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Fischer CP, Kastoft E, Olesen BRS, Myrup B. Delayed Treatment of Bloodstream Infection at Admission is Associated With Initial Low Early Warning Score and Increased Mortality. Crit Care Explor 2023; 5:e0959. [PMID: 37644974 PMCID: PMC10461960 DOI: 10.1097/cce.0000000000000959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVES To identify factors associated with antibiotic treatment delay in patients admitted with bloodstream infections (BSIs). DESIGN Retrospective cohort study. SETTING North Zealand Hospital, Denmark. PATIENTS Adult patients with positive blood cultures obtained within the first 48 hours of admission between January 1, 2015, and December 31, 2015 (n = 926). MEASUREMENTS AND MAIN RESULTS First recorded Early Warning Score (EWS), patient characteristics, time to antibiotic treatment, and survival at day 60 after admission were obtained from electronic health records and medicine module. Presence of contaminants and the match between the antibiotic treatment and susceptibility of the cultured microorganism were included in the analysis. Data were stratified according to EWS quartiles. Overall, time from admission to prescription of antibiotic treatment was 3.7 (3.4-4.0) hours, whereas time from admission to antibiotic treatment was 5.7 (5.4-6.1) hours. A gap between prescription and administration of antibiotic treatment was present across all EWS quartiles. Importantly, 23.4% of patients admitted with BSI presented with an initial EWS 0-1. Within this group of patients, time to antibiotic treatment was markedly higher among nonsurvivors at day 60 compared with survivors. Furthermore, time to antibiotic treatment later than 6 hours was associated with increased mortality at day 60. Among patients with an initial EWS of 0-1, 51.3% of survivors received antibiotic treatment within 6 hours, whereas only 19.0% of nonsurvivors received antibiotic treatment within 6 hours. CONCLUSIONS Among patients with initial low EWS, delay in antibiotic treatment of BSIs was associated with increased mortality at day 60. Lag from prescription to administration may contribute to delayed antibiotic treatment. A more frequent reevaluation of patients with infections with a low initial EWS and reduction of time from prescription to administration may reduce the time to antibiotic treatment, thus potentially improving survival.
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Affiliation(s)
| | - Emili Kastoft
- Department of Pulmonary and Infectious Diseases, North Zealand Hospital, North Zealand, Denmark
- Department of Forensic Medicine, University of Copenhagen, København, Denmark
| | | | - Bjarne Myrup
- Department of Pulmonary and Infectious Diseases, North Zealand Hospital, North Zealand, Denmark
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Schinkel M, Boerman AW, Bennis FC, Minderhoud TC, Lie M, Peters-Sengers H, Holleman F, Schade RP, de Jonge R, Wiersinga WJ, Nanayakkara PWB. Diagnostic stewardship for blood cultures in the emergency department: A multicenter validation and prospective evaluation of a machine learning prediction tool. EBioMedicine 2022; 82:104176. [PMID: 35853298 PMCID: PMC9294655 DOI: 10.1016/j.ebiom.2022.104176] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/16/2022] [Accepted: 07/04/2022] [Indexed: 11/19/2022] Open
Abstract
Background Overuse of blood cultures (BCs) in emergency departments (EDs) leads to low yields and high numbers of contaminated cultures, accompanied by increased diagnostics, antibiotic usage, prolonged hospitalization, and mortality. We aimed to simplify and validate a recently developed machine learning model to help safely withhold BC testing in low-risk patients. Methods We extracted data from the electronic health records (EHR) for 44.123 unique ED visits with BC sampling in the Amsterdam UMC (locations VUMC and AMC; the Netherlands), Zaans Medical Center (ZMC; the Netherlands), and Beth Israel Deaconess Medical Center (BIDMC; United States) in periods between 2011 and 2021. We trained a machine learning model on the VUMC data to predict blood culture outcomes and validated it in the AMC, ZMC, and BIDMC with subsequent real-time prospective evaluation in the VUMC. Findings The model had an Area Under the Receiver Operating Characteristics curve (AUROC) of 0.81 (95%-CI = 0.78–0.83) in the VUMC test set. The most important predictors were temperature, creatinine, and C-reactive protein. The AUROCs in the validation cohorts were 0.80 (AMC; 0.78–0.82), 0.76 (ZMC; 0.74–0.78), and 0.75 (BIDMC; 0.74–0.76). During real-time prospective evaluation in the EHR of the VUMC, it reached an AUROC of 0.76 (0.71–0.81) among 590 patients with BC draws in the ED. The prospective evaluation showed that the model can be used to safely withhold blood culture analyses in at least 30% of patients in the ED. Interpretation We developed a machine learning model to predict blood culture outcomes in the ED, which retained its performance during external validation and real-time prospective evaluation. Our model can identify patients at low risk of having a positive blood culture. Using the model in practice can significantly reduce the number of blood culture analyses and thus avoid the hidden costs of false-positive culture results. Funding This research project was funded by the Amsterdam Public Health – Quality of Care program and the Dutch “Doen of Laten” project (project number: 839205002).
