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Published on: October 15, 2014
Pediatric Anaerobic Blood Culture Practices in Industrialized Countries
Tama Thé1, Alison Curfman2, Carey-Ann D Burnham3
1Division of Emergency Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO; Tama.The@wustl.edu.
Insights
Pediatric hospitals show wide variation in collecting anaerobic blood cultures for febrile children. Practices differ across departments, influenced by concerns about blood volume and cost, despite clinical suspicion guiding selective collection.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Microbiology
- Healthcare Practices
Background:
- Routine anaerobic blood culture collection in febrile children is debated due to the low incidence of anaerobic bacteremia.
- Variations in clinical and laboratory practices can lead to inaccurate epidemiological data.
- Assessing current practices is crucial for standardizing care.
Purpose of the Study:
- To evaluate blood culture practices in pediatric patients across an international network of hospitals.
- To identify variations in routine and selective anaerobic blood culture collection.
- To understand the rationale behind current practices in pediatric healthcare settings.
Main Methods:
- A survey was conducted among international institutions in pediatric emergency research networks.
- Clinical and laboratory practice patterns regarding anaerobic blood cultures were assessed.
- Data were collected from emergency departments, pediatric intensive care units, and oncology wards.
Main Results:
- 41% of invited institutions participated, revealing significant practice variations.
- Routine anaerobic blood cultures are collected in 30% of EDs, 30% of ICUs, and 48% of oncology wards.
- Concerns about blood volume, low pretest probability, and cost influence collection restrictions, while clinical suspicion and immunosuppression guide selective collection.
Conclusions:
- There is considerable variation in anaerobic blood culture practices among pediatric hospitals in industrialized nations.
- Standardization of anaerobic blood culture protocols may be needed to improve data accuracy and patient care.
- Further research is warranted to optimize diagnostic strategies for febrile children.
Background:
Routine anaerobic blood culture collection in febrile children is controversial, as clinicians try to account for the severe but relative infrequency of anaerobic bacteremia. Furthermore, clinical and laboratory practice variation among institutions may lead to potentially inaccurate epidemiological data. Our goal was to assess blood culture practices in pediatric patients throughout an international network of hospitals in industrialized countries.
Methods:
We conducted a survey of current clinical and laboratory practice patterns in a convenience sample of international institutions participating in 6 pediatric emergency research networks in the US, Canada, Europe, Australia, and New Zealand. A lead clinician at each institution queried institutional practices from the emergency department, pediatric intensive care unit, and oncology medical directors. The microbiology director at each institution completed the laboratory survey.
Results:
Sixty-five of 160 (41%) invited institutions participated in the survey. Routine anaerobic blood cultures are collected in 30% of emergency departments, 30% of intensive care units, and 48% of oncology wards. Reasons for restricting anaerobic culture collection included concerns regarding blood volume (51%), low pretest probability (22%), and cost-effectiveness (16%). The most common reasons institutions allow for selectively obtaining anaerobic cultures are clinical suspicion (64%) and patients who are immunosuppressed (50%). The microbiology survey showed variation in systems, although most use the BACTEC™ culture system and MALDI-TOF for organism identification.
Conclusions:
There is broad variation in anaerobic blood culture practices among a network of pediatric hospitals in industrialized countries.
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