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[Blood cultures in the paediatric emergency department. Guidelines and recommendations on their indications,
S Hernández-Bou1, C Álvarez Álvarez2, M N Campo Fernández1
1Grupo para el estudio de la bacteriemia, Grupo de Trabajo de Enfermedades Infecciosas de la Sociedad Española de Urgencias de Pediatría (SEUP), Sociedad Española de Urgencias de Pediatría (SEUP).
Insights
This guideline updates pediatric blood culture (BC) practices for suspected bacteremia, addressing new challenges like vaccines and central lines. It provides evidence-based recommendations for optimal BC use in pediatric emergency care.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Microbiology
- Emergency Medicine
Background:
- Blood culture (BC) is crucial for diagnosing suspected bacteremia in pediatric patients.
- Recent advancements, including new vaccines and increased central vascular catheter use, necessitate updated BC guidelines.
- Continuous monitoring BC systems are also influencing diagnostic approaches.
Purpose of the Study:
- To present an updated practice guideline for blood cultures in pediatric emergency care.
- To provide evidence-based recommendations for optimizing BC technique and interpretation.
- To address special considerations for immunosuppressed patients and central line carriers.
Main Methods:
- Review of available scientific evidence on blood culture practices.
- Development of recommendations by the Spanish Society of Paediatric Emergency Care and the Spanish Society for Paediatric Infectious Diseases.
- Focus on key aspects: indications, collection, transport, processing, and interpretation.
Main Results:
- Specific recommendations are provided for BC indications in the Emergency Department.
- Guidelines cover optimal methods for obtaining, transporting, and processing blood cultures.
- Strategies are outlined for differentiating contamination from true bacteremia and managing positive BC results.
Conclusions:
- The guideline aims to optimize the use of blood cultures in pediatric emergency settings.
- It addresses critical aspects from sample collection to interpreting results in complex cases.
- Updated recommendations support accurate diagnosis and management of bacteremia in children.
Abstract:
Blood culture (BC) is the gold standard when a bacteraemia is suspected, and is one of the most requested microbiological tests in paediatrics. Some changes have occurred in recent years: the introduction of new vaccines, the increasing number of patients with central vascular catheters, as well as the introduction of continuous monitoring BC systems. These changes have led to the review and update of different factors related to this technique in order to optimise its use. A practice guideline is presented with recommendations on BC, established by the Spanish Society of Paediatric Emergency Care and the Spanish Society for Paediatric Infectious Diseases. After reviewing the available scientific evidence, several recommendations for each of the following aspects are presented: BC indications in the Emergency Department, how to obtain, transport and process cultures, special situations (indications and interpretation of results in immunosuppressed patients and/or central vascular catheter carriers, indications for anaerobic BC), differentiation between bacteraemia and contamination when a BC shows bacterial growth and actions to take with a positive BC in patients with fever of unknown origin.
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