Procession to Pediatric Bacteremia and Sepsis: Covert Operations and Failures in Diplomacy

Bateman, Stacey L.; Seed, Patrick C.

doi:10.1542/peds.2009-3169

Cited by 47 publications

(26 citation statements)

References 94 publications

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“…and GBS are important pathogens during the neonatal period, although there is wide regional variability. However, during the neonatal period, Klebsiella spp., Enterobacter spp., P. aeruginosa and S. marcescens emerge as etiologies of LOS which are rare pathogens within seven days of life [3,4]. Worldwide, neonatal sepses are the cause of approximately 36% of the four million deaths of neonates every year.…”

Section: Introductionmentioning

confidence: 99%

Urinary 1H-NMR and GC-MS metabolomics predicts early and late onset neonatal sepsis

Fanos¹,

Caboni²,

Corsello³

et al. 2014

Early Human Development

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The purpose of this article is to study one of the most significant causes of neonatal morbidity and mortality: neonatal sepsis. This pathology is due to a bacterial or fungal infection acquired during the perinatal period. Neonatal sepsis has been categorized into two groups: early onset if it occurs within 3-6 days and late onset after 4-7 days. Due to the not-specific clinical signs, along with the inaccuracy of available biomarkers, the diagnosis is still a major challenge. In this regard, the use of a combined approach based on both nuclear magnetic resonance ( 1 H-NMR) and gas-chromatography-mass spectrometry (GC-MS) techniques, coupled with a multivariate statistical analysis, may help to uncover features of the disease that are still hidden. The objective of our study was to evaluate the capability of the metabolomics approach to identify a potential metabolic profile related to the neonatal septic condition. The study population included 25 neonates (15 males and 10 females): 9 (6 males and 3 females) patients had a diagnosis of sepsis and 16 were healthy controls (9 males and 7 females). This study showed a unique metabolic profile of the patients affected by sepsis compared to non-affected ones with a statistically significant difference between the two groups (p = 0.05).

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Section: Introductionmentioning

confidence: 99%

Urinary 1H-NMR and GC-MS metabolomics predicts early and late onset neonatal sepsis

Fanos¹,

Caboni²,

Corsello³

et al. 2014

Early Human Development

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“…Immunocompromised children are susceptible to a broad range of bloodstream pathogens, including all of those previously mentioned as well as Pseudomonas aeruginosa and Candida spp. (3).…”

mentioning

confidence: 99%

Diagnosis of Bloodstream Infections in Children

Bard

TeKippe

2016

J Clin Microbiol

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Identification of bloodstream infections is among the most critical tasks performed by the clinical microbiology laboratory. While the criteria for achieving an adequate blood culture specimen in adults have been well described, there is much more ambiguity in pediatric populations. This minireview focuses on the available pediatric literature pertaining to the collection of an optimal blood culture specimen, including timing, volume, and bottle selection, as well as rapid diagnostic approaches and their role in the management of pediatric bloodstream infections. Blood cultures remain the mainstay of laboratory diagnosis of bloodstream infections (BSIs) in infants and children. Recovery of a pathogen is advantageous, as it confirms the diagnosis of bacteremia and allows for identification and susceptibility testing on the organism to optimize antimicrobial therapy and duration. A negative blood culture is just as important, as it rules out cases of bacteremia and prompts continued investigation of other infectious or noninfectious etiologies or cessation of unnecessary empirical antimicrobial therapy.The spectrum of pathogens causing pediatric BSI varies widely by age, presenting symptoms, and immune status. In 1979, an evaluation of pediatric blood culture found Haemophilus influenzae to be the most prevalent organism followed by Streptococcus pneumoniae and Staphylococcus aureus (1). Today, H. influenzae and S. pneumoniae are rare bloodstream pathogens due to widespread vaccination. A 2012 study of infants of Ͻ3 months of age found the leading causes of bacteremia to be Escherichia coli, group B Streptococcus (Streptococcus agalactiae), and S. aureus (2). The rate of BSI in otherwise healthy children drops precipitously after the first few months of life, but if occurring, the most common pathogens are S. aureus, S. pneumoniae due to communityacquired pneumonia, and Neisseria meningitidis in adolescents. Immunocompromised children are susceptible to a broad range of bloodstream pathogens, including all of those previously mentioned as well as Pseudomonas aeruginosa and Candida spp. (3).The majority of studies related to the laboratory diagnosis of BSI focus on the adult population. Thus, this minireview will be devoted to children and the multifactorial aspects involved in obtaining an optimal pediatric blood culture specimen, including timing, volume, and bottle selection. Lastly, a discussion on the rapid diagnostic approaches currently available and their impact on pediatric management and outcomes will be reviewed. BLOOD CULTURE COLLECTIONFactors that may influence the recovery of pathogens from the blood include the timing of blood collection, number of sets collected, and blood volume. It is well accepted that the volume of blood collected is the single most important factor. Evidence from both adult and pediatric studies show that the probability of recovering a pathogen from blood culture increases with the volume of blood obtained. In addition, the time to detection inversely correlates with the volum...

