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The Sepsis Bundle Effect: An Evaluation of Culture Results and Utilization in Pediatric Appendicitis
Krista J Stephenson1, Connor N Shewmake2, Beverly J Spray3
1Department of General Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Insights
Sepsis pathways often lead to unnecessary blood and urine cultures in children with appendicitis. Our study found few positive cultures, suggesting sepsis protocols could be refined to reduce testing in these cases.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Microbiology
- Surgical Infections
Background:
- Sepsis prevention pathways commonly incorporate blood and urine cultures in pediatric settings.
- Fever and tachycardia, symptoms of appendicitis, often trigger these sepsis protocols.
- This study investigated the hypothesis that cultures are frequently obtained in children diagnosed with appendicitis.
Purpose of the Study:
- To evaluate the frequency of blood and urine culture acquisition in children with confirmed appendicitis.
- To assess the impact of sepsis prevention pathways on culture acquisition rates.
- To determine the clinical significance of positive cultures in pediatric appendicitis cases.
Main Methods:
- A single-center retrospective cohort study was conducted.
- Data from children with image-confirmed appendicitis between April 2019 and October 2020 were analyzed.
- Factors associated with culture acquisition, results, treatment, and outcomes were examined.
Main Results:
- Of 658 children with appendicitis, 22.9% had cultures obtained (8.1% blood, 17.9% urine).
- Culture acquisition decreased by 17.6% after sepsis protocol initiation.
- Positive cultures were rare (4.24% urine, 1.89% blood, suspected contamination) and did not alter clinical management.
Conclusions:
- Positive cultures are infrequent in pediatric appendicitis and generally do not impact clinical management.
- Implementing sepsis bundles without automatic culture acquisition may reduce unnecessary testing.
- Refining sepsis protocols could optimize diagnostic strategies for appendicitis in children.
Introduction:
Sepsis prevention pathways, which often include blood and urine cultures, are common in children's hospitals. Fever and tachycardia, signs often seen in patients with appendicitis, frequently trigger these pathways. We hypothesized that cultures were frequently obtained in children with appendicitis.
Materials And Methods:
We conducted a single-center retrospective cohort study evaluating children with image-confirmed appendicitis from 4/1/2019 to 10/1/2020, coinciding with the initiation of sepsis prevention pathways. Factors associated with culture acquisition, as well as culture results, treatment, and outcomes were evaluated.
Results:
Six hundred and fifty eight children presented with acute appendicitis during the 1.5-year period, with a median age of 10.67 years (interquartile range (IQR) 8.17-14.08). Cultures were obtained in 22.9%, including blood culture (BCx) in 8.1% and urine culture (UCx) in 17.9%. Culture acquisition decreased by 17.6% after sepsis protocol initiation. Blood culture acquisition correlated with fever (P = .003) and younger age (P = .03), whereas the attainment of BCx and UCx was associated with female sex (P = .04, P < .0001), complicated appendicitis (P = .0001, P = .03), and unknown diagnosis (P < .0001, P < .0001). There were five positive UCx (4.24%); however, all remained asymptomatic despite a short antibiotic duration dictated by institutional appendicitis protocol. The one positive BCx (1.89%) was suspected contamination and not treated.
Discussion:
The findings of this cohort suggest a low incidence of positive culture as well as lack of impact on clinical management in image-proven appendicitis and the initiation of a sepsis bundle without automatic culture acquisition may result in decreased culture attainment.
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