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The mainstay of infectious work-ups and diagnosing bloodstream infections is the blood culture. This time-honored test has become so entrenched in clinicians' practices that, in one study, it appeared on three fourths of resident handoffs as a contingency plan for fever (Qual Saf Health Care 2009; 18:248). Investigators prospectively examined clinical factors surrounding, and indications for, 576 blood culture orders for 363 hospitalized patients during 7 months at a Veterans Affairs hospital. Positive blood cultures were categorized retrospectively as either true or false positives by consensus opinion of infectious disease and microbiology specialists who had access to clinical and testing data.
Many patients had risk factors for blood str…