| To reduce low-yield or unnecessary use of blood cultures, best practices include: |
- Draw no more than two sets of blood cultures at once, even for detection of endocarditis
- Do not order repeat blood cultures if blood cultures have already been drawn within 48 hours
- Ensure optimal filling of each blood culture bottle (8 to 10 mL)
- Do not use blood culture bottles for other specimen types (such as joint fluid, pleural fluid, etc)
- Avoid obtaining blood cultures when there is low pre-test probability for bacteremia:
- Isolated fever or leukocytosis and otherwise stable vital signs and clinical examination
- One out of two sets of blood cultures is growing a coagulase-negative staphylococcus (almost always a contaminant)
- Initial blood cultures are negative at 48 hours and there are no new signs or symptoms
- Initial bacteremia with a Gram-negative or streptococcal organism in patients with an appropriate clinical response to antibiotic therapy
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| Indications for repeat blood cultures include (drawn no more frequently than every 48 to 72 hours): |
- Detection of any of the following organisms
- Staphylococcus aureus
- Staphylococcus lugdunensis
- Candida spp
- Multidrug-resistant Gram-negative bacteria
- Concern for persistent bacteremia in the absence of source control
- Concern for endovascular infection in patients with a cardiac implantable electronic device, vascular graft, prosthetic valve, or history of endocarditis
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