Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Arch Dis Child Fetal Neonatal Ed. 2022 Sep;107(5):475-480. doi: 10.1136/archdischild-2021-322844. Epub 2021 Nov 9.
To determine whether culture yield and time to positivity (TTP) differ between peripheral and central vascular catheter-derived blood cultures (BCx) in neonatal intensive care unit (NICU) patients evaluated for late-onset sepsis.
Single-centre, retrospective, observational study.
Level IV NICU.
The study included infants >72 hours old admitted to NICU in 2007-2019 with culture-confirmed bacteraemia. All episodes had simultaneous BCx drawn from a peripheral site and a vascular catheter ('catheter culture').
Dual-site culture yield and TTP.
Among 179 episodes of late-onset bacteraemia (among 167 infants) with concurrently drawn peripheral and catheter BCx, the majority (67%, 120 of 179) were positive from both sites, compared with 17% (30 of 179) with positive catheter cultures only and 16% (29 of 179) with positive peripheral cultures only. 66% (19 of 29) of episodes with only positive peripheral BCx grew coagulase-negative , while 34% (10 of 29) were recognised bacterial pathogens. Among 120 episodes with both peripheral and catheter BCx growth, catheter cultures demonstrated bacterial growth prior to paired peripheral cultures in 78% of episodes (93 of 120, p<0.001). The median TTP was significantly shorter in catheter compared with peripheral cultures (15.0 hours vs 16.8 hours, p<0.001). The median elapsed time between paired catheter and peripheral culture growth was 1.3 hours.
Concurrently drawn peripheral and catheter BCx had similar yield. While a majority of episodes demonstrated dual-site BCx growth, a small but important minority of episodes grew virulent pathogens from either culture site alone. While dual-site culture practices may be useful, clinicians should balance the gain in sensitivity of bacteraemia detection against additive contamination risk.
确定在新生儿重症监护病房（NICU）中，对于疑似晚发性败血症的患者，外周血管导管和中央血管导管来源的血培养（BCx）在培养物产量和阳性时间（TTP）方面是否存在差异。
单中心、回顾性、观察性研究。
四级 NICU。
本研究纳入了 2007 年至 2019 年期间在 NICU 住院超过 72 小时且经培养证实有菌血症的婴儿。所有患者均同时从外周部位和血管导管（“导管培养”）采集血培养。
双部位培养物产量和 TTP。
在 179 例伴有同时采集的外周和导管 BCx 的晚发性菌血症发作（167 例婴儿）中，大多数（67%，120/179）两个部位均为阳性，而仅导管培养阳性的占 17%（30/179），仅外周培养阳性的占 16%（29/179）。29 例仅外周 BCx 阳性的患者中，66%（19/29）为凝固酶阴性菌，而 34%（10/29）为已识别的细菌病原体。在 120 例外周和导管 BCx 均有生长的患者中，导管培养在前的占 78%（93/120，p<0.001）。导管培养的中位 TTP 明显短于外周培养（15.0 小时 vs 16.8 小时，p<0.001）。配对的导管和外周培养物生长之间的中位时间间隔为 1.3 小时。
同时采集的外周和导管 BCx 具有相似的产量。虽然大多数患者均表现为双部位 BCx 生长，但一小部分重要的患者仅从单个培养部位就可生长出毒力较强的病原体。尽管双部位培养方法可能有用，但临床医生应权衡增加血培养检测的敏感性与增加污染风险之间的利弊。
