Blood culture diagnostic yield in a paediatric emergency department

Abstract

FWS is the main reason for BC in the PED. One-quarter of the BCs were not indicated, with the DY null in these cases. Due to the low DY in certain localized bacterial infections, a strict individualized ordering of BC in these cases should be considered.

The Outcome of Blood Cultures in Febrile Children Presenting at theEmergency Department

“…However, the value of BC in febrile children in the ED has been questioned recently [10,19,20]. In hospital-based studies, the proportion of patients with a positive blood culture was less than 3% [16], even reported to be low as 2% [21]. However, another concern is that blood culture contamination rates in the ED are also substantial and may vary from 1 to 9% and may reach as high as 11%.…”

Low utility of blood culture in pediatric community-acquired pneumonia

“…To the best of our knowledge, this study used the largest ED-based study population for studies on this topic. [7,9] The prevalence of bacteremia (0.11%) indicates that the number needed to test was approximately 909. Judicious use of BC can decrease unnecessary venipuncture and antibiotic treatment.…”

“…[7,8] A recent study performed on 238 children with CAP who underwent a BC at the ED shows 9 cases of bacteremia without any BC-directed change in the antibiotic regimen. [9] Despite this, there is a lack of ED-based studies on the utility of BC in pediatric CAP with larger study populations.…”

Children discharged from an emergency department with bacteraemia had lower C‐reactive protein and better outcomes than admissions

“…Blood cultures remain the gold standard for detecting bacteraemia and are commonly included in the evaluation of febrile children in the emergency department (ED), 5,6 despite their lack of immediate diagnostic utility 7 . Given the low rate of bacteraemia after the introduction of vaccines against haemophilus influenza and streptococcus pneumonia, 6‐8 children that are well enough to be discharged are released with, or without, antibiotic therapy before the blood culture results are known. Those children with positive cultures are recalled, re‐evaluated and frequently hospitalised.…”

“…The early diagnosis of bacterial infections in febrile children is challenging 1,2 and it is not possible to identify all cases with physical examinations or laboratory tests 3,4 . Blood cultures remain the gold standard for detecting bacteraemia and are commonly included in the evaluation of febrile children in the emergency department (ED), 5,6 despite their lack of immediate diagnostic utility 7 . Given the low rate of bacteraemia after the introduction of vaccines against haemophilus influenza and streptococcus pneumonia, 6‐8 children that are well enough to be discharged are released with, or without, antibiotic therapy before the blood culture results are known.…”