The never-ending quest to detect bacteremia: time for a culture change.

www.hospitalpediatrics.org doi:10.1542/hpeds.2013-0122 Address correspondence to Alan R. Schroeder, MD, 751 S Bascom Ave, San Jose, CA 95128. E-mail: [email protected] HOSPITAL PEDIATRICS (ISSN Numbers: Print, 2154 1663; Online, 2154 1671). Copyright © 2014 by the American Academy of Pediatrics FINANCIAL DISCLOSURE: The authors have indicated they have no fi nancial relationships relevant to this article to disclose. FUNDING: No external funding. POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential confl icts of interest to disclose. “If we’re drawing blood, we might as well throw in a blood culture.” This pervasive and seemingly innocuous statement, intended perhaps to save a child from an additional poke or to prevent a provider from having to come back and write another order, illustrates a dramatic misconception about the perceived benign nature of this common laboratory test. If you are skeptical about this misconception, try quizzing your trainees or colleagues about the risks of a blood culture the next time they want to order one. Many will give you a blank stare. Some will tell you about contaminated cultures, and the well-read might even be able to cite published data on the risk of contamination, where estimates are generally in the 1% to 5% range,1,2 but have been reported to be as high as 11% to 12% in select populations.3,4 If a new venipuncture is required for the blood culture, some might appropriately express concern over the child’s resultant pain and anxiety, an important yet understudied harm in hospitalized children. However, few of your respondents (who at this point really just want to move on to the next patient) are likely to be concerned about overdiagnosis: the detection of abnormalities that would not have caused harm.5 After all, why would we question the utility of a test that found precisely what it is we were looking for?