Blood Culture Time to Positivity in Febrile Infants With Bacteremia

Biondi, Eric; Mischler, Matthew; Jerardi, Karen; Statile, Angela; French, Jason; Evans, Rianna; Lee, Vivian; Chen, Clifford; Asche, Carl V.; Ren, Jinma; Shah, Samir S.

doi:10.1001/jamapediatrics.2014.895

Cited by 102 publications

(82 citation statements)

References 31 publications

(37 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Sixtyfive percent of positive blood cultures deemed to be contaminants had inadequate blood volume (13), and recovery of contaminant was twice as likely when inadequate blood volume was obtained (5.1% versus 2.8%) (12). These findings further support the necessity of obtaining sufficient blood culture volume, as the recovery of contaminants has been reported in 25% to 69% of all positive blood cultures in pediatric patients (12)(13)(14) and is associated with unnecessary antimicrobial therapy, prolonged hospitalization, and incurred cost. It is not particularly clear why low volume blood cultures are more prone to yield contaminants; one theory is that the acquisition of contaminants is independent of blood volume, and rather the collection of larger blood volume dilutes the concentration of the contaminant present in the blood culture bottle, reducing the chance of detection during the incubation period (13,15).…”

Section: Blood Culture Collectionmentioning

confidence: 57%

Diagnosis of Bloodstream Infections in Children

Bard

TeKippe

2016

J Clin Microbiol

View full text Add to dashboard Cite

Identification of bloodstream infections is among the most critical tasks performed by the clinical microbiology laboratory. While the criteria for achieving an adequate blood culture specimen in adults have been well described, there is much more ambiguity in pediatric populations. This minireview focuses on the available pediatric literature pertaining to the collection of an optimal blood culture specimen, including timing, volume, and bottle selection, as well as rapid diagnostic approaches and their role in the management of pediatric bloodstream infections. Blood cultures remain the mainstay of laboratory diagnosis of bloodstream infections (BSIs) in infants and children. Recovery of a pathogen is advantageous, as it confirms the diagnosis of bacteremia and allows for identification and susceptibility testing on the organism to optimize antimicrobial therapy and duration. A negative blood culture is just as important, as it rules out cases of bacteremia and prompts continued investigation of other infectious or noninfectious etiologies or cessation of unnecessary empirical antimicrobial therapy.The spectrum of pathogens causing pediatric BSI varies widely by age, presenting symptoms, and immune status. In 1979, an evaluation of pediatric blood culture found Haemophilus influenzae to be the most prevalent organism followed by Streptococcus pneumoniae and Staphylococcus aureus (1). Today, H. influenzae and S. pneumoniae are rare bloodstream pathogens due to widespread vaccination. A 2012 study of infants of Ͻ3 months of age found the leading causes of bacteremia to be Escherichia coli, group B Streptococcus (Streptococcus agalactiae), and S. aureus (2). The rate of BSI in otherwise healthy children drops precipitously after the first few months of life, but if occurring, the most common pathogens are S. aureus, S. pneumoniae due to communityacquired pneumonia, and Neisseria meningitidis in adolescents. Immunocompromised children are susceptible to a broad range of bloodstream pathogens, including all of those previously mentioned as well as Pseudomonas aeruginosa and Candida spp. (3).The majority of studies related to the laboratory diagnosis of BSI focus on the adult population. Thus, this minireview will be devoted to children and the multifactorial aspects involved in obtaining an optimal pediatric blood culture specimen, including timing, volume, and bottle selection. Lastly, a discussion on the rapid diagnostic approaches currently available and their impact on pediatric management and outcomes will be reviewed. BLOOD CULTURE COLLECTIONFactors that may influence the recovery of pathogens from the blood include the timing of blood collection, number of sets collected, and blood volume. It is well accepted that the volume of blood collected is the single most important factor. Evidence from both adult and pediatric studies show that the probability of recovering a pathogen from blood culture increases with the volume of blood obtained. In addition, the time to detection inversely correlates with the volum...

show abstract

Section: Blood Culture Collectionmentioning

confidence: 57%

Diagnosis of Bloodstream Infections in Children

Bard

TeKippe

2016

J Clin Microbiol

View full text Add to dashboard Cite

show abstract

“…23 In total, 392 cultures were identifi ed from 17 sites for analysis. Figure 1 displays the geographic distribution of culture collection from our sample, with the largest number of cultures collected in Minnesota, Texas, Ohio, and Colorado, representing a fairly diverse geographic sample.…”

