fungi is called fungemia. Minor damage to the skin or mucous membranes, which can occur in situations like toothbrushing or defecation, can introduce bacteria into the bloodstream, but this bacteremia is normally transient and is rarely detected in cultures because the immune system and reticuloendothelial system quickly sequester and destroy the organisms. Bacteria can enter the blood from infections such as cellulitis, UTIs and pneumonia; and infections within the vascular system, such as bacterial endocarditis or infections associated with intravenous lines, may result in a constant bacteremia. Fungemia occurs most commonly in people with poorly functioning immune systems. If bacteria or fungi are not cleared from the bloodstream, they can spread to other organs and tissues, or evoke an immune response that leads to a systemic inflammatory condition called sepsis, which can be life-threatening. When sepsis is suspected, it is necessary to draw blood cultures to identify the causative agent and provide targeted antimicrobial therapy. People who are hospitalized and have a fever, a low body temperature, a high white blood cell count or a low count of granulocytes (a category of white blood cells) commonly have cultures drawn to detect a possible bloodstream infection. Blood cultures are used to detect bloodstream infections in febrile neutropenia, a common complication of chemotherapy in which fever occurs alongside a severely low count of neutrophils (white blood cells that defend against bacterial and fungal pathogens). Bacteremia is common in some types of infections, such as meningitis, septic arthritis and epidural abscesses, so blood cultures are indicated in these conditions. In infections less strongly associated with bacteremia, blood culture may still be indicated if the individual is at high risk of acquiring an intravascular infection or if cultures cannot be promptly obtained from the main site of infection (for example, a urine culture in pyelonephritis or a sputum culture in severe community-acquired pneumonia). Blood culture can identify an underlying microbial cause in cases of endocarditis and fever of unknown origin. The pathogens most frequently identified in blood cultures include Staphylococcus aureus, Escherichia coli and other members of the family Enterobacteriaceae, Enterococcus species, Pseudomonas aeruginosa and Candida albicans. Coagulase-negative staphylococci (CNS) are also commonly encountered, although it is often unclear whether these organisms, which constitute part of the normal skin flora, are true pathogens or merely contaminants. In blood cultures taken from newborn babies and children, CNS can indicate significant infections. The epidemiology of bloodstream