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Published on: October 15, 2014
Follow-up Blood Cultures in Children With Staphylococcus aureus Bacteremia
Caitlin Cardenas-Comfort1, Sheldon L Kaplan1,2,3, Jesus G Vallejo2,1,3
1Section of Pediatric Infectious Diseases, Baylor College of Medicine, Houston, Texas; and.
Insights
For pediatric Staphylococcus aureus bacteremia, two negative follow-up blood cultures (FUBCs) are sufficient to confirm infection clearance. This reduces unnecessary testing, healthcare costs, and patient trauma.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Microbiology
- Epidemiology
Background:
- Staphylococcus aureus bacteremia (SAB) is a significant cause of pediatric bloodstream infections.
- Current guidelines lack evidence-based recommendations for determining the number of follow-up blood cultures (FUBCs) needed to confirm SAB clearance.
- Unnecessary FUBCs lead to increased healthcare costs, false-positive results, and distress for pediatric patients and families.
Purpose of the Study:
- To identify risk factors associated with persistent SAB and intermittent positive blood cultures in children.
- To determine the optimal number of FUBCs required to demonstrate infection clearance in pediatric SAB cases.
- To inform evidence-based recommendations for FUBC strategies in pediatric SAB.
Main Methods:
- Retrospective review of pediatric patients (≤18 years) hospitalized with SAB in 2018.
- Assessment of infectious disease diagnoses and comorbidities influencing bacteremia duration.
- Analysis of patients with intermittent positive cultures to determine reversion rates and characteristics.
Main Results:
- A total of 122 pediatric patients with SAB were included in the study.
- The median duration of bacteremia was 1-2 days; only 16% had bacteremia lasting ≥3 days, primarily with central line-associated bloodstream infection, osteomyelitis, or endocarditis.
- Intermittent positive cultures occurred in 5% of patients, with reversion to positive after two negative FUBCs in <1%; these were linked to osteomyelitis and endocarditis.
Conclusions:
- Two negative FUBCs are adequate to document infection clearance in pediatric patients with SAB.
- Further FUBCs beyond two negative results are generally not necessary for well-appearing children with SAB.
- This finding supports reducing unnecessary testing, associated costs, and patient burden.
Background:
Staphylococcus aureus is a common pathogen seen in pediatric bloodstream infections. Currently, no evidence-based recommendations are used to guide decisions on the number of follow-up blood cultures (FUBCs) needed to demonstrate infection clearance. Unnecessary cultures increase the risk of false-positives, add to health care costs, and create additional trauma to children and their families. In this study, we examined risk factors for persistent S aureus bacteremia (SAB) and intermittent positive blood cultures (positive cultures obtained after a documented negative FUBC result) to determine the number of FUBCs needed to demonstrate infection clearance in children.
Methods:
Patients ≤18 years who were hospitalized with SAB at Texas Children's Hospital in 2018 were reviewed. We assessed the impact of an infectious disease diagnosis (central line-associated bloodstream infection, osteomyelitis, soft tissue infection, endocarditis, etc) and medical comorbidities on bacteremia duration. Patients with intermittent positive blood cultures were studied to determine the characteristics of this group and overall frequency of reversion to positive cultures.
Results:
A total of 122 subjects met the inclusion criteria. The median duration of bacteremia was 1 day (interquartile range: 1-2 days). Only 19 patients (16%) had bacteremia lasting ≥3 days, all of whom had a diagnosis of central line-associated bloodstream infection, osteomyelitis, or endocarditis. Intermittent positive cultures occurred in 5% of patients, with positive cultures after 2 negative FUBC results seen in <1% of patients. Intermittent positive cultures were strongly associated with osteomyelitis and endocarditis.
Conclusions:
On the basis of our sample of children with SAB, additional blood cultures to document sterility are not necessary after 2 FUBC results are negative in well-appearing patients.
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