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. 2021 Nov 23;224(Supple 5):S484-S493.
doi: 10.1093/infdis/jiab357.

Factors Predicting Blood Culture Positivity in Children With Enteric Fever

Manikandan Srinivasan  1 , Kulandaipalayam Natarajan Sindhu  1 , Karthikeyan Ramanujam  1 , Ranjith Kumar Ramasamy  1 , Sathyapriya Subramaniam  1 , Santhosh Kumar Ganesan  1 , Swathi Vajja  1 , Anita Shirley David  1 , Pramitha Lankala  2 , Winsley Rose  3 , Prabhakar D Moses  1 , Nicholas C Grassly  4 , Gagandeep Kang  1 , Jacob John  2
Affiliations

Factors Predicting Blood Culture Positivity in Children With Enteric Fever

Manikandan Srinivasan et al. J Infect Dis. .

Abstract

Background: Blood culture, despite low sensitivity, is the gold standard for enteric fever diagnosis. Understanding predictors of blood culture positivity may help design strategies to optimize enteric fever diagnosis.

Methods: A cohort of 6760 children aged 0.5-15 years was followed for 3 years for enteric fever with blood cultures in an automated system, for fevers >3 days. Factors affecting test positivity in fevers and participant-level predictors for culture refusals were analyzed using regression models.

Results: Overall, 6097 suspected typhoid/paratyphoid fever (STF) episodes were reported, of which 5703 (93.5%) STFs had sampling for blood cultures, with 394 (6.5%) refusals. Salmonella enterica serovar Typhi/Paratyphi positivity was culture-confirmed in 3.8% (218/5703) of STF episodes. Older children (odds ratio [OR], 1.96 [95% CI, 1.39-2.77]), larger blood volume inoculated (OR, 2.82 [95% CI, 1.71-4.66]), higher temperatures during fever (OR, 3.77 [95% CI, 2.89-4.91]), and fevers diagnosed as suspected typhoid or acute undifferentiated fever (OR, 6.06 [95% CI, 3.11-11.78]) had a higher probability of culture positivity. Antibiotics before culture did not decrease culture positivity. Blood culture refusals were higher for children from wealthier households or with milder illness.

Conclusions: Performing blood cultures in older children with fever, especially those fevers with toxic presentation and increasing blood volume for inoculation are strategies to improve enteric fever detection in surveillance settings.

Keywords: Salmonella Typhi; India; blood culture; children; enteric fever.

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Figures

Figure 1.
Figure 1.
Flowchart depicting the number of children enrolled in the Vellore Surveillance for Enteric Fever in India cohort who were followed up for suspected typhoid fever (STF) with blood cultures being performed to detect Salmonella enterica serovars Typhi/Paratyphi among the eligible cases.
Figure 2.
Figure 2.
Relationship between blood culture positivity for Salmonella enterica serovars Typhi/Paratyphi and age of children in the Surveillance for Enteric Fever in India cohort. Position of each circle in the graph represents the proportion of blood cultures positive in children in each age group; size of circle represents the number of fever episodes included in each age category.
See this image and copyright information in PMC

References

    1. Stanaway JD, Reiner RC, Blacker BF, et al. The global burden of typhoid and paratyphoid fevers: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Infect Dis 2019;19:369–81. - PMC - PubMed
    1. John J, Van Aart CJC, Grassly NC. The burden of typhoid and paratyphoid in India: systematic review and meta-analysis. PLoS Negl Trop Dis 2016; 10:e0004616. - PMC - PubMed
    1. World Health Organization. Typhoid vaccines: WHO position paper-March 2018. Wkly Epidemiol Recd 2018; 93:152–72. - PubMed
    1. Crump JA, Sjölund-Karlsson M, Gordon MA, Parry CM. Epidemiology, clinical presentation, laboratory diagnosis, antimicrobial resistance, and antimicrobial management of invasive Salmonella infections. Clin Microbiol Rev 2015; 28:901–37. - PMC - PubMed
    1. World Health Organization. Typhoid and other invasive salmonellosis—surveillance standards.https://www.who.int/immunization/monitoring_surveillance/burden/vpd/WHO_.... Accessed 18 May 2020.

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