Franz-O'Neal Erika, Olson Jared, Thorell Emily A, Cipriano Frank A
Primary Children's Hospital, Salt Lake City, Utah.
School of Medicine, University of Utah, Salt Lake City, Utah.
Hosp Pediatr. 2021 Dec 1. doi: 10.1542/hpeds.2021-006012.
Researchers in previous studies suggest that the clinical yield of follow-up blood cultures (FUBCs) is low in infants with bacteremic urinary tract infection (UTI) because persistent bacteremia is rare; however, no researchers have analyzed the practice of routinely obtaining FUBCs. In our study, we evaluate outcomes in infants with FUBCs, examine opportunities for improvement of blood culture practices, and add important information to inform both clinical practice as well as further study.
This retrospective cohort study included infants <90 days of age with bacteremia and UTI with the same pathogen at 22 hospitals that make up Intermountain Healthcare between 2002 to 2020. Infants with culture proven meningitis, osteomyelitis, central line infection, and infections occurring during NICU hospitalization were excluded.
Total number of patients with bacteremic UTI was 174, 153 (88%) patients had at least 1 FUBC, 14 of 153 (9%) had a positive FUBC with same organism, and 4 of 153 (3%) were contaminants. The length of stay was longer for patients with positive FUBCs. Patients with Escherichia coli are more likely to have a negative FUBC. Readmissions within 30 days were similar among infants with positive FUBCs, negative FUBCs, and no FUBCs.
FUBCs in infants with bacteremic UTI should not be routinely performed, especially for E coli, and it is unclear whether FUBCs improve outcomes.
既往研究的研究者认为，由于持续性菌血症罕见，菌血症性尿路感染（UTI）婴儿的后续血培养（FUBC）临床检出率较低；然而，尚无研究者分析常规进行FUBC的实际情况。在我们的研究中，我们评估了接受FUBC的婴儿的结局，探讨了改进血培养操作的机会，并补充了重要信息，以指导临床实践和进一步研究。
这项回顾性队列研究纳入了2002年至2020年期间在组成山间医疗保健系统的22家医院中年龄小于90天、患有菌血症且UTI病原体相同的婴儿。排除了血培养证实患有脑膜炎、骨髓炎、中心静脉导管感染以及在新生儿重症监护病房住院期间发生感染的婴儿。
菌血症性UTI患者总数为174例，153例（88%）患者至少进行了1次FUBC，153例中有14例（9%）FUBC结果为同一病原体阳性，153例中有4例（3%）为污染菌。FUBC结果为阳性的患者住院时间更长。大肠杆菌感染患者更有可能FUBC结果为阴性。FUBC结果为阳性、阴性和未进行FUBC的婴儿在30天内的再入院率相似。
菌血症性UTI婴儿不应常规进行FUBC，尤其是对于大肠杆菌感染，并且尚不清楚FUBC是否能改善结局。