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Affiliation(s)
- Michiel Schinkel
- Section General Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, location VU University Medical Center, De Boelelaan 1118, 1081 HZ Amsterdam, the Netherlands; Center for Experimental and Molecular Medicine (CEMM), Amsterdam UMC, location Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Anneroos W Boerman
- Section General Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, location VU University Medical Center, De Boelelaan 1118, 1081 HZ Amsterdam, the Netherlands; Department of Clinical Chemistry, Amsterdam UMC, Vrije Universiteit Amsterdam, AGEM Research Institute, De Boelelaan 1118, 1081 HZ Amsterdam, the Netherlands
| | - Frank C Bennis
- Department of Computer Science, Quantitative Data Analytics Group, Department of Computer Science, Faculty of Science, VU University, De Boelelaan 1105, 1081HV Amsterdam, the Netherlands
| | - Tanca C Minderhoud
- Section General Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, location VU University Medical Center, De Boelelaan 1118, 1081 HZ Amsterdam, the Netherlands
| | - Mei Lie
- Department of EVA Service Center, Amsterdam UMC, location VU University Medical Center, De Boelelaan 1118, 1081 HZ Amsterdam, the Netherlands; Department of EVA Service Center, Amsterdam UMC, location Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Hessel Peters-Sengers
- Center for Experimental and Molecular Medicine (CEMM), Amsterdam UMC, location Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Frits Holleman
- Section General and Acute Internal Medicine, Department of Internal Medicine, Amsterdam UMC, location Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Rogier P Schade
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, location Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Robert de Jonge
- Department of Clinical Chemistry, Amsterdam UMC, Vrije Universiteit Amsterdam, AGEM Research Institute, De Boelelaan 1118, 1081 HZ Amsterdam, the Netherlands
| | - W Joost Wiersinga
- Center for Experimental and Molecular Medicine (CEMM), Amsterdam UMC, location Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Section Infectious Diseases, Department of Internal Medicine, Amsterdam UMC, location Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Prabath W B Nanayakkara
- Section General Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, location VU University Medical Center, De Boelelaan 1118, 1081 HZ Amsterdam, the Netherlands.
