Kornberg A E, Jain N, Dannenhoffer R
Department of Pediatrics, Children's Hospital of Buffalo, NY 14222.
Pediatr Emerg Care. 1994 Feb;10(1):20-2. doi: 10.1097/00006565-199402000-00006.
Young, febrile children are at risk for occult bacteremia. However, some positive blood cultures are contaminants. This study assesses the ability of preliminary blood culture results to distinguish between pathogens and contaminants. Positive blood cultures were obtained and evaluated from 210 otherwise well febrile children, at risk for occult bacteremia, three months to three years of age, who were without invasive bacterial disease. These children had entered a pediatric emergency department between 1983 and 1989 and were not admitted to the hospital. Blood cultures of true pathogens became positive more rapidly than contaminants, 13.8 +/- 7.0 hours versus 37.6 +/- 29.9 hours, respectively (P < 0.0001). Gram stain results were used as a diagnostic test for pathogenicity with a sensitivity of 98.1% and specificity of 54.5% for the entire population, and 100% and 77.3% respectively, for those cultures becoming positive after 24 hours. Time to positivity and initial gram stain results are valuable diagnostic tests in distinguishing between pathogens and contaminants for blood cultures obtained from children at risk for occult bacteremia.
发热的幼儿有患隐匿性菌血症的风险。然而，一些血培养阳性结果是污染所致。本研究评估了初步血培养结果区分病原体和污染物的能力。对210名3个月至3岁、有隐匿性菌血症风险、无侵袭性细菌疾病的发热儿童进行血培养并评估，这些儿童于1983年至1989年间进入儿科急诊科但未住院。真正病原体的血培养阳性出现得比污染物更快，分别为13.8±7.0小时和37.6±29.9小时（P<0.0001）。革兰氏染色结果用作致病性诊断试验，对全体人群的敏感性为98.1%，特异性为54.5%，对于24小时后呈阳性的培养物，敏感性和特异性分别为100%和77.3%。对于有隐匿性菌血症风险的儿童所做的血培养，阳性时间和初始革兰氏染色结果是区分病原体和污染物的有价值的诊断试验。
