Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

Appendix D: UNIVERSITY OF WISCONSIN HOSPITAL & CLINICS AND CHILDREN’S HOSPITALBEST PRACTICES FOR BLOOD CULTURING• SURVEILLANCE CULTURES ARE NOT USEFUL AND SHOULD NOT BE ORDERED.• STANDING ORDERS ARE NOT APPROPRIATE FOR BLOOD CULTURES.WHEN TO OBTAIN CULTURESTIMING OF BLOOD CULTURES• NEW ONSET OF FEVER (≥38.2º°C)WITH OR WITHOUT OTHER• DRAW ONLY DURING A FEBRILEEPISODE, ideally before fever abates.SIGNS OF SEPSIS (rigors, hypotension,leukocytosis, mental status change,oliguria, hypoxia, tachypnea or metabolic• If patient has endocarditis or intravasculardevice-related sepsis, cultures may be drawn anytime.acidosis)• CULTURES MUST BE DRAWN FROM• REPEATED CULTURING OFNEUTROPENIC PATIENTS ISUNNECESSARY, UNLESS THEREIS A NEW ONSET OF FEVERTWO SEPARATE SITES; VENIPUNCTUREIS BY FAR THE PREFERRED SPECIMENBECAUSE LINES ARE TWICE AS LIKELYTO YIELD CONTAMINANTS.• “Test of cure” cultures are warrantedONLY if the patient has endocarditis, S.aureus or fungal sepsis or continuedsigns and symptoms of sepsis despite• TWO SETS (40 mL TOTAL) IS THEVOLUME NEEDED TO DIAGNOSISSEPSIS; LARGER VOLUMES AREUNNECESSARYantiinfective therapy. Begin 48 hour afterlast positive blood culture anddiscontinue after 2 negative cultures.• Surveillance cultures should not be requestedSITES AND NUMBER• Inoculate one culture set from each oftwo separate sites.VENIPUNCTURES AREPREFERRED BECAUSE OFLOWER CONTAMINATION RATES• If venous access is severely limited,draw one via venipuncture and onethrough a line• If venous access is unavailable, draw onethrough each of two separate lines• When one or both specimens are fromlines, specimens must be of equalvolume, drawn within 10 min of oneanother, and sent together or inimmediate succession.BLOOD CULTURE FOR BACTERIA AND YEAST (e.g., Candida and Cryptococcus)WeightPatient weightBlood culture set 1 Blood culture set 2Category(kg)(pediatric) bottle(mL)Purple (anaerobic) bottle(mL)(pediatric) bottle(mL)Purple (anaerobic)bottle (mL)A ≤1 1.5 0.5 - -B 1.1-2.0 1.5 1.5 1.5 -C 2.1-12.7 1.5 3.0 1.5 -C’ (Special Peds)* 12.8-20.0 1.5 3.0 1.5 3.0Weight Category Patient weight(kg)Blue (aerobic)bottle (mL)Purple (anaerobic) bottle(mL)Blue (aerobic)bottle (mL)Purple (anaerobic)bottle (mL)D 12.8-36.3 6.5 5.0 6.5 5.0E >36.3 10 10 10 10