Section: Resultsmentioning

confidence: 99%

“…A detailed description of culture inclusion and exclusion criteria, including full methodology of the epidemiology aspect of the cultures, has been previously published. 23 Cultures were included for analysis if they were positive for bacteria, obtained from an infant 90 days of age or younger with a temperature ≥38°C recorded on presentation or reported by a caregiver, analyzed using an automated bacterial detection system, and treated as a pathogen by the medical team (defi ned as a full course of antibiotics intended to treat the bacteria identifi ed in culture). Cultures were excluded if they were drawn in any method other than peripheral venipuncture, obtained from a patient in the ICU or admitted to the ICU within 5 hours after the culture, from patients with central indwelling catheters or hardware, or with a history of intraabdominal, intracranial, or intrathoracic comorbidities or surgical procedures, or drawn from a hospital or clinic outside the system of any participating site.…”

Section: Methodsmentioning

confidence: 99%

Epidemiology of Bacteremia in Previously Healthy Febrile Infants: A Follow-up Study

Mischler

Ryan

Leyenaar

et al. 2015

Hospital Pediatrics

Self Cite

View full text Add to dashboard Cite

OBJECTIVE: Describe the etiology of bacteremia among a geographically diverse sample of previously well infants with fever admitted for general pediatric care and to characterize demographic and clinical characteristics of infants with bacteremia according to bacterial etiology. We hypothesized that the epidemiology of bacteremia in febrile infants from a geographically diverse cohort would show similar results to smaller or single-center cohorts previously reported. METHODS:This was a retrospective review of positive, pathogenic blood cultures in previously healthy, febrile infants ≤90 days old admitted to a general unit. In total, there were 17 participating sites from diverse geographic regions of the United States. Cultures were included if the results were positive for bacteria, obtained from an infant 90 days old or younger with a temperature ≥38.0°C, analyzed using an automated detection system, and treated as pathogenic. RESULTS:Escherichia coli was the most prevalent species, followed by group B Streptococcus, Streptococcus viridans, and Staphylococcus aureus. Among the most prevalent bacteria, there was no association between gender and species (Ps > .05). Age at presentation was associated only with Streptococcus pneumoniae. There were no cases of Listeria monocytogenes. CONCLUSIONS:Our study confi rms the data from smaller or single-center studies and suggests that the management of febrile well-appearing infants should change to refl ect the current epidemiology of bacteremia. Further research is needed into the role of lumbar puncture, as well as the role of Listeria and Enterococcus species in infantile bacteremia.

show abstract

“…7,[33][34][35][36][37][38] The extreme rarity of listeriosis without meningitis after the first week of life in our study is consistent with and supported by previous studies that analyzed fever evaluations in neonates and young infants. 9,13, 16,17,39 Previous studies showed that listeriosis disproportionately affects the poor, but these did not specifically look at this phenomenon in young infants. 40,41 We found that infants with Medicaid (versus private) insurance 42 and infants living in a lower-income household were overrepresented among those discharged for listeriosis (see Table 1).…”

Section: Discussionmentioning

confidence: 99%

Trends in US Hospital Stays for Listeriosis in Infants

Veesenmeyer

Edmonson

2016

Hospital Pediatrics

View full text Add to dashboard Cite

A B S T R A C T BACKGROUND AND OBJECTIVES: Although listeriosis is rare in infants, it is commonfor young infants with suspected serious bacterial infection to be treated empirically with agents selected, in part, for their activity against Listeria monocytogenes. Our objectives were to describe the recent epidemiology of hospital discharges for listeriosis among infants in the United States and to precisely estimate the incidence of listeriosis according to infant age and meningitis status. METHODS:We generated national estimates for listeriosis discharges in each of the 6 years for which samples were available in the Kids' Inpatient Database during the period 1997-2012. We used random-effects models to pool descriptive information and population rates across study years. RESULTS:The cumulative number of US hospital discharges for listeriosis in infants was 344 (95% confidence interval [CI]: 290-397) over the 6 study years. The pooled annual incidence rate in infants (per 100 000 births) was 1.41 (95% CI: 1.01-1.80) after accounting for marked fluctuation in annual rates (range: 0.66-1.86; I 2 5 79.3%). Discharges for listeriosis without meningitis were particularly rare after the first week of life. Our models predicted only 2.7 (95% CI: 1.1-4.2) and 1.8 (95% CI: 0.0-3.6) such discharges per year in infants admitted at ages 7 to 28 days and 29 to 364 days, respectively. CONCLUSIONS:From the perspective of providing coverage against listeriosis, the routine practice of including ampicillin in the empirical treatment of febrile infants should be reevaluated for those older than 1 week without clinical evidence of meningitis.

show abstract

Blood Culture Time to Positivity in Febrile Infants With Bacteremia

Cited by 102 publications

References 31 publications

Diagnosis of Bloodstream Infections in Children

Diagnosis of Bloodstream Infections in Children

Epidemiology of Bacteremia in Previously Healthy Febrile Infants: A Follow-up Study

Trends in US Hospital Stays for Listeriosis in Infants

Contact Info

Product

Resources

About