Sullivan T D, LaScolea L J, Neter E
Pediatrics. 1982 Jun;69(6):699-702.
The relationship between the magnitude of bacteremia due to Haemophilus influenzae, Streptococcus pneumoniae, and Neisseria meningitidis and the clinical diagnosis was determined on 79 children who were not receiving prior antibiotic therapy and had fever, either in the presence or absence of focal signs of infection. Bacteremia was quantitated by the recently described Quantitative Direct Plating procedure in which heparinized blood (0.5 ml each) is plated onto blood and chocolate agar plates. Additionally, blood was cultured by means of the radiometric Bactec technique. In the case of H. influenzae and S pneumoniae, 23 (92%) of 25 patients with more than 100 organisms per milliliter of blood had meningitis or epiglottitis in contrast to only four (9.5%) of 42 patients with less than 100 organisms (P less than .001). No significant difference was noted in the magnitude of bacteremia due to N meningitidis among 12 patients with meningitis or other serious infections. The possible predictive value of the quantitation of bacteremia is illustrated by the observation of three children with seemingly mild respiratory infection and counts in excess of 100 organisms per milliliter who, within 20 hours, developed meningitis or epiglottitis. High bacterial counts of H influenzae and S pneumoniae in excess of 100 organisms per milliliter of blood should alert the physician to the existence or possible development of serious disease.
对79名未接受过抗生素治疗、伴有或不伴有局部感染体征且发热的儿童，确定了流感嗜血杆菌、肺炎链球菌和脑膜炎奈瑟菌所致菌血症的严重程度与临床诊断之间的关系。采用最近描述的定量直接接种法对菌血症进行定量，即将肝素化血液（各0.5 ml）接种到血琼脂平板和巧克力琼脂平板上。此外，采用放射性Bactec技术进行血培养。对于流感嗜血杆菌和肺炎链球菌，每毫升血液中细菌数超过100个的25例患者中有23例（92%）患有脑膜炎或会厌炎，相比之下，每毫升血液中细菌数少于100个的42例患者中只有4例（9.5%）患有脑膜炎或会厌炎（P<0.001）。在12例患有脑膜炎或其他严重感染的患者中，脑膜炎奈瑟菌所致菌血症的严重程度未发现显著差异。3名看似患有轻度呼吸道感染、每毫升血液中细菌数超过100个的儿童在20小时内发展为脑膜炎或会厌炎，这一观察结果说明了菌血症定量的可能预测价值。每毫升血液中流感嗜血杆菌和肺炎链球菌的细菌数超过100个，应提醒医生注意严重疾病的存在或可能发展。
