{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T03:19:09Z","timestamp":1778901549636,"version":"3.51.4"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"Supplement_3","license":[{"start":{"date-parts":[[2020,12,1]],"date-time":"2020-12-01T00:00:00Z","timestamp":1606780800000},"content-version":"vor","delay-in-days":30,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-008335"],"award-info":[{"award-number":["INV-008335"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Blood culture is the current standard for diagnosing bacteremic illnesses, yet it is not clear how physicians in many low- and middle-income countries utilize blood culture for diagnostic purposes and to inform treatment decisions.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We screened suspected enteric fever cases from 6 hospitals in Bangladesh, Nepal, and Pakistan, and enrolled patients if blood culture was prescribed by the treating physician. We used generalized additive regression models to analyze the probability of receiving blood culture by age, and linear regression models to analyze changes by month to the proportion of febrile cases prescribed a blood culture compared with the burden of febrile illness, stratified by hospital. We used logistic regression to analyze predictors for receiving antibiotics empirically. We descriptively reviewed changes in antibiotic therapy by susceptibility patterns and coverage, stratified by country.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We screened 30\u2005809 outpatients resulting in 1819 enteric fever cases; 1935 additional cases were enrolled from other hospital locations. Younger outpatients were less likely to receive a blood culture. The association between the number of febrile outpatients and the proportion prescribed blood culture varied by hospital. Antibiotics prescribed empirically were associated with severity and provisional diagnoses, but 31% (1147\/3754) of enteric fever cases were not covered by initial therapy; this was highest in Pakistan (50%) as many isolates were resistant to cephalosporins, which were commonly prescribed empirically.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Understanding hospital-level communication between laboratories and physicians may improve patient care and timeliness of appropriate antibiotics, which is important considering the rise of antimicrobial resistance.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciaa1322","type":"journal-article","created":{"date-parts":[[2020,9,1]],"date-time":"2020-09-01T19:41:03Z","timestamp":1598989263000},"page":"S266-S275","source":"Crossref","is-referenced-by-count":11,"title":["Utilization of Blood Culture in South Asia for the Diagnosis and Treatment of Febrile Illness"],"prefix":"10.1093","volume":"71","author":[{"given":"Caitlin","family":"Hemlock","sequence":"first","affiliation":[{"name":"Applied Epidemiology, Sabin Vaccine Institute, Washington, DC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen P","family":"Luby","sequence":"additional","affiliation":[{"name":"Stanford University, Stanford, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shampa","family":"Saha","sequence":"additional","affiliation":[{"name":"Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Sher-E-Bangla Nagar, Dhaka, Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Farah","family":"Qamar","sequence":"additional","affiliation":[{"name":"Aga Khan University, Karachi, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason R","family":"Andrews","sequence":"additional","affiliation":[{"name":"Stanford University, Stanford, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samir K","family":"Saha","sequence":"additional","affiliation":[{"name":"Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Sher-E-Bangla Nagar, Dhaka, Bangladesh"},{"name":"Bangladesh Institute of Child Health, Dhaka Shishu Hospital, Sher-E-Bangla Nagar, Dhaka, Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dipesh","family":"Tamrakar","sequence":"additional","affiliation":[{"name":"Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kashmira","family":"Date","sequence":"additional","affiliation":[{"name":"Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashley T","family":"Longley","sequence":"additional","affiliation":[{"name":"Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA"},{"name":"National Foundation for the Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Denise O","family":"Garrett","sequence":"additional","affiliation":[{"name":"Applied Epidemiology, Sabin Vaccine Institute, Washington, DC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isaac I","family":"Bogoch","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2020,12,1]]},"reference":[{"key":"2020120621020862900_CIT0001","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1086\/499363","article-title":"Laboratory medicine in Africa: a barrier to effective health care","volume":"42","author":"Petti","year":"2006","journal-title":"Clin Infect Dis"},{"key":"2020120621020862900_CIT0002","doi-asserted-by":"crossref","first-page":"e248","DOI":"10.1016\/S1473-3099(18)30093-8","article-title":"Clinical bacteriology in low-resource settings: today\u2019s solutions","volume":"18","author":"Ombelet","year":"2018","journal-title":"Lancet Infect Dis"},{"key":"2020120621020862900_CIT0003","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1038\/s41564-018-0217-4","article-title":"Dynamics of antimicrobial resistance in intestinal Escherichia coli from children in community settings in South Asia and sub-Saharan 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