Tran Paul, Dowell Elaine, Hamilton Stacey, Dolan Susan A, Messacar Kevin, Dominguez Samuel R, Todd James
Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.
Department of Pathology, Children's Hospital Colorado, Aurora, Colorado, USA.
Open Forum Infect Dis. 2020 Jan 27;7(2):ofaa028. doi: 10.1093/ofid/ofaa028. eCollection 2020 Feb.
Multiple blood cultures have been shown to improve pathogen yield and antimicrobial stewardship for adult patients with suspected serious bacterial infection (SBI). For children, the use of multiple blood cultures is less common and volume recommendations are more complicated, often resulting in single cultures with low volume.
In 2010, Children's Hospital Colorado instituted electronic medical record (EMR) decision support to recommend collection of 2 blood cultures before administration of antibiotics for suspected SBI. Recommended blood culture volumes were calculated by age rather than weight. We evaluated all children admitted to inpatient units between 2008 and 2009 (pre-intervention) and 2011 and 2013 (postintervention) who received antibiotics in the hospital after having blood cultures drawn in the emergency department, excluding those with a length of stay >8 days. We compared blood culture yield, isolate classification (pathogen vs contaminant), and antimicrobial modifications before and after the interventions.
A total of 3948 children were included in the study. EMR guidelines were associated with a significantly higher number of children with multiple blood cultures drawn before antibiotic administration (88.0% vs 12.3%; < .001) and an increased percentage of blood cultures with the recommended volume (74.3% vs 15.2%; < .001), resulting in a significantly higher pathogen isolation rate and improved antimicrobial decisions. Multiple cultures helped define the role of common contaminants in the clinical decision process.
Multiple blood cultures with age-based volumes taken before starting antibiotics increase pathogen isolation rates and appropriate modification of antimicrobial treatment in children.
对于疑似严重细菌感染（SBI）的成年患者，多次血培养已被证明可提高病原体检出率并改善抗菌药物管理。对于儿童，多次血培养的使用较少见，且血量推荐更为复杂，常导致采集血量少的单次培养。
2010年，科罗拉多儿童医院建立了电子病历（EMR）决策支持系统，以推荐在对疑似SBI患者使用抗生素前采集2次血培养。推荐的血培养血量按年龄而非体重计算。我们评估了2008年至2009年（干预前）以及2011年至2013年（干预后）入住住院病房、在急诊科采集血培养后在医院接受抗生素治疗的所有儿童，排除住院时间>8天的儿童。我们比较了干预前后的血培养检出率、分离菌分类（病原体与污染物）以及抗菌药物调整情况。
共有3948名儿童纳入研究。EMR指南与抗生素给药前采集多次血培养的儿童数量显著增加相关（88.0%对12.3%；P<0.001），且血培养血量达到推荐量的百分比增加（74.3%对15.2%；P<0.001），从而使病原体分离率显著提高，抗菌药物决策得到改善。多次培养有助于明确常见污染物在临床决策过程中的作用。
在开始使用抗生素前采集基于年龄的血量进行多次血培养，可提高儿童病原体分离率，并适当调整抗菌治疗。
