to determine the need for blood culture.
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Title Annotation:Clinical Capsules
Author:Worcester, Sharon
Publication:Internal Medicine News
Article Type:Brief Article
Geographic Code:1USA
Date:Mar 15, 2004
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