In bacteremia, which statement is most accurate?

• A. Fever and positive cultures are not typical.
• B. Fever is common and blood cultures are positive; the source must be identified.
• C. Bacteremia is diagnosed by imaging alone.
• D. Bacteremia never involves heart valves.

Answer: (B)

Bacteremia is characterized by bacteria in the bloodstream, and clinically it most often presents with fever while blood cultures come back positive. This combination is why fever plus a positive blood culture is the hallmark you look for. Once bacteremia is detected, identifying the source of infection becomes essential because antibiotics and duration of therapy, as well as any needed source control (drainage, removal of infected devices, etc.), depend on pinpointing where the bacteria originated. Imaging can help locate a source or assess complications, but it doesn’t establish bacteremia by itself. It’s also important to recognize that bacteremia can involve heart valves (as in infective endocarditis), so the idea that it never involves heart valves isn’t accurate. The option stating that fever is common and blood cultures are positive, with the source identified, best captures the typical and most useful clinical scenario.