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Time-to-Positivity of Blood Cultures in Children With Sepsis

Alexa Dierig1, Christoph Berger2, Philipp K A Agyeman3

  • 1Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland.

Frontiers in Pediatrics
|August 24, 2018
PubMed

Insights

Blood cultures detect sepsis in children within 24 hours for most cases. A 48-hour observation period for suspected pediatric sepsis is often unnecessary, improving patient care.

Area of Science:

  • Pediatric Infectious Diseases
  • Clinical Microbiology
  • Neonatal and Pediatric Critical Care

Background:

  • Blood cultures are crucial for diagnosing sepsis in children and guiding treatment.
  • Current practice often involves 48-hour empirical treatment or monitoring while awaiting blood culture results.
  • Advancements in blood culture technology prompt re-evaluation of optimal observation durations.

Purpose of the Study:

  • To investigate the time-to-positivity (TTP) of blood cultures in pediatric patients diagnosed with sepsis.
  • To determine if the standard 48-hour observation period is justified based on TTP data.

Main Methods:

  • Prospective enrollment of children (0-16 years) with blood culture-positive sepsis (Swiss Pediatric Sepsis Study, 2011-2015).
  • Assessment of TTP using fully automated blood culture systems across six academic pediatric hospitals.
  • Analysis of TTP in relation to patient demographics, comorbidities, infection site, and severity.

Main Results:

  • Valid TTP data was obtained for 521 of 562 bacteremia episodes (93%).
  • Median TTP was 12 hours; 88% of cultures were positive within 24 hours, and 98% within 48 hours.
  • TTP was not significantly influenced by age, sex, comorbidities, infection site, or severity. Group B Streptococcus showed the shortest median TTP (8.7h), while coagulase-negative staphylococci had the longest (16.2h).

Conclusions:

  • Bacterial growth in blood cultures is typically detected within 24 hours in 90% of pediatric sepsis cases.
  • A mandatory 48-hour observation or treatment period for all suspected pediatric sepsis cases is not supported by this data.
  • Earlier interpretation of blood culture results can potentially optimize clinical management and resource utilization.

Keywords:
bacteremiablood cultureschildrensepsistime-to-positivity

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