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Boerman AW, Schinkel M, Meijerink L, van den Ende ES, Pladet LC, Scholtemeijer MG, Zeeuw J, van der Zaag AY, Minderhoud TC, Elbers PWG, Wiersinga WJ, de Jonge R, Kramer MH, Nanayakkara PWB. Using machine learning to predict blood culture outcomes in the emergency department: a single-centre, retrospective, observational study. BMJ Open 2022; 12:e053332. [PMID: 34983764 PMCID: PMC8728456 DOI: 10.1136/bmjopen-2021-053332] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To develop predictive models for blood culture (BC) outcomes in an emergency department (ED) setting. DESIGN Retrospective observational study. SETTING ED of a large teaching hospital in the Netherlands between 1 September 2018 and 24 June 2020. PARTICIPANTS Adult patients from whom BCs were collected in the ED. Data of demographic information, vital signs, administered medications in the ED and laboratory and radiology results were extracted from the electronic health record, if available at the end of the ED visits. MAIN OUTCOME MEASURES The primary outcome was the performance of two models (logistic regression and gradient boosted trees) to predict bacteraemia in ED patients, defined as at least one true positive BC collected at the ED. RESULTS In 4885 out of 51 399 ED visits (9.5%), BCs were collected. In 598/4885 (12.2%) visits, at least one of the BCs was true positive. Both a gradient boosted tree model and a logistic regression model showed good performance in predicting BC results with area under curve of the receiver operating characteristics of 0.77 (95% CI 0.73 to 0.82) and 0.78 (95% CI 0.73 to 0.82) in the test sets, respectively. In the gradient boosted tree model, the optimal threshold would predict 69% of BCs in the test set to be negative, with a negative predictive value of over 94%. CONCLUSIONS Both models can accurately identify patients with low risk of bacteraemia at the ED in this single-centre setting and may be useful to reduce unnecessary BCs and associated healthcare costs. Further studies are necessary for validation and to investigate the potential clinical benefits and possible risks after implementation.
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Affiliation(s)
- Anneroos W Boerman
- Section General and Acute Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Department of Clinical Chemistry, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Michiel Schinkel
- Section General and Acute Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Center for Experimental and Molecular Medicine, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | | | - Eva S van den Ende
- Section General and Acute Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Lara Ca Pladet
- Section General and Acute Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | | | | | - Anuschka Y van der Zaag
- Section General and Acute Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Tanca C Minderhoud
- Section General and Acute Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Paul W G Elbers
- Department of Intensive Care Medicine, Amsterdam Medical Data Science, Amsterdam Cardiovascular Science, Amsterdam Infection and Immunity Institute, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - W Joost Wiersinga
- Center for Experimental and Molecular Medicine, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Section Infectious Diseases, Department of Internal Medicine, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Robert de Jonge
- Department of Clinical Chemistry, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Mark Hh Kramer
- Board of Directors, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Prabath W B Nanayakkara
- Section General and Acute Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
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Liu J, Fang Z, Yu Y, Ding Y, Liu Z, Zhang C, He H, Geng H, Chen W, Zhao G, Liu Q, Wang B, Sun X, Wang S, Sun R, Fu D, Liu X, Huang L, Li J, Xing X, Wang X, Gao Y, Zhu R, Han M, Peng F, Geng M, Deng L. Pathogens distribution and antimicrobial resistance in bloodstream infections in twenty-five neonatal intensive care units in China, 2017-2019. Antimicrob Resist Infect Control 2021; 10:121. [PMID: 34399840 PMCID: PMC8365905 DOI: 10.1186/s13756-021-00989-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 08/01/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Overcrowding, abuse of antibiotics and increasing antimicrobial resistance negatively affect neonatal survival rates in developing countries. We aimed to define pathogens and their antimicrobial resistance (AMR) of early-onset sepsis (EOS), hospital-acquired late-onset sepsis (HALOS) and community-acquired late-onset sepsis (CALOS) in 25 neonatal intensive care units (NICUs) in China. STUDY DESIGN This retrospective descriptive study included pathogens and their AMR from all neonates with bloodstream infections (BSIs) admitted to 25 tertiary hospitals in China from January 1, 2017, and December 31, 2019. We defined EOS as the occurrence of BSI at or before 72 h of life and late-onset sepsis (LOS) if BSI occurred after 72 h of life. LOS were classified as CALOS if occurrence of BSI was ≤ 48 h after admission, and HALOS, if occurrence was > 48 h after admission. RESULTS We identified 1092 pathogens of BSIs in 1088 infants from 25 NICUs. Thirty-two percent of all pathogens were responsible for EOS, 64.3% HALOS, and 3.7% CALOS. Gram-negative (GN) bacteria accounted for a majority of pathogens in EOS (56.7%) and HALOS (62.2%). The most frequent pathogens causing EOS were Escherichia coli (27.2%) and group B streptococcus (GBS; 14.6%) whereas in CALOS they were GBS (46.3%) and Staphylococcus aureus (41.5%). Klebsiella pneumoniae (27.9%), Escherichia coli (15.7%) and Fungi (12.8%) were the top three isolates in HALOS. Third-generation cephalosporin resistance rates in GN bacteria ranged from 9.7 to 55.6% in EOS and 26% to 63.3% in HALOS. Carbapenem resistance rates in GN bacteria ranged from 2.7 to 31.3% in HALOS and only six isolates in EOS were carbapenem resistant. High rates of multidrug resistance were observed in Klebsiella pneumoniae (60.7%) in HALOS and in Escherichia coli (44.4%) in EOS. All gram-positive bacteria were susceptible to vancomycin except for three Enterococcus faecalis in HALOS. All-cause mortality was higher among neonates with EOS than HALOS (7.4% VS 4.4%, [OR] 0.577, 95% CI 0.337-0.989; P = 0.045). CONCLUSIONS Escherichia coli, Klebsiella pneumoniae and GBS were the leading pathogens in EOS, HALOS and CALOS, respectively. The high proportion of pathogens and high degree of antimicrobial resistance in HALOS underscore understanding of the pathogenesis and emphasise the need to devise effective interventions in developing countries.
