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. 2024 Jul 5;6(7):e1115.
doi: 10.1097/CCE.0000000000001115. eCollection 2024 Jul 1.

Time to Positive Blood Cultures Among Critically Ill Children Admitted to the PICU

Stephanie M Yasechko  1 , Margot M Hillyer  2 , Alison G C Smith  3 , Anna L Rodenbough  2 , Alfred J Fernandez  4 , Mark D Gonzalez  5 , Preeti Jaggi  6
Affiliations

Time to Positive Blood Cultures Among Critically Ill Children Admitted to the PICU

Stephanie M Yasechko et al. Crit Care Explor. .

Abstract

Objectives: Our study aimed to assess the time to positivity (TTP) of clinically significant blood cultures in critically ill children admitted to the PICU.

Design: Retrospective review of positive blood cultures in patients admitted or transferred to the PICU.

Setting: Large tertiary-care medical center with over 90 PICU beds.

Patients: Patients 0-20 years old with bacteremia admitted or transferred to the PICU.

Interventions: None.

Measurements and main results: The primary endpoint was the TTP, defined as time from blood culture draw to initial Gram stain result. Secondary endpoints included percentage of cultures reported by elapsed time, as well as the impact of pathogen and host immune status on TTP. Host immune status was classified as previously healthy, standard risk, or immunocompromised. Linear regression for TTP was performed to account for age, blood volume, and Gram stain. Among 164 episodes of clinically significant bacteremia, the median TTP was 13.3 hours (interquartile range, 10.7-16.8 hr). Enterobacterales, Staphylococcus aureus, Streptococcus agalactiae, and Streptococcus pneumoniae were most commonly identified. By 12, 24, 36, and 48 hours, 37%, 89%, 95%, and 97% of positive cultures had resulted positive, respectively. Median TTP stratified by host immune status was 13.2 hours for previously healthy patients, 14.0 hours for those considered standard risk, and 10.6 hours for immunocompromised patients (p = 0.001). Median TTP was found to be independent of blood volume. No difference was seen in TTP for Gram-negative vs. Gram-positive organisms (12.2 vs. 13.9 hr; p = 0.2).

Conclusions: Among critically ill children, 95% of clinically significant blood cultures had an initial positive result within 36 hours, regardless of host immune status. Need for antimicrobial therapy should be frequently reassessed and implementation of a shorter duration of empiric antibiotics should be considered in patients with low suspicion for infection.

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Conflict of interest statement

The authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Percentages of positive cultures by time stratified by underlying host condition.
See this image and copyright information in PMC

References

    1. Liu VX, Fielding-Singh V, Greene JD, et al. : The timing of early antibiotics and hospital mortality in sepsis. Am J Respir Crit Care Med 2017; 196:856–863 - PMC - PubMed
    1. Centers for Disease Control and Prevention: Antibiotic Resistance Threats in the United States. Atlanta, GA, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2019
    1. Dierig A, Berger C, Agyeman PKA, et al. ; Swiss Pediatric Sepsis Study: Time-to-positivity of blood cultures in children with sepsis. Front Pediatr 2018; 6:222. - PMC - PubMed
    1. Biondi EA, Mischler M, Jerardi KE, et al. ; Pediatric Research in Inpatient Settings (PRIS) Network: Blood culture time to positivity in febrile infants with bacteremia. JAMA Pediatr 2014; 168:844–849 - PubMed
    1. Pan F, Zhao W, Zhang H: Value of time to positivity of blood culture in children with bloodstream infections. Can J Infect Dis Med Microbiol 2019; 2019:5975837. - PMC - PubMed

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