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. 2025 Oct 20;10(10):e020448.
doi: 10.1136/bmjgh-2025-020448.

Factors associated with positive blood cultures in children in nine African and Asian countries: the ACORN2 surveillance network

Cristina Ardura-Garcia  1 , Jill Hopkins  2   3 , Sue J Lee  3   4   5 , Naomi Waithira  3   4 , Chris Painter  3   4   6 , Clare L Ling  2   3 , Tamalee Roberts  3   6 , Thyl Miliya  2 , Noah Obeng-Nkrumah  7 , Japheth A Opintan  8 , Emmanuel P Abbeyquaye  9 , Raph L Hamers  3   10 , Yulia R Saharman  11   12 , Robert Sinto  12   13 , Mulya R Karyanti  14 , R Fera Ibrahim  11   15 , Samuel O Akech  16 , Anousone Duangnouvong  17 , Khamla Choumlivong  18 , Nicholas A Feasey  19   20   21 , Diana Kululanga  19 , Samantha Lissauer  19   22 , Abhilasha Karkey  23 , Narayan Kunwar  23 , Justice E Erakhaiwu  24 , Iruka N Okeke  25 , Ini Adebiyi  26 , Abiodun B Oduola  26 , Babatunde O Ogunbosi  27   28 , Olukemi O Tongo  29 , Ifeoma A Ude  30 , Oladipo Aboderin  31 , Adeyemi T Adeyemo  31 , Sylvester S Edward  31 , Ugowe Osagie  32 , Hoa Nguyen Thi  33 , Pham Ngoc Thach  34 , Tran Van Giang  34   35 , Lan Huong Hoang Thi  36 , Huu Tung Trinh  37 , H Rogier van Doorn  3   33 , Elizabeth A Ashley  3   6 , Paul Turner  2   3
Affiliations

Factors associated with positive blood cultures in children in nine African and Asian countries: the ACORN2 surveillance network

Cristina Ardura-Garcia et al. BMJ Glob Health. .

Abstract

Background: Blood culture (BC) in children has relatively low diagnostic yield and high contamination rates, limiting cost-effectiveness. We aimed to determine readily available baseline characteristics to identify hospitalised children with a likelihood of higher diagnostic yield in low- and middle-income countries.

Methods: We used data from ACORN2, a prospective clinical surveillance network including 19 hospitals across Africa and Asia. We included participants <18 years, hospitalised for a suspected infection, prescribed parenteral antibiotics and with a BC sample. Sociodemographic and clinical data were recorded for each infection episode and linked to routine microbiology data. We described true pathogen (non-contaminant) BC positivity proportion and performed mixed-effects logistic regression, with study site and patient as the random effect, to identify factors associated with BC positivity.

Results: Of the 26 407 paediatric infection episodes, 17 815 (67%) had a BC sample and 15 384 were included in the analysis. BC results were: true pathogens in 689 (4.5%), contaminants in 1399 (9%) and uncertain pathogens in 143 (0.9%). In the multivariable model, factors associated with a positive BC were age (29 days-12-month-olds OR 1.33, 95% CI 1.06 to 1.66 and 5-18 year-olds OR 1.62, 95% CI 1.30 to 2.01 vs 1-4 year-olds), number of clinical severity signs (OR 1.29, 95% CI 1.18 to 1.40 per one sign) and hospital acquired infection (OR 3.05, 95% CI 2.30 to 4.06 vs community-acquired). Suspected diagnosis of sepsis (OR 2.09, 95% CI 1.67 to 2.61), gastrointestinal/abdominal (OR 2.36, 95% CI 1.78 to 3.13), skin and soft tissue or bone (OR 3.64, 95% CI 2.57 to 5.14) and genitourinary infection (OR 2.22, 95% CI 1.39 to 3.56) were more likely to have a positive BC, compared with respiratory infections.

Conclusion: We confirmed the low BC yield among hospitalised children. We identified groups for which diagnostic stewardship efforts to increase BC uptake should be prioritised and others in which it could be limited in times of financial or logistic constraints.

Keywords: Africa South of the Sahara; Blood disorders; Global Health; Other diagnostic or tool; Paediatrics.

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Conflict of interest statement

Competing interests: CAG, JH, SJL, NW, CP, CLL, TR, TM, NON, JAP, EPA, RLH, YRS, RS, MRK, RFA, SOA, AD, KC, DK, SL, AK, NK, JEE, IA, ABO, BOO, OOT, IAU, AOA, ATA, SSE, UO, HNT, NTP, VGT, LHHT, HTT and EAA have no competing interests to disclose. NAF has received support for the present manuscript from NIHR Global Health Professorship. BOO has received a travel grant from Pfizer Nigeria and is the General Secretary of the Nigerian Society for Paediatric Infectious Diseases. HRvD is a Board Member of Wellcome Surveillance and Epidemiology of Drug Resistant Infections Consortium. IO has received support for the present manuscript from NIHR, Bill & Melinda Gates Foundation, the Wellcome Trust and DELGEME Plus program; grants from Bill & Melinda Gates Foundation, UK Medical Research Council/ Department for International Development African Research Leaders Award; royalties from Oxford University Press, Cornell University Press and Springer; consulting fees from Wellcome Trust and UK Medical Research Council; honorarium from Springer Nature; travel and meetings support from Bill & Melinda Gates Foundation, Cambridge University, American Society for Microbiology and The Lancet AMR series/One health Trust; has a fiduciary role at Thomas Bassir Biomedical Foundation Nigeria and International Centre for Antimicrobial Resistance Solutions (ICARS) Technical Advisory Forum; has other financial or non-financial interests as Senior Editor at Microbial Genomics and Surveillance Lead, AMR Technical Work Group. PT has received support for the present manuscript from the Wellcome Trust; travel and meetings support from WHO.

Figures

Figure 1
Figure 1. Study population. HAI, hospital acquired infection; QC, quality control.
Figure 2
Figure 2. Pathogens identified from the 689 positive blood cultures, by age group (A), by region (B) and by suspected infection (C). (n=705).
Figure 3
Figure 3. Countries and sites participating in ACORN2 and proportion of blood culture positivity.
See this image and copyright information in PMC

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