How to interpret a paediatric blood culture

O’Hagan, Shaun; Nelson, Peter Kim; Speirs, Lynne; Moriarty, Paul; Mallett, Peter

doi:10.1136/archdischild-2020-321121

Cited by 8 publications

(9 citation statements)

References 32 publications

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“…Upon the clinical suspicion of a BSI, whole blood was drawn synchronously from the same vein or central venous line for the BC and the molecular diagnosis. According to hospital practices and international recommendations for pediatric populations [ 19 , 20 , 21 ], the BCs collected one bottle inoculated with 1.5–3 mL whole blood for each pediatric patient. An amount of 1–1.5 mL whole blood inoculated into an ethylenediaminetetraacetate (EDTA) blood collection tube was used for ddPCR detection.…”

Section: Methodsmentioning

confidence: 99%

Clinical Application of a Multiplex Droplet Digital PCR in the Rapid Diagnosis of Children with Suspected Bloodstream Infections

et al. 2023

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Droplet digital PCR (ddPCR) recently has been shown to be a potential diagnostic tool for adults with bloodstream infections (BSIs); however, its application in children remains obscure. In this study, 76 blood samples of children with suspected BSIs were synchronously detected by traditional blood cultures (BCs) and ddPCRs. Our team validated the diagnostic performance of ddPCR including sensitivity, specificity, and positive and negative predictive values. The 76 pediatric patients from the hematology department (67.1%), the pediatric intensive care unit (PICU, 27.6%), and other departments (5.2%) were enrolled. The positive rate of ddPCR results was 47.9%, whereas that for BC was 6.6%. In addition, the time consumption of ddPCR was shorter, only for 4.7 ± 0.9 h, in comparison with the detection timing of BC (76.7 ± 10.4 h, p < 0.01). The levels of agreement and disagreement between BC and ddPCR were 96.1% and 4.2%, and the negative agreement reached 95.6%. The sensitivity of ddPCR was 100%, with corresponding specificities ranging from 95.3 to 100.0%. In addition, a total of nine viruses were identified by ddPCR. In China, the multiplexed ddPCR first could be a tool for the rapid and accurate diagnosis of children with suspected BSIs and can be an early indicator of the possibility of viraemia in children with immunosuppression.

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Section: Methodsmentioning

confidence: 99%

Clinical Application of a Multiplex Droplet Digital PCR in the Rapid Diagnosis of Children with Suspected Bloodstream Infections

et al. 2023

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“…It is of great importance to guarantee sterility at the time of sample collection. The volume of blood to be extracted varies according to the age and weight of the patient, and can range from 1 mL in patients < 5 kg under 1 year of age, up to 10–15 mL in patients of 15 years of age [ 63 ]. The sensitivity of blood cultures increases with each additional mL of blood drawn, but this can be difficult to achieve in young patients with a low body surface area [ 64 ].…”

Section: Diagnosismentioning

confidence: 99%

“…Blood cultures should be interpreted according to the following principles [ 63 ]: Blood cultures should be taken as soon as possible, ideally < 1 h; Three sets of blood cultures should be drawn, in aerobic and anaerobic culture bottles. If a limited volume of blood is available, aerobic culture media should be preferred, as anaerobic IE is very rare; Usually, the incubation time necessary to observe bacterial growth and obtain antibiotic sensitivity is 24–48 h; If there is a high clinical suspicion of bacterial IE and negative blood cultures, it is important to consider molecular techniques to increase sensitivity, such as PCR, to detect bacterial DNA or the 16S subunit of bacterial ribosomes, which is species-specific.…”

Section: Diagnosismentioning

confidence: 99%

“…If a limited volume of blood is available, aerobic culture media should be preferred, as anaerobic IE is very rare; Usually, the incubation time necessary to observe bacterial growth and obtain antibiotic sensitivity is 24–48 h; If there is a high clinical suspicion of bacterial IE and negative blood cultures, it is important to consider molecular techniques to increase sensitivity, such as PCR, to detect bacterial DNA or the 16S subunit of bacterial ribosomes, which is species-specific. Bacterial identification by PCR also allows an earlier result to be obtained [ 63 ]; It is of great importance to take blood cultures in the absence of antibiotic treatment, in those stable patients in whom the clinical situation allows the antibiotic to be discontinued; Consider repeating the cultures at 48–72 h in the presence of persistent or recurrent symptoms (fever, inflammatory parameters in laboratory tests, systemic inflammatory response). …”

