Department of Pediatrics and Pediatric Surgery, Hospital Roberto del Rio, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
Department of Pediatrics and Pediatric Surgery, Hospital Luis Calvo Mackenna, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
Pediatr Infect Dis J. 2024 Feb 1;43(2):160-164. doi: 10.1097/INF.0000000000004168. Epub 2023 Dec 6.
The collection of blood cultures (BC) is key for guiding antimicrobial therapy in children with febrile neutropenia (FN), more than 90% have central venous catheters (CVC). There is no consensus on the need for peripheral BC over central BC in this population. The aim of this study was to determine the contribution of peripheral BC over central BC in the diagnosis of bloodstream infections in children with FN.
Descriptive, retrospective study, episodes of FN recorded prospectively in 6 hospitals in Santiago, Chile, from 2016 to 2021. Central and peripheral BC were drawn upon admission. All episodes with at least one (+) BC were allocated to one of these groups: consistent (+) BC, inconsistent (+) BC, only CVC (+) BC and only peripheral (+) BC. The volume of the samples was recorded.
The analysis included 241 episodes of FN with at least one (+) BC. The median age was 7.2 years, 51% were female, 84% had hematological cancer and 98% had episodes of high-risk FN. Of a total of 241 episodes, 135 (56%) had consistent (+) BC, 13 (5%) had inconsistent (+) BC, 35 (15%) had only CVC (+) BC and 58 (24%) had only peripheral (+) BC. There were no significant differences in the volume of the samples between central and peripheral BC.
The proportion of bloodstream infections detected only through peripheral BC was 24%, higher than previously reported, not due to sample volume. We recommend obtaining peripheral as well CVC BC in children with FN.
采集血培养（BC）对于指导发热性中性粒细胞减少症（FN）患儿的抗菌治疗至关重要，超过 90%的患儿有中心静脉导管（CVC）。在这一人群中，对于外周血 BC 是否优于中心血 BC，尚无共识。本研究旨在确定在 FN 患儿中，外周血 BC 对血流感染的诊断贡献。
描述性、回顾性研究，2016 年至 2021 年在智利圣地亚哥的 6 家医院前瞻性记录 FN 发作。入院时采集中心和外周血 BC。所有至少有一次（+）BC 的发作都被分配到以下组之一：一致（+）BC、不一致（+）BC、仅 CVC（+）BC 和仅外周（+）BC。记录样本量。
分析纳入了 241 例至少有一次（+）BC 的 FN 发作。中位年龄为 7.2 岁，51%为女性，84%患有血液系统恶性肿瘤，98%为高危 FN 发作。在总共 241 例发作中，135 例（56%）有一致（+）BC，13 例（5%）有不一致（+）BC，35 例（15%）仅有 CVC（+）BC，58 例（24%）仅有外周（+）BC。中心和外周 BC 的样本量之间无显著差异。
仅通过外周 BC 检测到的血流感染比例为 24%，高于以往报道，这不是由于样本量的原因。我们建议在 FN 患儿中同时采集外周和 CVC BC。
