Blood cultures for febrile patients in the acute care setting: too quick on the draw?
OBJECTIVE
To review the fever literature and determine how 38.3 degrees C was deemed the optimal fever threshold that predicts bacteremia.


METHODS
PubMed, MEDLINE, Cochrane database, and the Cumulative Index to Nursing and Allied Health.


CONCLUSIONS
A temperature of 38.3 degrees C has come to be the threshold value that typically triggers diagnostic fever evaluation for bacteremia in hospitalized patients. Studies that define predictors of bacteremia provide conflicting results, and most bacteremia predictor models have not been externally validated. Therefore, current fever guidelines are based on consensus opinion rather than large clinical trials identifying a specific threshold with high sensitivity and a high negative predictive value.


CONCLUSIONS
The use of a single temperature threshold of 38.3 degrees C for the prediction of bacteremia is not sufficient in all patients. Additional factors should be considered, including patient population, supporting clinical signs and symptoms, and the patient's medical history.
Chesnutt
Barbara K
BK
School of Nursing Acute Care Nurse Practitioner Program, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. barb.chesnutt@gmail.com
Zamora
Martin R
MR
Kleinpell
Ruth M
RM
D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D001431:Bacteriological Techniques / Q000379:methods / Q000592:standards; D001800:Blood Specimen Collection / Q000379:methods / Q000592:standards; D001831:Body Temperature; D042241:Early Diagnosis; D055317:Evidence-Based Practice; D005189:False Positive Reactions; D005334:Fever / Q000382:microbiology*; D006801:Humans; D016867:Immunocompromised Host; D007297:Inpatients; D009722:Nurse Practitioners / Q000458:organization & administration; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis; D013997:Time Factors