{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T13:12:18Z","timestamp":1788873138940,"version":"build-2803163510"},"reference-count":33,"publisher":"Cambridge University Press (CUP)","issue":"9","license":[{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S0899823X26105078_as1\">\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Blood culture over-ordering is a recognized diagnostic stewardship challenge, contributing to contamination, inappropriate antimicrobial escalation, and laboratory burden. Validated tools to guide culture ordering at initial patient assessment are lacking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X26105078_as2\">\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>We aim to derive and externally validate a two-step diagnostic stewardship rule for blood culture ordering in the emergency department (ED) patients with suspected infection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X26105078_as3\">\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We derived the Stepwise Culture Assessment with NEWS and NLR in ED (SCANNED) rule using consecutive blood cultures from a Singapore ED (April\u2013July 2025) and validated it in Vancouver, Canada (2016\u20132019). The rule uses age-stratified National Early Warning Score (NEWS) thresholds (Step 1), followed by neutrophil-lymphocyte ratio (NLR) \u22655 for remaining patients (Step 2). Thresholds were selected via exhaustive grid search, optimizing culture reduction while constraining the false-negative rate to &lt;5%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X26105078_as4\">\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>We included 1,224 derivation and 808 validation encounters. Blood culture positivity was 9.6% (117\/1,224) and 13.8% (112\/808), respectively. The optimal rule (NEWS \u22655 if age &lt;75 or NEWS \u22653 if age \u226575; NLR \u22655 for remainder) reduced cultures by 18.8% (95% CI 16.6\u201320.9%) in derivation and 15.1% (95% CI 12.8\u201317.6%) in validation, missing &lt;5% of bacteremia cases in both cohorts. Performance was consistent across infection sources, including unclear\/occult infections (17.5% reduction, 3.7% false-negative rate).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X26105078_as5\">\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The SCANNED rule represents a practical diagnostic stewardship intervention that can reduce unnecessary blood cultures by 15\u201319% while maintaining &gt;95% sensitivity for bacteremia. It requires no electronic health record integration and can be applied at triage. Prospective validation is needed before clinical implementation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/ice.2026.10507","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T06:37:01Z","timestamp":1784011021000},"page":"908-914","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["The SCANNED rule: derivation and validation of a two-step rule for blood culture stewardship in patients presenting with suspected infection"],"prefix":"10.1017","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3361-3818","authenticated-orcid":false,"given":"Zhenghong","family":"Liu","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/036j6sg82","id-type":"ROR","asserted-by":"publisher"}],"name":"Singapore General Hospital"},{"id":[{"id":"https:\/\/ror.org\/04d0rfg41","id-type":"ROR","asserted-by":"publisher"}],"name":"St Paul\u2019s 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