{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T05:25:09Z","timestamp":1788413109549,"version":"build-2803163510"},"reference-count":48,"publisher":"Oxford University Press (OUP)","issue":"suppl_4","license":[{"start":{"date-parts":[[2018,10,11]],"date-time":"2018-10-11T00:00:00Z","timestamp":1539216000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1116967"],"award-info":[{"award-number":["OPP1116967"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1151153"],"award-info":[{"award-number":["OPP1151153"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["106158\/Z\/14\/Z"],"award-info":[{"award-number":["106158\/Z\/14\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100001491","name":"Belgian American Educational Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001491","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,11,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Blood culture is the standard diagnostic method for typhoid and paratyphoid (enteric) fever in surveillance studies and clinical trials, but sensitivity is widely acknowledged to be suboptimal. We conducted a systematic review and meta-analysis to examine sources of heterogeneity across studies and quantified the effect of blood volume.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We searched the literature to identify all studies that performed blood culture alongside bone marrow culture (a gold standard) to detect cases of enteric fever. We performed a meta-regression analysis to quantify the relationship between blood sample volume and diagnostic sensitivity. Furthermore, we evaluated the impact of patient age, antimicrobial use, and symptom duration on sensitivity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We estimated blood culture diagnostic sensitivity was 0.59 (95% confidence interval [CI], 0.54\u20130.64) with significant between-study heterogeneity (I2, 76% [95% CI, 68%\u201382%]; P &amp;lt; .01). Sensitivity ranged from 0.51 (95% CI, 0.44\u20130.57) for a 2-mL blood specimen to 0.65 (95% CI, 0.58\u20130.70) for a 10-mL blood specimen, indicative of a relationship between specimen volume and sensitivity. Subgroup analysis showed significant heterogeneity by patient age and a weak trend towards higher sensitivity among more recent studies. Sensitivity was 34% lower (95% CI, 4%\u201354%) among patients with prior antimicrobial use and 31% lower after the first week of symptoms (95% CI, 19%\u201341%). There was no evidence of confounding by patient age, antimicrobial use, symptom duration, or study date on the relationship between specimen volume and sensitivity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The relationship between the blood sample volume and culture sensitivity should be accounted for in incidence and next-generation diagnostic studies.<\/jats:p><\/jats:sec>","DOI":"10.1093\/infdis\/jiy471","type":"journal-article","created":{"date-parts":[[2018,8,17]],"date-time":"2018-08-17T19:17:54Z","timestamp":1534533474000},"page":"S255-S267","source":"Crossref","is-referenced-by-count":102,"title":["The Relationship Between Blood Sample Volume and Diagnostic Sensitivity of Blood Culture for Typhoid and Paratyphoid Fever: A Systematic Review and Meta-Analysis"],"prefix":"10.1093","volume":"218","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0235-6030","authenticated-orcid":false,"given":"Marina","family":"Antillon","sequence":"first","affiliation":[{"name":"Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut"},{"name":"Center for Health Economics Research and Modeling of Infectious Diseases, University of Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil J","family":"Saad","sequence":"additional","affiliation":[{"name":"Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Baker","sequence":"additional","affiliation":[{"name":"Oxford University Clinical Research Unit Vietnam, Ho Chi Minh City, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J","family":"Pollard","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, University of Oxford , Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginia E","family":"Pitzer","sequence":"additional","affiliation":[{"name":"Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2018,10,11]]},"reference":[{"key":"2019121022392352200_CIT0001","doi-asserted-by":"crossref","first-page":"e0005376","DOI":"10.1371\/journal.pntd.0005376","article-title":"The burden of typhoid fever in low- and middle-income countries: a meta-regression approach","volume":"11","author":"Antill\u00f3n","year":"2017","journal-title":"PLoS Negl Trop Dis"},{"key":"2019121022392352200_CIT0002","doi-asserted-by":"crossref","first-page":"1545","DOI":"10.1016\/S0140-6736(16)31678-6","article-title":"Global, 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