Kee Penny Pei Lee, Chinnappan Maidhili, Nair Ajit, Yeak Daryl, Chen Annie, Starr Mike, Daley Andrew J, Cheng Allen C, Burgner David
From the *Department of General Medicine and †Department of Microbiology, Royal Children's Hospital, Parkville, Victoria, Australia; ‡Faculty of Medicine, §Department of Epidemiology and Preventive Medicine, and ¶Department of Paediatrics, Monash University, Clayton, Victoria, Australia; ‖Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia; **Infection Prevention and Healthcare Epidemiology, Alfred Health, Melbourne, Victoria, Australia; ††Murdoch Childrens Research Institute, Parkville, Victoria, Australia.
Pediatr Infect Dis J. 2016 Aug;35(8):846-50. doi: 10.1097/INF.0000000000001189.
Conventional practice involves obtaining a blood culture during or immediately after a fever to increase diagnostic yield. There are no data to support this practice in children.
Retrospective single-center case-control study of children (0-18 years) who had blood cultures performed as part of routine care. Cases had an a priori defined pathogen isolated from blood culture (n = 410) and were age-matched with contemporaneous controls with a sterile blood culture (n = 410). The predictive value of fever (before and after blood culture), C-reactive protein and hematologic indices were analyzed by multivariate regression and area under the receiver operating characteristic curves (AUCs) in neonatal, general pediatric and pediatric oncology patients.
One thousand one hundred seventy-two (6.7%) of 17,607 blood cultures were positive, of which 410 (35%) cultured pathogen(s). Three hundred and twenty four (79%) cases and 275 (67.1%) controls had a fever (≥37.5°C) during the 12 hours pre- or post-collection. Fever 2-6 hours before a blood culture was neither sensitive nor specific for predicting bacteremia in neonatal or pediatric patients and marginally predictive in oncology patients (AUC 0.59-0.63). Cultures obtained 2-6 hours before fever were nonpredictive in neonates (AUC 0.56-0.59), marginally predictive in pediatric patients (AUC 0.64-0.67) and moderately predictive in oncology patients (AUC 0.70). C-reactive protein was marginally predictive in neonates (AUC 0.60). Hematologic indices were nonpredictive in all groups.
Fever before obtaining blood culture was neither sensitive nor specific for culture positivity; timing of pediatric blood cultures relative to fever is unimportant. Bacteremia precedes a fever, but this is of limited clinical applicability.
传统做法是在发热期间或发热后立即进行血培养，以提高诊断率。但尚无数据支持在儿童中采用这种做法。
对作为常规护理一部分进行血培养的0至18岁儿童进行回顾性单中心病例对照研究。病例组有从血培养中分离出的预先定义的病原体（n = 410），并与同期血培养无菌的对照组（n = 410）进行年龄匹配。通过多因素回归和受试者操作特征曲线下面积（AUC）分析新生儿、普通儿科和儿科肿瘤患者发热（血培养前后）、C反应蛋白和血液学指标的预测价值。
17607次血培养中有1172次（6.7%）呈阳性，其中410次（35%）培养出病原体。324例（79%）病例和275例（67.1%）对照在采血前或采血后12小时内出现发热（≥37.5°C）。血培养前2至6小时发热对新生儿或儿科患者预测菌血症既不敏感也无特异性，对肿瘤患者的预测性略低（AUC 0.59 - 0.63）。发热前2至6小时进行的培养对新生儿无预测性（AUC 0.56 - 0.59），对儿科患者预测性略低（AUC 0.64 - 0.67），对肿瘤患者有中度预测性（AUC 0.70）。C反应蛋白对新生儿有略低的预测性（AUC 0.60）。血液学指标在所有组中均无预测性。
采血前发热对培养阳性既不敏感也无特异性；儿科血培养相对于发热的时间并不重要。菌血症先于发热出现，但这在临床应用中有限。
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