Can the main infectious laboratory data estimate blood culture positivity in the emergency department

Year 2026, Volume: 6 Issue: 1, 1 - 7, 12.03.2026

İsmail Kıvanç Cebecioğlu , İlhan Korkmaz , Yusuf Kenan Tekin , Sefa Yurtbay , Şimşek Çelik , Onur Türkdoğan

https://doi.org/10.66235/kumj.1901888

https://izlik.org/JA26DW36WN

Abstract

Aims: The aim of this study was to predict the positivity of patients admitted to the emergency department with blood cultures according to laboratory results.

Method: Patients admitted to a university emergency department in the previous year with blood cultures were retrospectively analysed, and laboratory and vital signs were compared with blood culture positivity.

Results: Retrospective analysis of patients whose blood cultures were obtained in the emergency department showed that increases in C-reactive protein (CRP) and procalcitonin (PCT), which are acute phase reactants, correlated with blood culture positivity. In addition, the increase in fever, which is one of the vital signs, was also correlated with blood culture positivity. When the laboratory values in our study were analysed, it was found that blood culture was positive when the CRP value was 171.15 ± 121.344 mg/L, and the PCT value was 14.30 ± 25.910 µg/L.

Conclusion: As a result of our study, we found that blood culture positivity can be poorly predicted in patients with high CRP and PCT who present to the emergency department, especially due to infection findings.

Keywords

Blood culture , C-reactive protein , procalcitonin , septicaemia , white blood cell

Ethical Statement

The study was carried out with the permission of the Sivas Cumhuriyet University Ethics Committee (Date: 24.04.2025, Decision No: 2025/21).

