Clinical prediction rule is more useful than qSOFA and the Sepsis-3 definition of sepsis for screening bacteremia.

Abstract Background Clinical guidelines recommend blood cultures for patients suspected with sepsis and bacteremia. Sepsis-3 task force introduced the new definition of sepsis in 2016; however, the relationship between the Sepsis-3 definition of sepsis and bacteremia remains unclear. This study aimed to investigate how to detect patients who need blood cultures. Methods Consecutive patients who visited the emergency department in our hospital with suspected symptoms of bacterial infection and with collected blood culture were retrospectively examined between April and September 2019. The relationship between bacteremia and Sepsis-3 definition of sepsis, and the relationship between bacteremia and clinical scores (quick-Sequential Organ Failure Assessment [qSOFA], systematic inflammatory response syndrome [SIRS], and Shapiro's clinical prediction rule) were investigated. In any scores used, ≥2 points were considered positive. Results Among the 986 patients who met the inclusion criteria, 171 (17%) were complicated with bacteremia and 270 (27%) were patients with sepsis. Sepsis was more frequent (61% vs. 20%, P  Conclusion Blood cultures should be obtained for patients with sepsis and positive qSOFA because of its high specificities to predict bacteremia; however, because of low sensitivities, Shapiro's clinical prediction rule can be more efficiently used for screening bacteremia.