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Pneumococcal bacteremia and focal infection in young children
S J Teach1, D M Dryja, D Tristram
1Division of Emergency Medicine, Children's Hospital of Buffalo, State University of New York, Buffalo School of Medicine and Biomedical Sciences, USA.
Insights
Higher Streptococcus pneumoniae levels in blood cultures of children indicate a greater risk of focal infection. Quantitative blood culture methods are crucial for detecting all bacterial isolates, improving diagnostic accuracy.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Streptococcus pneumoniae is a common cause of serious infections in children.
- Accurate detection and quantification of bacteremia are essential for appropriate clinical management.
- Distinguishing true infection from contamination is critical in pediatric blood cultures.
Purpose of the Study:
- To evaluate the correlation between the magnitude of Streptococcus pneumoniae bacteremia and the presence of focal infections in immunocompetent children.
- To compare the diagnostic yield of quantitative blood culture methods versus traditional broth methods for detecting Streptococcus pneumoniae.
Main Methods:
- Retrospective review of 178 immunocompetent children aged 3-36 months with positive blood cultures for Streptococcus pneumoniae.
- Analysis of paired broth and quantitative blood cultures, correlating bacterial load (colony-forming units/mL) with clinical data.
- Comparison of detection rates between quantitative and broth culture methods.
Main Results:
- A significantly higher incidence of focal infection was observed in children with >10 colony-forming units (cfu)/mL compared to those with <=10 cfu/mL (30.4% vs 12.9%, p=0.04).
- No significant associations were found between bacteremia magnitude and patient age, gender, temperature, or white blood cell counts.
- The quantitative method detected 33.1% of isolates, including 2.8% missed by the broth method.
Conclusions:
- Quantitative assessment of Streptococcus pneumoniae bacteremia is valuable for predicting focal infections in children.
- Quantitative blood cultures offer superior detection rates for Streptococcus pneumoniae compared to traditional broth methods.
- These findings underscore the importance of quantitative blood cultures in pediatric infectious disease diagnosis.
Abstract:
We reviewed a consecutive case series of 178 immunocompetent children aged 3-36 months without central venous lines who had blood cultures positive for Streptococcus pneumoniae by either of paired broth and quantitative culture methods. The incidence of accompanying focal infection was significantly greater in patients with > 10 colony-forming units (cfu)/mL than in patients with < or = 10 cfu/mL (30.4% vs 12.9% respectively, p = 0.04). No significant relationships existed between the magnitude of bacteremia and the age, gender, presenting temperature, interval until the blood culture turned positive, total peripheral blood white cell count, absolute neutrophil count, or absolute band count. Overall, the quantitative method detected 59/178 (33.1%) of the isolates, including five isolates (2.8%) that the broth method failed to detect.