References

• 1. Boyles TH, Davis K, Crede T, Malan J, Mendelson M, Lesosky M. Blood cultures taken from patients attending emergency departments in South Africa are an important antibiotic stewardship tool, which directly influences patient management. BMC Infect Dis. 2015;15:410. doi:10.1186/s12879-015-1127-1
• 2. Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med. 2017;43(3):304-377. doi:10.1007/s00134-017-4683-6
• 3. Weinstein MP, Reller LB, Murphy JR, Lichtenstein KA. The clinical significance of positive blood cultures: a comprehensive analysis of 500 episodes of bacteremia and fungemia in adults. I. Laboratory and epidemiologic observations. Rev Infect Dis. 1983;5(1):35-53. doi:10.1093/clinids/5.1.35
• 4. Lee CC, Chen SY, Chang IJ, Chen SC, Wu SC. Comparison of clinical manifestations and outcome of community-acquired bloodstream infections among the oldest old, elderly, and adult patients [published correction appears in Medicine (Baltimore). 2013 Jul;92(4):216]. Medicine (Baltimore). 2007;86(3):138-144. doi:10.1097/SHK.0b013e318067da56
• 5. Weinstein MP, Towns ML, Quartey SM, et al. The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults. Clin Infect Dis. 1997;24(4):584-602. doi:10.1093/clind/24.4.584
• 6. Coburn B, Morris AM, Tomlinson G, Detsky AS. Does this adult patient with suspected bacteremia require blood cultures? [published correction appears in JAMA. 23;309(4):343]. JAMA. 2012;308(5):502-511. doi:10.1001/jama.2012.8262
• 7. Timsit JF, Ruppé E, Barbier F, Tabah A, Bassetti M. Bloodstream infections in critically ill patients: an expert statement. Intensive Care Med. 2020;46(2):266-284. doi:10.1007/s00134-020-05950-6
• 8. Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med. 2017;43(3):304-377. doi:10.1007/s00134-017-4683-6
• 9. Levy MM, Evans LE, Rhodes A. The Surviving Sepsis Campaign Bundle: 2018 update. Intensive Care Med. 2018;44(6):925-928. doi:10.1007/s00134-018-5085-0
• 10. Bates DW, Goldman L, Lee TH. Contaminant blood cultures and resource utilization. The true consequences of false-positive results. JAMA. 1991;265(3):365-369.
• 11. Skoglund E, Dempsey CJ, Chen H, Garey KW. Estimated Clinical and Economic Impact through Use of a Novel Blood Collection Device To Reduce Blood Culture Contamination in the Emergency Department: a Cost-Benefit Analysis. J Clin Microbiol. 2019;57(1):e01015-18. doi:10.1128/JCM.01015-18
• 12. Shapiro NI, Wolfe RE, Wright SB, Moore R, Bates DW. Who needs a blood culture? A prospectively derived and validated prediction rule. J Emerg Med. 2008;35(3):255-264. doi:10.1016/j.jemermed.2008.04.001
• 13. Jones GR, Lowes JA. The systemic inflammatory response syndrome as a predictor of bacteraemia and outcome from sepsis. QJM. 1996;89(7):515-522. doi:10.1093/qjmed/89.7.515
• 14. Nasimfar A, Sadeghi E, Karamyyar M, Manesh LJ. Comparison of serum procalcitonin level with erythrocytes sedimentation rate, C-reactive protein, white blood cell count, and blood culture in the diagnosis of bacterial infections in patients hospitalized in Motahhari hospital of Urmia (2016). J Adv Pharm Technol Res. 2018;9(4):147-152. doi:10.4103/japtr.JAPTR_319_18
• 15. Bonomo RA, Humphries R, Abrahamian FM, et al. 2024 Clinical Practice Guideline Update by the Infectious Diseases Society of America on Complicated Intra-abdominal Infections: Utility of Blood Cultures in Adults, Children, and Pregnant People. Clin Infect Dis. 2024;79(Suppl 3):S118-S122. doi:10.1093/cid/ciae352
• 16. Xia Y, Wang Y, He HW, et al. Zhonghua Yi Xue Za Zhi. 2019;99(5):365-369. doi:10.3760/cma.j.issn.0376-2491.2019.05.009
• 17. Nasimfar A, Sadeghi E, Karamyyar M, Manesh LJ. Comparison of serum procalcitonin level with erythrocytes sedimentation rate, C-reactive protein, white blood cell count, and blood culture in the diagnosis of bacterial infections in patients hospitalized in Motahhari hospital of Urmia (2016). J Adv Pharm Technol Res. 2018;9(4):147-152. doi:10.4103/japtr.JAPTR_319_18
• 18. Ticinesi A, Lauretani F, Nouvenne A, et al. C-reactive protein (CRP) measurement in geriatric patients hospitalized for acute infection. Eur J Intern Med. 2017;37:7-12. doi:10.1016/j.ejim.2016.08.026
• 19. Xu HG, Tian M, Pan SY. Clinical utility of procalcitonin and its association with pathogenic microorganisms. Crit Rev Clin Lab Sci. 2022;59(2):93-111. doi:10.1080/10408363.2021.1988047
• 20. Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bohuon C. High Serum Procalcitonin Concentrations İn Patients With Sepsis And İnfection. Lancet. 1993;341(8844):515-518. doi:10.1016/0140-6736(93)90277-N
• 21. Semiha Çelik-Ekinci. Acil Servise Başvuran Hastalarda Prokalsitonin Yüksekliği Bakteriyemi İçin Doğru Bir Biyobelirteç mi? Klimik Dergisi 2023; 36(4): 246-50
• 22. Thomas-Rüddel DO, Poidinger B, Kott M, et al. Influence of pathogen and focus of infection on procalcitonin values in sepsis patients with bacteremia or candidemia. Crit Care. 2018;22(1):128. doi:10.1186/s13054-018-2050-9
• 23. Daanen HAM, Hoitinga G, Kruijt DJ, et al. Body Core Temperature Assessment in Emergency Care Departments. J Emerg Med. 2024;66(3):e277-e283. doi:10.1016/j.jemermed.2023.10.027
• 24. Akbari H, Mirfazaelian H, Safaei A, Aghdam HG, Akhgar A, Jalili M. Predicting mortality in geriatric patients with fever in the emergency departments: a prospective validation study. BMC Geriatr. 2024;24(1):758. doi:10.1186/s12877-024-05346-x
• 25. Howard-Anderson J, Schwab KE, Chang S, Wilhalme H, Graber CJ, Quinn R. Internal medicine residents' evaluation of fevers overnight. Diagnosis (Berl). 2019;6(2):157-163. doi:10.1515/dx-2018-0066
• 26. Riedel S, Bourbeau P, Swartz B, et al. Timing of specimen collection for blood cultures from febrile patients with bacteremia [published correction appears in J Clin Microbiol. 2008 Jul;46(7):2475]. J Clin Microbiol. 2008;46(4):1381-1385. doi:10.1128/JCM.02033-07
• 27. Lamy B, Dargère S, Arendrup MC, Parienti JJ, Tattevin P. How to Optimize the Use of Blood Cultures for the Diagnosis of Bloodstream Infections? A State-of-the Art. Front Microbiol. 2016;7:697. doi:10.3389/fmicb.2016.00697
• 28. Foong KS, Munigala S, Kern-Allely S, Warren DK. Blood culture utilization practices among febrile and/or hypothermic inpatients. BMC Infect Dis. 2022;22(1):779. doi:10.1186/s12879-022-07748-x
• 29. Kee PP, Chinnappan M, Nair A, et al. Diagnostic Yield of Timing Blood Culture Collection Relative to Fever. Pediatr Infect Dis J. 2016;35(8):846-850. doi:10.1097/INF.0000000000001189
• 30. Riedel S, Bourbeau P, Swartz B, et al. Timing of specimen collection for blood cultures from febrile patients with bacteremia [published correction appears in J Clin Microbiol. 2008 Jul;46(7):2475]. J Clin Microbiol. 2008;46(4):1381-1385. doi:10.1128/JCM.02033-07
• 31. Farkas JD. The complete blood count to diagnose septic shock. J Thorac Dis. 2020;12(Suppl 1):S16-S21. doi:10.21037/jtd.2019.12.63
• 32. Seigel, Todd A., et al. "Inadequacy of temperature and white blood cell count in predicting bacteremia in patients with suspected infection." The Journal of emergency medicine 42.3 (2012): 254-259.
• 33. Honda T, Uehara T, Matsumoto G, Arai S, Sugano M. Neutrophil left shift and white blood cell count as markers of bacterial infection. Clin Chim Acta. 2016;457:46-53. doi:10.1016/j.cca.2016.03.017
• 34. Stalnikowicz R, Block C. The yield of blood cultures in a department of emergency medicine. Eur J Emerg Med. 2001;8(2):93-97. doi:10.1097/00063110-200106000-00004