Time to identification of positive bacterial cultures in infants under three months of age hospitalized to rule out sepsis

Friedman, JN; Matlow, Anne

doi:10.1093/pch/4.5.331

Cited by 6 publications

(6 citation statements)

References 9 publications

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“…[23][24][25] Recent studies have reported a decrease in the TTP for blood culture results in pediatric patients; however, these studies were small single-center examinations or focused on populations very different from the classic febrile infant admitted to a general inpatient unit for observation. 3,8,9,23,[26][27][28] Our data suggest that 24 hours (as opposed to the generally accepted 48-hour inpatient observation period) is adequate to detect most clinically significant bacteremia and by using this cutoff, we can minimize the number of nights spent in the hospital for these infants and caregivers. We were unable to examine the TTP of urine and cerebrospinal fluid cultures, typically followed as part of the febrile infant evaluation; however, analyses of urine and cerebrospinal fluid samples (eg, white blood cell count and Gram stain) can be performed within hours of presentation and have high sensitivity for urinary tract infection and meningitis, respectively.…”

Section: Discussionmentioning

confidence: 99%

Blood Culture Time to Positivity in Febrile Infants With Bacteremia

et al. 2014

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IMPORTANCE Blood cultures are often obtained as part of the evaluation of infants with fever and these infants are typically observed until their cultures are determined to have no growth. However, the time to positivity of blood culture results in this population is not known.OBJECTIVE To determine the time to positivity of blood culture results in febrile infants admitted to a general inpatient unit. DESIGN, SETTING, AND PARTICIPANTS Multicenter, retrospective, cross-sectional evaluation of blood culture time to positivity. Data were collected by community and academic hospital systems associated with the Pediatric Research in Inpatient Settings Network. The study included febrile infants 90 days of age or younger with bacteremia and without surgical histories outside of an intensive care unit.EXPOSURES Blood culture growing pathogenic bacteria.MAIN OUTCOMES AND MEASURES Time to positivity and proportion of positive blood culture results that become positive more than 24 hours after placement in the analyzer.RESULTS A total of 392 pathogenic blood cultures were included from 17 hospital systems across the United States. The mean (SD) time to positivity was 15.41 (8.30) hours. By 24 hours, 91% (95% CI, 88-93) had turned positive. By 36 and 48 hours, 96% (95% CI, 95-98) and 99% (95% CI, 97-100) had become positive, respectively.CONCLUSIONS AND RELEVANCE Most pathogens in febrile, bacteremic infants 90 days of age or younger hospitalized on a general inpatient unit will be identified within 24 hours of collection. These data suggest that inpatient observation of febrile infants for more than 24 hours may be unnecessary in most infants.

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Section: Discussionmentioning

confidence: 99%

Blood Culture Time to Positivity in Febrile Infants With Bacteremia

et al. 2014

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“…[11][12][13][14] Length of hospitalization was widely studied in infants between 1979 and 1999, and results showed that the majority of clinically important bacterial pathogens can be detected within 48 hours. [15][16][17] Many textbooks and online references, based on this literature, continue to support 48 to 72 hours of observation and empiric antimicrobial treatment for febrile infants. 18,19 A 2012 AAP Clinical Report advocated for limiting the antimicrobial treatment in low-risk infants suspected of early-onset sepsis to 48 hours.…”

Section: Why You Might Think Hospitalization For At Least 48 Hours Is...mentioning

confidence: 99%

Things We Do for No Reason – The “48 Hour Rule‐out” for Well‐Appearing Febrile Infants

Herzke¹,

Chang

Leazer

2018

Journal of Hospital Medicine

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The "Things We Do for No Reason" (TWDFNR) series reviews practices that have become common parts of hospital care but may provide little value to our patients. Practices reviewed in the TWDFNR series do not represent "black and white" conclusions or clinical practice standards but are meant as a starting place for research and active discussions among hospitalists and patients. We invite you to be part of that discussion. informed the parents that the infant would be observed in the hospital for 48 hours while monitoring the bacterial cultures. Is it necessary for the hospitalization of this child to last a full 48 hours?

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“…13 One study examined time to positivity in infants aged ≤3 months, specifi cally excluding cultures drawn from central lines but did not stratify according to age. 14 The aims of the current study were to determine the probability of positive pathogenic blood and CSF cultures after 24 hours in infants aged ≤30 days hospitalized outside of an ICU setting for suspected serious bacterial infections and to assess whether stratifying infants into high-and low-risk categories based on presentation modifi es that probability.…”

Section: Ruling Out Bacteremia and Bacterial Meningitis In Infants Lementioning

confidence: 99%

Ruling Out Bacteremia and Bacterial Meningitis in Infants Less Than One Month of Age: Is 48 Hours of Hospitalization Necessary?

Fielding‐Singh

Hong

Harris

et al. 2013

Hospital Pediatrics

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Objective: The appropriate duration of hospitalization for infants ≤ 30 days admitted for fever or other concerns for a serious bacterial infection is an understudied area. We sought to determine the risk of a positive, pathogenic bacterial culture of blood or cerebrospinal fluid (CSF) in this population beyond 24 hours after collection. Methods: This study was a retrospective review of 1145 infants aged ≤30 days who had a blood or CSF culture from 1999 to 2010 at Santa Clara Valley Medical Center, a county health system in San Jose, California. Time to notification and the probability of a positive culture result after 24 hours were calculated. Infants were considered high risk if they had either a white blood cell count <5000 or >15 000 per µL, a band count >1500 per µL, or an abnormal urinalysis. Results: We identified 1876 cultures (1244 blood, 632 CSF) in 1145 infants aged ≤30 days; 901 (79%) of 1145 were hospitalized and 408 (45%) of 901 hospitalizations were for fever without source (FWS). Thirty-one (2.7%) of the 1145 infants had pathogenic cultures; 6 of 1145 infants (0.5% [95% confidence interval: 0.2–1.1]) had a time to notification >24 hours. All 6 patients had FWS (1.5% of hospitalized FWS sample) and met high-risk criteria on presentation. No low-risk patients had a time to notification >24 hours. Low-risk characteristics were found in 57% (232 of 408) of the entire hospitalized FWS population. Conclusions: Low-risk infants hospitalized for FWS or other concerns for serious bacterial infection may not need hospitalization for a full 48 hours simply to rule out bacteremia and bacterial meningitis.

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Time to identification of positive bacterial cultures in infants under three months of age hospitalized to rule out sepsis

Abstract: With the present culture technique, most, if not all, clinically significant positive blood and CSF results are reported by 48 h of culture incubation.

Cited by 6 publications

References 9 publications

Blood Culture Time to Positivity in Febrile Infants With Bacteremia

Blood Culture Time to Positivity in Febrile Infants With Bacteremia

Things We Do for No Reason – The “48 Hour Rule‐out” for Well‐Appearing Febrile Infants

Ruling Out Bacteremia and Bacterial Meningitis in Infants Less Than One Month of Age: Is 48 Hours of Hospitalization Necessary?

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