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Follow-Up Blood Cultures in Young Infants With Bacteremic Urinary Tract Infections
Erika Franz-O'Neal1,2, Jared Olson1,2, Emily A Thorell1,2
1Primary Children's Hospital, Salt Lake City, Utah.
Insights
Routine follow-up blood cultures (FUBCs) in infants with bacteremic urinary tract infection (UTI) are not recommended. This practice, particularly for E. coli infections, shows low yield and uncertain benefits for infant outcomes.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Microbiology
Background:
- Previous research indicates a low clinical yield for follow-up blood cultures (FUBCs) in infants with bacteremic urinary tract infection (UTI).
- Persistent bacteremia is uncommon in this population, questioning the necessity of routine FUBCs.
- Analysis of the practice of routine FUBCs in infants with bacteremic UTI has been lacking.
Purpose of the Study:
- To evaluate outcomes in infants with bacteremic UTI who underwent FUBCs.
- To identify opportunities for improving blood culture practices in this demographic.
- To provide evidence for clinical practice guidelines and future research regarding FUBCs.
Main Methods:
- Retrospective cohort study design.
- Inclusion of infants under 90 days of age with bacteremia and UTI caused by the same pathogen.
- Data collected from 22 Intermountain Healthcare hospitals between 2002 and 2020, excluding specific complex infections.
Main Results:
- Out of 174 infants with bacteremic UTI, 153 (88%) had at least one FUBC.
- Only 9% of FUBCs were positive for the same organism, with 3% identified as contaminants.
- Infants with positive FUBCs had a longer length of stay; E. coli infections were more likely to have negative FUBCs. Readmission rates were similar across groups.
Conclusions:
- Routine FUBCs are not recommended for infants diagnosed with bacteremic UTI.
- The practice is particularly discouraged for infections caused by E. coli due to low yield.
- The impact of FUBCs on improving infant outcomes remains unclear.
Background And Objectives:
Researchers in previous studies suggest that the clinical yield of follow-up blood cultures (FUBCs) is low in infants with bacteremic urinary tract infection (UTI) because persistent bacteremia is rare; however, no researchers have analyzed the practice of routinely obtaining FUBCs. In our study, we evaluate outcomes in infants with FUBCs, examine opportunities for improvement of blood culture practices, and add important information to inform both clinical practice as well as further study.
Design:
This retrospective cohort study included infants <90 days of age with bacteremia and UTI with the same pathogen at 22 hospitals that make up Intermountain Healthcare between 2002 to 2020. Infants with culture proven meningitis, osteomyelitis, central line infection, and infections occurring during NICU hospitalization were excluded.
Results:
Total number of patients with bacteremic UTI was 174, 153 (88%) patients had at least 1 FUBC, 14 of 153 (9%) had a positive FUBC with same organism, and 4 of 153 (3%) were contaminants. The length of stay was longer for patients with positive FUBCs. Patients with Escherichia coli are more likely to have a negative FUBC. Readmissions within 30 days were similar among infants with positive FUBCs, negative FUBCs, and no FUBCs.
Conclusions:
FUBCs in infants with bacteremic UTI should not be routinely performed, especially for E coli, and it is unclear whether FUBCs improve outcomes.
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