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Less Is More
October 2014

Routine Blood Cultures for the Febrile InpatientA Teachable Moment

Author Affiliations
  • 1Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
JAMA Intern Med. 2014;174(10):1546-1547. doi:10.1001/jamainternmed.2014.3687

A 67-year-old woman with a history of hypertension presented to the hospital after 1 week of fever, cough, and dyspnea. Physical examination demonstrated a temperature of 39°C, respiratory rate of 24 breaths/min, and inspiratory crackles auscultated at the left lung base. A chest radiograph showed a left lower lobe infiltrate. Findings from laboratory studies were notable for a blood urea nitrogen level of 21 mg/dL (to convert to millimoles per liter, multiply by 0.357). The patient was admitted to the general medicine inpatient service and started on ceftriaxone and azithromycin therapies for community-acquired pneumonia. During hospital day 1, the patient noted improvement in her symptoms. On attending physician rounds, a plan was made for transition to oral antibiotics on the following day, with consideration for discharge.

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