Aronson Paul L, Wang Marie E, Nigrovic Lise E, Shah Samir S, Desai Sanyukta, Pruitt Christopher M, Balamuth Fran, Sartori Laura, Marble Richard D, Rooholamini Sahar N, Leazer Rianna C, Woll Christopher, DePorre Adrienne G, Neuman Mark I
Section of Pediatric Emergency Medicine, Departments of Pediatrics and Emergency Medicine, Yale School of Medicine, New Haven, Connecticut;
Division of Pediatric Hospital Medicine, Department of Pediatrics, Lucile Packard Children's Hospital Stanford and Stanford University School of Medicine, Palo Alto, California.
Hosp Pediatr. 2018 Jul;8(7):379-384. doi: 10.1542/hpeds.2018-0002.
We sought to determine the time to pathogen detection in blood and cerebrospinal fluid (CSF) for infants ≤60 days old with bacteremia and/or bacterial meningitis and to explore whether time to pathogen detection differed for non-ill-appearing and ill-appearing infants.
We included infants ≤60 days old with bacteremia and/or bacterial meningitis evaluated in the emergency departments of 10 children's hospitals between July 1, 2011, and June 30, 2016. The microbiology laboratories at each site were queried to identify infants in whom a bacterial pathogen was isolated from blood and/or CSF. Medical records were then reviewed to confirm the presence of a pathogen and to extract demographic characteristics, clinical appearance, and the time to pathogen detection.
Among 360 infants with bacteremia, 316 (87.8%) pathogens were detected within 24 hours and 343 (95.3%) within 36 hours. A lower proportion of non-ill-appearing infants with bacteremia had a pathogen detected on blood culture within 24 hours compared with ill-appearing infants (85.0% vs 92.9%, respectively; = .03). Among 62 infants with bacterial meningitis, 55 (88.7%) pathogens were detected within 24 hours and 59 (95.2%) were detected within 36 hours, with no difference based on ill appearance.
Among infants ≤60 days old with bacteremia and/or bacterial meningitis, pathogens were commonly identified from blood or CSF within 24 and 36 hours. However, clinicians must weigh the potential for missed bacteremia in non-ill-appearing infants discharged within 24 hours against the overall low prevalence of infection.
我们试图确定60日龄及以下患菌血症和/或细菌性脑膜炎婴儿的血液和脑脊液（CSF）中病原体检测时间，并探讨病原体检测时间在无病容和有病容婴儿中是否存在差异。
我们纳入了2011年7月1日至2016年6月30日期间在10家儿童医院急诊科接受评估的60日龄及以下患菌血症和/或细菌性脑膜炎的婴儿。查询各机构的微生物实验室，以确定从血液和/或脑脊液中分离出细菌病原体的婴儿。然后查阅病历以确认病原体的存在，并提取人口统计学特征、临床表现以及病原体检测时间。
在360例菌血症婴儿中，316例（87.8%）在24小时内检测到病原体，343例（95.3%）在36小时内检测到。与有病容的菌血症婴儿相比，无病容的菌血症婴儿在24小时内血培养检测到病原体的比例较低（分别为85.0%和92.9%；P = 0.03）。在62例细菌性脑膜炎婴儿中，55例（88.7%）在24小时内检测到病原体，59例（95.2%）在36小时内检测到，基于病容无差异。
在60日龄及以下患菌血症和/或细菌性脑膜炎的婴儿中，通常在24小时和36小时内从血液或脑脊液中鉴定出病原体。然而，临床医生必须权衡24小时内出院的无病容婴儿漏诊菌血症的可能性与总体低感染率。
