Blood cultures are often over ordered without clear justification, straining healthcare resources and contributing to inappropriate antibiotic use pressures worsened by the global shortage. In study of 135483 emergency department (ED) blood culture orders, we developed machine learning (ML) models to predict the risk of bacteremia using structured electronic health record (EHR) data and provider notes via a large language model (LLM). The structured models AUC improved from 0.76 to 0.79 with note embeddings and reached 0.81 with added diagnosis codes. Compared to an expert recommendation framework applied by human reviewers and an LLM-based pipeline, our ML approach offered higher specificity without compromising sensitivity. The recommendation framework achieved sensitivity 86%, specificity 57%, while the LLM maintained high sensitivity (96%) but over classified negatives, reducing specificity (16%). These findings demonstrate that ML models integrating structured and unstructured data can outperform consensus recommendations, enhancing diagnostic stewardship beyond existing standards of care.

Few studies have investigated the diagnostic utilities of biomarkers for predicting bacteremia among septic patients admitted to intensive care units (ICU). Therefore, this study evaluated the prediction power of laboratory biomarkers to utilize those markers with high performance to optimize the predictive model for bacteremia. This retrospective cross-sectional study was conducted at the ICU department of Gyeongsang National University Changwon Hospital in 2019. Adult patients qualifying SEPSIS-3 (increase in sequential organ failure score greater than or equal to 2) criteria with at least two sets of blood culture were selected. Collected data was initially analyzed independently to identify the significant predictors, which was then used to build the multivariable logistic regression (MLR) model. A total of 218 patients with 48 cases of true bacteremia were analyzed in this research. Both CRP and PCT showed a substantial area under the curve (AUC) value for discriminating bacteremia among septic patients (0.757 and 0.845, respectively). To further enhance the predictive accuracy, we combined PCT, bilirubin, neutrophil lymphocyte ratio (NLR), platelets, lactic acid, erythrocyte sedimentation rate (ESR), and Glasgow Coma Scale (GCS) score to build the predictive model with an AUC of 0.907 (95% CI, 0.843 to 0.956). In addition, a high association between bacteremia and mortality rate was discovered through the survival analysis (0.004). While PCT is certainly a useful index for distinguishing patients with and without bacteremia by itself, our MLR model indicates that the accuracy of bacteremia prediction substantially improves by the combined use of PCT, bilirubin, NLR, platelets, lactic acid, ESR, and GCS score.