Rowley A H, Wald E R
Clin Pediatr (Phila). 1986 Oct;25(10):485-9. doi: 10.1177/000992288602501001.
The authors determined the time required for blood cultures to be detected as positive for the common bacterial pathogens in immunocompetent infants and children with fever who had no apparent source of infection. Records of the bacteriology laboratory were reviewed retrospectively from 1981 to 1984 for blood cultures that were positive for Haemophilus influenzae type b, Streptococcus pneumoniae, Neisseria meningitidis, Salmonella species, and group B streptococcus. Blood culturing by a conventional technique and a radiometric method were compared sequentially. Only four (1.5%) of 268 specimens were detected as positive after the second day of incubation; in each case that detection of bacteremia was delayed there was an identified source of infection. For H. influenzae, but not S. pneumoniae, significantly more bacteremias were detected earlier by the radiometric method. Discontinuation of empiric antibiotic therapy in immunocompetent children with suspected bacteremia and without focal infection appears warranted when blood cultures have been sterile for at least 48 hours.
作者确定了免疫功能正常、发热但无明显感染源的婴幼儿和儿童血液培养中常见细菌病原体检测呈阳性所需的时间。回顾性查阅了1981年至1984年细菌学实验室记录中b型流感嗜血杆菌、肺炎链球菌、脑膜炎奈瑟菌、沙门氏菌属和B组链球菌血液培养呈阳性的记录。依次比较了传统技术和放射性测量法进行血液培养的情况。在孵育第二天后，268份标本中只有4份（1.5%）检测呈阳性；在每一例菌血症检测延迟的病例中，均有明确的感染源。对于流感嗜血杆菌，而非肺炎链球菌，放射性测量法能更早地检测到更多菌血症。当血液培养至少48小时无菌时，对于疑似菌血症且无局灶性感染的免疫功能正常儿童，似乎有必要停止经验性抗生素治疗。
