Department of Pediatrics, Section Critical Care, Yale University School of Medicine, New Haven, Connecticut, USA.
Frank H. Netter School of Medicine, Department of Medical Sciences, Quinnipiac University, Hamden, Connecticut, USA.
J Clin Microbiol. 2024 Nov 13;62(11):e0099824. doi: 10.1128/jcm.00998-24. Epub 2024 Oct 4.
Repeat blood cultures are common in children after an initial positive culture. However, in contrast to adults, there are little data to help guide clinicians when a repeat culture is necessary to assess for persistent bacteremia. This study identifies factors associated with persistent bloodstream infections (BSI) in children to inform diagnostic stewardship. This cross-sectional study of children less than 18 years with at least one positive blood culture over a 5-year period utilized a generalized linear equation model to predict patient and microbial factors associated with persistent BSI defined as a positive blood culture with the same organism >48 hours after the index culture. Four hundred and five patients had 502 positive blood cultures yielding 556 organisms. Sixty-seven (13.2%) cultures were persistently positive. Anaerobic organisms (0/37) and species (0/104) were never recovered from repeat cultures. (OR 9.45, CI 5.15-17.35) and yeast (OR 78.18, CI 9.45-646.6) were statistically associated with persistent BSI. Patients with prior positive cultures (OR 1.44, CI 1.12-1.84) or a central venous catheter (OR 2.20, 95% CI 1.04-3.92) were also at risk for persistence. Immune dysfunction and elevated inflammatory markers at the time of the index blood culture were not significantly associated with persistence. Yeast or were associated with persistent BSI, while anaerobes and species were never persistent. Patient characteristics at the time of blood draw did not predict persistence other than having previous positive blood cultures or a central venous catheter. These data can inform when repeat blood cultures have clinical value and reduce the risk of unnecessary blood draws in children.
We identify factors associated with bloodstream infection persistence in children. Our findings can help guide blood culture stewardship efforts in pediatric patients, especially in light of blood culture supply shortages.
重复血培养在初始阳性培养后在儿童中很常见。然而，与成人不同，几乎没有数据可以帮助指导临床医生何时需要重复培养以评估持续性菌血症。本研究旨在确定与儿童持续性血流感染（BSI）相关的因素，以指导诊断管理。这项为期 5 年的儿童研究纳入了至少一次阳性血培养的年龄＜18 岁的患者，使用广义线性方程模型来预测与持续性 BSI 相关的患者和微生物因素，持续性 BSI 定义为在初次培养后＞48 小时出现同一病原体的阳性血培养。405 例患者共进行了 502 次血培养，获得了 556 种微生物。67 例（13.2%）培养物持续阳性。重复培养从未分离出厌氧菌（0/37）和 种（0/104）。 （OR 9.45，CI 5.15-17.35）和酵母（OR 78.18，CI 9.45-646.6）与持续性 BSI 有统计学关联。有先前阳性培养史（OR 1.44，CI 1.12-1.84）或中央静脉导管（OR 2.20，95%CI 1.04-3.92）的患者也有持续性感染的风险。在进行初次血培养时免疫功能障碍和炎症标志物升高与持续性感染无显著相关性。酵母或 与持续性 BSI 相关，而厌氧菌和 种从不持续存在。除了先前有阳性血培养史或中央静脉导管外，在进行血培养时患者的特征不能预测其是否持续存在。这些数据可用于指导何时进行重复血培养具有临床价值，并降低儿童不必要的血培养风险。
我们确定了与儿童血流感染持续性相关的因素。我们的发现可以帮助指导儿科患者的血培养管理工作，特别是在血培养供应短缺的情况下。