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“…3,[15][16][17] Delay in diagnosing these conditions by discouraging parents from self-referring their child to the ED may result in significant morbidity and mortality. [18][19][20] This study aimed to assess the severity of illness of febrile children who were self-referred to the ED by their parents compared with those referred by the general practitioner (GP). We hypothesized that parents are capable of assessing their child' s severity of illness and adequately decide to present their child to the ED.…”

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confidence: 99%

Self-Referral and Serious Illness in Children With Fever

et al. 2012

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WHAT'S KNOWN ON THIS SUBJECT: General measures discourage all self-referrals to the emergency department. For adults, selfreferral to the emergency department has been associated with nonsevere disease, whereas severity of illness of self-referred children is still unknown. WHAT THIS STUDY ADDS:One in four parents properly judged and acted on their febrile child' s illness by presentation to the emergency department on their own initiative. Measures to discourage parents from self-referral may potentially result in delayed or missed diagnoses. abstract OBJECTIVE: The goal of this study was to evaluate parents' capability to assess their febrile child' s severity of illness and decision to present to the emergency department. We compared children referred by a general practitioner (GP) with those self-referred on the basis of illness-severity markers.METHODS: This was a cross-sectional observational study conducted at the emergency departments of a university and a teaching hospital. GP-referred or self-referred children with fever (aged ,16 years) who presented to the emergency department (2006)(2007)(2008) were included. Markers for severity of illness were urgency according to the Manchester Triage System, diagnostic interventions, therapeutic interventions, and follow-up. Associations between markers and referral type were assessed by using logistic regression analysis. Subgroup analyses were performed for patients with the most common presenting problems that accompanied the fever (ie, dyspnea, gastrointestinal complaints, neurologic symptoms, fever without specific symptoms).RESULTS: Thirty-eightpercentof4609childrenwerereferredbytheirGPand 62% wereself-referred.GP-referredchildrenwere classifiedas highurgency (immediate/very urgent categories) in 46% of the cases and self-referrals in 45%. Forty-three percent of GP referrals versus 27% of self-referrals needed extensive diagnostic intervention, intravenous medication/aerosol treatment, hospitalization, or a combination of these (odds ratio: 2.0 [95% confidence interval: 1.75-2.27]). In all subgroups, high urgency was not associated with referral type. GP-referred and self-referred children with dyspnea had similar frequencies of illness-severity markers.CONCLUSIONS: Although febrile self-referred children were less severely ill than GP-referred children, many parents properly judged and acted on the severity of their child' s illness. To avoid delayed or missed diagnoses, recommendations regarding interventions that would discourage selfreferral to the emergency department should be reconsidered.

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Procession to Pediatric Bacteremia and Sepsis: Covert Operations and Failures in Diplomacy

Cited by 47 publications

References 94 publications

Urinary 1H-NMR and GC-MS metabolomics predicts early and late onset neonatal sepsis

Urinary 1H-NMR and GC-MS metabolomics predicts early and late onset neonatal sepsis

Diagnosis of Bloodstream Infections in Children

Self-Referral and Serious Illness in Children With Fever

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