Clin Infect Dis. 1994 Oct;19(4):668-74. Unique Identifier : AIDSLINE
In cases of advanced infection with human immunodeficiency virus,
mycobacterial blood cultures are frequently used to diagnose
disseminated infection with the Mycobacterium avium complex (MAC).
However, no prospectively validated guidelines exist for the use of such
cultures. In this study, a two-part model for predicting MAC bacteremia
was developed and then validated prospectively. First, a CD4+ cell count
of < or = 50/microL was used to predict bacteremia. Then, among patients
with < or = 50 CD4+ cells/microL, the documentation of fever on more
than 30 days during the preceding 3 months, a hematocrit of < 30%, or a
serum albumin concentration of < 3.0 g/dL was used to predict
bacteremia. This model had a sensitivity of 89% and positive and
negative predictive values of 30% and 98%, respectively, for the
identification of patients with bacteremia. Had the model been applied
to patients in this study, the number of blood cultures performed would
have decreased by 61%, but 11% of the positive cultures would have been
missed. In short, this model can predict MAC bacteremia and can
potentially guide the use of mycobacterial blood cultures.
Adult AIDS-Related Opportunistic Infections/BLOOD/*DIAGNOSIS/
Bacteriological Techniques CD4 Lymphocyte Count *Decision Support
Techniques Female Human HIV Infections/COMPLICATIONS Male Middle
Age Mycobacterium avium Complex/ISOLATION & PURIF Mycobacterium
*DIAGNOSIS/PHYSIOPATHOLOGY Predictive Value of Tests Support, U.S.
Gov't, P.H.S. JOURNAL ARTICLE