Indications For Cultures

Blood cultures should be obtained (PRIOR to initiation of antimicrobial therapy) for any patient in whom there is suspicion of bacteremia, including hospitalized patients with fever and leukocytosis or leukopenia. Circumstances in which blood cultures are especially important include sepsis, meningitis, osteomyelitis, arthritis, endocarditis, pneumonia, and fever of unknown origin.

I. INDICATIONS

Routine blood cultures should be performed on any patient in whom there is a suspicion of bacteremia or candidemia.

Isolator blood cultures should be performed on any patient suspected of having one of the following:

1. Subacute or chronic endocarditis with multiple negative BACTEC system cultures. It is appropriate to use the BACTEC system for the initial workup of endocarditis of any suspected etiology. Isolators should be used after multiple BACTEC cultures are obtained and fail to reveal an etiologic agent (including HACEK).

2. Suspected deep fungal infection, such as histoplasmosis, blastomycosis, and coccidioidomycosis. Ordinarily, cultures of other sites, such as tissue biopsy, and in some cases serological tests such as antigen and antibody tests, are more helpful than blood culture.

3. Suspected mycobacteremia, particularly in HIV patients with CD4 counts <50 .="." span="span">

4. Suspected disseminated gonococcal infection.

5. Suspected bartonellosis.

6. Suspected candidemia or disseminated cryptococcosis in patients for whom routine cultures have not detected Candida species or Cryptococcus neoformans, respectively.

7. Suspected Malassezia furfur infection, an agent of catheter-associated infection in patients receiving intravenous lipid.