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Affiliation(s)
- Jing Liu
- Department of Neonatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Zengyu Fang
- Department of Neonatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Yonghui Yu
- Department of Neonatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China.
- Department of Neonatology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, No. 234, Jingwu Road, Huai Yin District, Jinan, 250021, Shandong, China.
| | - Yanjie Ding
- Department of Pediatrics, Yantai Yuhuangding Hospital, Yantai, 264000, Shandong, China
| | - Zhijie Liu
- Department of Neonatology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Chengyuan Zhang
- Department of Neonatology, Weifang Maternal and Child Health Hospital, Weifang, China
| | - Haiying He
- Department of Pediatrics, Baogang Third Hospital of Hongci Group, Baotou, China
| | - Hongli Geng
- Department of Neonatology, Zibo Maternal and Child Health Hospital, Zibo, China
| | - Weibing Chen
- Department of Pediatrics, People's Hospital of Rizhao, Rizhao, China
| | - Guoying Zhao
- Department of Pediatrics, Binzhou Medical University Hospital, Binzhou, China
| | - Qiang Liu
- Department of Pediatrics, Linyi People's Hospital, Linyi, China
| | - Baoying Wang
- Department of Pediatrics, Women and Children's Health Care Hospital of Linyi, Linyi, China
| | - Xueming Sun
- Department of Pediatrics, Weifang Yidu Central Hospital, Weifang, China
| | - Shaofeng Wang
- Department of Neonatology, Jinan Maternity and Child Health Care Hospital, Jinan, China
| | - Rongrong Sun
- Department of Pediatrics, Dongying People's Hospital, Dongying, China
| | - Delong Fu
- Department of Pediatrics, Tengzhou Central People's Hospital, Tengzhou, China
| | - Xinjian Liu
- Department of Pediatrics, Hebei Petro China Central Hospital, Langfang, China
| | - Lei Huang
- Department of Neonatology, Shandong Provincial Maternity and Child Health Care Hospital, Jinan, China
| | - Jing Li
- Department of Pediatrics, The Second Affiliated Hospital of Shandong First Medical University, Taian, China
| | - Xuexue Xing
- Department of Pediatrics, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiaokang Wang
- Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yanling Gao
- Department of Pediatrics, Dezhou People's Hospital, Dezhou, China
| | - Renxia Zhu
- Department of Pediatrics, Zibo Central Hospital, Zibo, China
| | - Meiying Han
- Department of Pediatrics, Liaocheng People's Hospital, Liaocheng, China
| | - Fudong Peng
- Department of Pediatrics, The Second People's Hospital of Liaocheng, Liaocheng, China
| | - Min Geng
- Department of Neonatology, The Second Children and Women's Healthcare of Jinan City, Jinan, China
| | - Liping Deng
- Department of Pediatrics, Heze Municipal Hospital, Heze, China
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Furr M, McKenzie H. Factors associated with the risk of positive blood culture in neonatal foals presented to a referral center (2000-2014). J Vet Intern Med 2020; 34:2738-2750. [PMID: 33044020 PMCID: PMC7694804 DOI: 10.1111/jvim.15923] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 09/17/2020] [Accepted: 09/22/2020] [Indexed: 01/12/2023] Open
Abstract
Background Bloodstream infections (BSI) are common in sick foals and increase foal morbidity and mortality when they occur. Recognition of risk factors for BSI could be an important means to limit their occurrence, but studies on this topic are limited. Objectives Historical as well as maternal and foal physical examination findings will predict risk of BSI in neonatal foals. Animals Foals <14 days of age admitted to a referral equine hospital for care. Methods Retrospective case‐control study with univariate and multivariable logistic regression analysis. Results Four hundred twenty‐nine (143 cases and 286 controls) foals <14 days of age were studied. Risk of a foal having a BSI was increased in foals with umbilical