Blood cultures in paediatrics: clinical indications to obtain a blood culture

Globally there is no consensus on the ideal set of indications for obtaining a blood culture in paediatric and neonatal practice. In sub-Saharan Africa, where paediatric sepsis is associated with worse outcomes than other regions, early and accurate detection of bacteraemia is particularly important. However, use of blood culture in sub-Saharan Africa is complicated by resource limitation, variable availability of microbiological laboratory services, and prevalence of coinfections such as malaria, tuberculosis and HIV. Additional factors, such as different vaccination profiles and disease severity at presentation, limit generalisability of approaches developed for use in high-income countries. We review the literature on clinical indications for blood cultures in paediatric and neonatal practice, including current practices from sub-Saharan Africa and low-middle income countries, and propose a simple, practical set of clinical indications for blood culture in paediatric and neonatal practice in this setting.