From the Division of Pediatric Emergency Medicine, Department of Pediatrics, School of Medicine, Washington University in St. Louis, St. Louis, MO.
Division of Pediatric Hospital Medicine, Department of Pediatrics, School of Medicine, Washington University in St. Louis, St. Louis, MO.
Pediatr Emerg Care. 2024 Jan 1;40(1):33-37. doi: 10.1097/PEC.0000000000003008. Epub 2023 Jul 31.
Existing literature suggests that for some pediatric conditions, blood cultures may be of low value in specific clinical circumstances. The goals of our study were to: 1) identify common pediatric illnesses and define criteria for low-value blood cultures in children aged from 91 days to 19 years, 2) apply these criteria retrospectively to identify the patients in our emergency department (ED) who had low-value blood cultures obtained, and 3) describe this cohort and assess the proportion of true bacteremia in low-value blood cultures.
The study team reviewed the literature and developed consensus criteria to identify conditions in which blood cultures were of low value for our study population. The criteria were applied retrospectively to well-appearing patients aged from 91 days to 19 years, without a central venous catheter, and evaluated in our ED with a peripheral blood culture from June 2018 to April 2020. Children admitted to the intensive care/hematology-oncology/cardiology/pulmonary units, those transferred from our ED to an outside facility, who transferred to our ED due to a positive blood culture from an outside facility, and repeat visits of a patient within 30 days from a previous visit were excluded from the study. After chart review, children with fever for 7 days or more, who were unvaccinated, immunosuppressed, had implanted devices, had a complex medical history, or had provider concerns for bacteremia/sepsis were excluded.
The study population consisted of 1436 children. Children at risk for bacteremia (n = 718) were excluded. Four hundred twenty-four children had discharge diagnoses not included in our study. There were 294 (20.5%) patients who had low-value cultures per our study criteria. Nine children (9/294, 3.1%) had false-positive blood cultures, and three (3/294, 1.0%) had true-positive blood cultures.
We identified a cohort of patients in our ED with blood cultures obtained when available literature indicates they were of low value.
现有文献表明，对于某些儿科疾病，在特定临床情况下，血培养的价值可能较低。我们研究的目的是：1）确定常见儿科疾病，并为 91 天至 19 岁儿童制定低价值血培养的标准；2）应用这些标准回顾性地识别我们急诊科（ED）中获得低价值血培养的患者；3）描述这一队列并评估低价值血培养中真正菌血症的比例。
研究小组查阅文献并制定了共识标准，以确定我们研究人群中血培养价值较低的情况。标准适用于 2018 年 6 月至 2020 年 4 月在我们 ED 就诊的外观良好、无中心静脉导管、年龄在 91 天至 19 岁的患者。从我们 ED 转至外部医疗机构、因外部医疗机构的血培养阳性而转至我们 ED、或在 30 天内从上次就诊重复就诊的患者被排除在研究之外。在病历回顾后，排除发热超过 7 天、未接种疫苗、免疫抑制、有植入设备、病史复杂或医生怀疑菌血症/败血症的患儿。
研究人群包括 1436 名儿童。排除了有菌血症风险的儿童（n=718）。424 名儿童的出院诊断未包含在我们的研究中。根据我们的研究标准，有 294 名（20.5%）患者的血培养为低价值。9 名儿童（9/294，3.1%）血培养假阳性，3 名（3/294，1.0%）血培养真阳性。
我们确定了一个 ED 患者队列，他们的血培养是在有可用文献表明其价值较低的情况下获得的。
