title: Limited utility of blood cultures in the management of febrile outpatient kidney transplant recipients.
abstract: OBJECTIVE
  Blood cultures for patients suspected of having bacteremia are standard practice, although several studies demonstrate that blood cultures have limited utility because of a low true-positive rate and infrequent resultant changes in antibiotic treatment. However, most reports exclude immunocompromised patients such as transplant recipients. We assessed the utility of blood cultures in transplant recipients hospitalized for community-acquired infections and evaluated clinical characteristics to predict bacteremia.
  
  
  METHODS
  This retrospective study included 136 febrile cases in 97 kidney transplant recipients admitted to our hospital for whom blood cultures were performed between February 2001 and March 2013.
  
  
  RESULTS
  Among the 136 cases, blood cultures were positive, contaminated, and negative in seven (5.1%) cases, 12 (8.8%) cases, and 117 cases (86.1%), respectively. All bacteria detected in the seven cases were sensitive to the initial empirical antibiotics. Antibiotic treatment was changed based on the blood culture results only in one case for which the coverage was narrowed. The white blood cell count and C-reactive protein level were significantly higher in the patients with bacteremia. The predictive model based on these two factors successfully identified the high-risk group with a sensitivity and specificity of 86% and 91%, respectively.
  
  
  CONCLUSIONS
  Among the outpatient kidney transplant recipients, positive blood cultures were uncommon and scarcely affected antibiotic therapy, especially in patients with upper respiratory tract or urinary tract infections. Therefore, it may be reasonable to perform blood cultures only for patients with marked leukocytosis and high C-reactive protein level, even among transplant recipients.
authors.affiliation: Department of Surgery, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan; Department of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Sendai, Japan. Electronic address: tsu7ka5so8mi@med.tohoku.ac.jp.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Tokodai
authors.affiliation: Department of Surgery, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan.
authors.forename: Noritoshi
authors.initials: N
authors.lastname: Amada
authors.affiliation: Department of Surgery, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan.
authors.forename: Izumi
authors.initials: I
authors.lastname: Haga
authors.affiliation: Department of Surgery, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nakamura
authors.affiliation: Department of Surgery, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Kashiwadate
authors.affiliation: Department of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Sendai, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Kawagishi
authors.affiliation: Department of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Sendai, Japan.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Ohuchi
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000382:microbiology; D001419:Bacteria / Q000302:isolation & purification; D000071997:Blood Culture / Q000379:methods*; D002097:C-Reactive Protein / Q000032:analysis; D017714:Community-Acquired Infections / Q000188:drug therapy; D005260:Female; D005334:Fever / Q000097:blood*; D006801:Humans; D016867:Immunocompromised Host; D016030:Kidney Transplantation; D007958:Leukocyte Count / Q000379:methods; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010045:Outpatients; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014552:Urinary Tract Infections / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein
keywords: C-reactive protein; blood culture; community-acquired infection; kidney transplantation; white blood cell count