Section: Diagnosismentioning

confidence: 99%

“…If there is a high clinical suspicion of bacterial IE and negative blood cultures, it is important to consider molecular techniques to increase sensitivity, such as PCR, to detect bacterial DNA or the 16S subunit of bacterial ribosomes, which is species-specific. Bacterial identification by PCR also allows an earlier result to be obtained [ 63 ];…”

Section: Diagnosismentioning

confidence: 99%

See 2 more Smart Citations

Pediatric Infective Endocarditis: A Literature Review

Vicent

Luna

Sellés

2022

JCM

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Infective endocarditis in children is a rare entity that poses multiple challenges. A history of congenital heart disease is the most common risk factor, although in recent years, other emerging predisposing conditions have gained relevance, such as central venous catheters carriers or children with chronic debilitating conditions; cases in previously healthy children with no medical history are also seen. Diagnosis is complex, although it has improved with the use of multimodal imaging techniques. Antibiotic treatment should be started early, according to causative microorganism and risk factors. Complications are frequent and continue to cause significant morbidity. Most studies have been conducted in adults and have been generalized to the pediatric population, with subsequent limitations. Our manuscript presents a comprehensive review of pediatric infective endocarditis, including recent advances in diagnosis and management.

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Pediatric blood cultures—turning up the volume: a before and after intervention study

Whelan,

Mulrooney,

Moriarty

et al. 2024

Eur J Pediatr

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The major determinant of blood culture (BC) diagnostic performance is blood volume, and pediatric sample volumes are frequently low. We aimed to assess BC volumes in our institution, design an intervention to increase volumes, and assess its impact. All pediatric BCs submitted over a 7-month period to the microbiology laboratory in a university hospital (including emergency department, pediatric ward, and neonatal unit) were included. A pre-intervention period assessed current practice. A multi-faceted intervention (education, guideline introduction, active feedback strategies) was collaboratively designed by all stakeholders. Impact was assessed in a post-intervention period. The main outcome measures included the percentage of samples adequately filled using three measures of sample adequacy (1) manufacturer-recommended minimum validated volume—> 0.5 ml, (2) manufacturer-recommended optimal minimum volume—> 1.0 ml, (3) newly introduced age-specific recommendations. Three hundred ninety-eight pre-intervention and 388 post-intervention samples were included. Initial volumes were low but increased significantly post-intervention (median 0.77 ml vs. 1.52 ml), with multivariable regression analysis estimating volumes increased 89% post-intervention. There were significant increases in all measures of volume adequacy, including an increase in age-appropriate filling (20.4–53.1%), with less improvement in those aged > 3 years. Overall, 68.4% of pathogens were from adequately filled cultures, while 76% of contaminants were from inadequately filled cultures. A pathogen was detected in a higher proportion of adequately filled than inadequately filled cultures (9.4% vs. 2.2%, p < 0.001). Conclusion: Blood volume impacts BC sensitivity, with lower volumes yielding fewer pathogens and more contaminants. Focused intervention can significantly improve volumes to improve diagnostic performance. What is Known:• Blood volume is the major determinant of blood culture positivity, and yet pediatric blood culture volumes are frequently low, resulting in missed pathogens and increased contamination. What is New:• Adequately filled (for age) blood cultures have a pathogen detection rate three times higher than inadequately filled blood cultures.• This interventional study shows that collaboratively designed multi-modal interventions including focus on accurate volume measurement can lead to significant increases in blood volumes and improve blood culture diagnostic performance.

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How to interpret a paediatric blood culture

Cited by 8 publications

References 32 publications

Clinical Application of a Multiplex Droplet Digital PCR in the Rapid Diagnosis of Children with Suspected Bloodstream Infections

Clinical Application of a Multiplex Droplet Digital PCR in the Rapid Diagnosis of Children with Suspected Bloodstream Infections

Pediatric Infective Endocarditis: A Literature Review

Pediatric blood cultures—turning up the volume: a before and after intervention study

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