Does This Patient Need Blood Cultures? A Scoping Review of Indications for Blood Cultures in Adult Non-Neutropenic Inpatients

Guidance regarding indications for initial or follow-up (FU) blood cultures (BCx) is limited. We conducted a scoping review of articles published between 1/2004-6/2019 that reported the yield of BCx and/or their impact in the clinical management of fever and common infectious syndromes in non-neutropenic adult inpatients. 2,893 articles were screened; 51 were included. Based on the reported incidence of bacteremia, syndromes were categorized into low, moderate and high pre-test probability of bacteremia. Routine BCx are recommended in syndromes with a high likelihood of bacteremia (e.g., endovascular infections) and those with moderate likelihood when cultures from the primary source of infection are unavailable or prompt initiation of antibiotics is needed prior to obtaining primary source cultures. In syndromes where BCx are low-yield, BCx can be considered for patients at risk of adverse events if a bacteremia is missed (e.g., patient with pacemaker and severe purulent cellulitis). If a patient has adequate source control and risk factors or concern for endovascular infection are not present, most Streptococci or Enterobacterales bacteremias do not require routine FUBCx.