disease (adjusted odds ratio [OR], 11.01; P = .02), hypoglycemia (adjusted OR, 13.51; P = .03), and the combined presence of umbilical disease and low hematocrit (adjusted OR, >999.99; P = .04). Factors not found to be risk factors for development of BSI included prematurity, hypothermia, abdominal disease, diarrhea, failure of passive transfer, and maternal uterine infection. Conclusions and Clinical Importance Several historical and physical examination findings increase the risk of foals being blood culture positive at presentation to the hospital. This knowledge may aid early identification of blood culture status, thus aiding in treatment decisions.
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Affiliation(s)
- Martin Furr
- College of Veterinary Medicine, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Harold McKenzie
- Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, USA
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Dargère S, Cormier H, Verdon R. Contaminants in blood cultures: importance, implications, interpretation and prevention. Clin Microbiol Infect 2018; 24:964-969. [DOI: 10.1016/j.cmi.2018.03.030] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 03/17/2018] [Accepted: 03/20/2018] [Indexed: 11/24/2022]
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Prävention von Infektionen, die von Gefäßkathetern ausgehen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60:216-230. [DOI: 10.1007/s00103-016-2485-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Min H, Park CS, Kim DS, Kim KH. Blood culture contamination in hospitalized pediatric patients: a single institution experience. KOREAN JOURNAL OF PEDIATRICS 2014; 57:178-85. [PMID: 24868215 PMCID: PMC4030119 DOI: 10.3345/kjp.2014.57.4.178] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 10/20/2013] [Accepted: 11/05/2013] [Indexed: 11/27/2022]
Abstract
PURPOSE Blood culture is the most important tool for detecting bacteremia in children with fever. However, blood culture contamination rates range from 0.6% to 6.0% in adults; rates for young children have been considered higher than these, although data are limited, especially in Korea. This study determined the contamination rate and risk factors in pediatric patients visiting the emergency room (ER) or being admitted to the ward. METHODS We conducted a retrospective chart review of blood cultures obtained from children who visited Yonsei Severance Hospital, Korea between 2006 and 2010. Positive blood cultures were labeled as true bacteremia or contamination according to Centers for Disease Control and Prevention/National Healthcare Safety Network definitions for laboratory-confirmed bloodstream infection, after exclusion of cultures drawn from preexisting central lines only. RESULTS Among 40,542 blood cultures, 610 were positive, of which 479 were contaminations and 131 were true bacteremia (overall contamination rate, 1.18%). The contamination rate in the ER was significantly higher than in the ward (1.32% vs. 0.66%, P<0.001). The rate was higher in younger children (2.07%, 0.94%, and 0.61% in children aged <1 year, 1-6 years, and >6 years, respectively). CONCLUSION Overall, contamination rates were higher in younger children than in older children, given the difficulty of performing blood sampling in younger children. The contamination rates from the ER were higher than those from the ward, not accounted for only by overcrowding and lack of experience among personnel collecting samples. Further study to investigate other factors affecting contamination should be required.
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Affiliation(s)
- Hyewon Min
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Cheong Soo Park
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Soo Kim
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ki Hwan Kim
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
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