In reading the guideline “Evaluation and Management of Well-Appearing Febrile Infants 8 to 60 Days Old,”1 I hoped the authors would have commented on the importance of technical aspects of blood cultures: both sample volume and ideal minimum sample to broth ratios.

The consideration of the technical aspects of blood cultures is within the scope of the guideline because of the emphasis placed on IMs. The volume of blood required for IMs can exceed that required for more typical laboratory studies (complete blood cell count, etc). In cases in which limited volumes of blood are collected, a common challenge in young infants, any blood sent for IMs might decrease the blood volume included in the blood culture. Data suggest that the concentration of bacteremia is low in infants,2 current practice results in small volumes of blood obtained for culture,3 and rates of pathogen identification are improved with larger amounts of...

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