Value of routine anaerobic blood cultures for pediatric patients

Zaidi, Anita K. M.; Knaut, Andrew L.; Mirrett, Stanley; Reller, L. Barth

doi:10.1016/s0022-3476(95)70305-5

Cited by 67 publications

(38 citation statements)

References 25 publications

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“…We might have missed many anaerobes in the present study. Zaidi et al, reported that anaerobic blood cultures are rarely helpful in the majority of paediatric patients and that they usually show positive results only in the clinical settings which are associated with anaerobic infections [15].…”

Section: Discussionmentioning

confidence: 99%

Staphylococcus Aureus- The Predominant Pathogen in the Neonatal ICU of a Tertiary Care Hospital in Amritsar, India

Sharma¹

2013

JCDR

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Background: An early treatment and the appropriate and the rational use of antibiotics would minimize the risk of severe morbidity and mortality in neonatal sepsis, and reduce the emergence of multi-drug resistant organisms in intensive care units. For the success of an early empiric treatment, a periodic review of the cases to assess any changing trends in the infecting organisms and their antimicrobial susceptibility is important. AIM:To study the most commonly encountered bacterial pathogens which caused neonatal sepsis and their sensitivity patterns, so that guidelines could be prepared for a rational antibiotic therapy. Setting and Design:This was a retrospective study which was conducted in the Department of Microbiology and the Neonatal Intensive Care Unit (NICU) at SGRDIMSAR, Amritsar, during June 2011 to June 2012. Methods and Materials:Blood specimens for culture were drawn from 311 newborns who were admitted in an NICU with sepsis. The specimens were inoculated into brain heart infusion broth. Subcultures were performed on days 1, 2, 3, 5, 7 and 10. The isolates were identified by doing standard biochemical tests. The antibiotic resistance patterns of the isolates were studied by the Kirby Bauer disc diffusion technique.Results: A total of 131 organisms were isolated from the 311 blood cultures. These included Staphylococcus aureus (n=68), Coagulase Negative Staphylococcus (CoNS) (n=30), Klebsiella pneumoniae (n=10), Acinetobacter baumannii (n=9), Escherichia coli (n=05), Enterobacter cloacae (n=04), Citrobacter diversus (n=02), Pseudomonas aeruginosa (n=02) and Candida (n=01). Staphylococcus aureus was the main pathogen in both early and late-onset sepsis. On antibiotic sensitivity testing, 57.35% of the Staphylococcus aureus isolates were found to be methicillin resistant. More than 90% gram negative rods were resistant to amikacin. The resistance to the third generation cephalosporins varied between 50-55%. The resistance to ciprofloxacin was quite high; however, most of the isolates were susceptible to levofloxacin. A majority of the isolates were susceptible to piperacillin-tazobactum and imipenem. Conclusion:The present study emphasized the importance of periodic surveys on the microbial flora which was encountered in particular neonatal settings to recognize the trend.

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Section: Discussionmentioning

confidence: 99%

Staphylococcus Aureus- The Predominant Pathogen in the Neonatal ICU of a Tertiary Care Hospital in Amritsar, India

Sharma¹

2013

JCDR

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“…Anaerobic sepsis in the neonatal population is exceedingly rare, with many centers preferring to use all the blood for aerobic cultures unless specific clinical indications exist. [17][18][19][20] Although there are no neonatal or pediatric data on timing of blood cultures, it is generally recommended that the optimal time to culture for bacteremia is 'as early as possible' in the course of a sepsis episode. 20 The interval between repeat blood cultures does not appear to be important 20,21 and the studies in adults demonstrate that high-volume blood cultures drawn serially or simultaneously return the best yields.…”

Section: Discussionmentioning

confidence: 99%

A study of the role of multiple site blood cultures in the evaluation of neonatal sepsis

et al. 2005

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Background: The optimal number of blood cultures needed to document sepsis in an ill neonate has undergone little critical evaluation. Multiple site cultures may improve pathogen detection if intermittent bacteremia occurs, or if a low density of bacteria is present in the blood. We hypothesized, however, that bacterial clearance is slower and bacteremia more continuous in septic neonates, so that a single site blood culture should be sufficient to accurately document true septicemia.Objective: To determine the need for multiple site blood cultures in the evaluation of neonates for sepsis.Design/Methods: Clinical data were prospectively collected for 216 neonates who had 269 pairs of blood cultures taken from two different peripheral sites for the evaluation of possible sepsis. A minimum of 1 ml of blood was obtained from the two peripheral sites within 15-30 min of each other. Based on prior retrospective data, we determined that 203 infants would need to have two site blood cultures to demonstrate a significant improvement in pathogen detection at an alpha of 0.05 and a beta of 0.20 (80%) power.Results: A total of 186 culture pairs were taken for evaluation of earlyonset sepsis in 186 neonates, while 83 pairs were drawn for evaluation of late-onset sepsis in 43 neonates. In all, 21 neonates from the late-onset group were evaluated more than once, and 12 neonates were evaluated for both early-and late-onset sepsis. In all, 20 (9.2%) of 216 neonates had 22 episodes of culture-proven sepsis at a median age of 18 days. All neonates with positive cultures had the same organism with a similar sensitivity pattern obtained from the two different peripheral sites. The other 196 study neonates had negative blood cultures from both sites. The single episode of early-onset sepsis was caused by Listeria monocytogenes, while all remaining episodes were late-onset with the following organisms: Staphylococcus epidermidis (7), methicillin-resistant Staphylococcus aureus (MRSA) (3), combined MRSA and Candida albicans (2), Candida albicans alone (2), late-onset Group B b-hemolytic Streptococcus (GBS) (2), Klebsiella pneumoniae (2), Enterococcus fecalis (1), Escherichia coli (1), and Serratia marcescens (1). Since no infant grew organisms from only one of the two sites, the data indicate that the diagnosis of sepsis would have been made correctly in all infants with a single site culture. Conclusions:Two site blood cultures for the initial evaluation of neonatal sepsis do not have a better yield in pathogen detection. Sepsis in neonates can be detected with no loss of accuracy with a single site blood culture with blood volume of X1 ml.

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“…Recent studies have demonstrated that the level of anaerobic bacteremia in children is much lower than that in adults. A study of nearly 10,000 paired aerobic and anaerobic blood culture bottles submitted for culture revealed that 7.7% were positive for clinically significant microorganisms, but of this group, only 15 blood cultures (0.16%) were positive for obligate anaerobes (36). Chart review determined that the 15 cultures yielding anaerobes belonged to 5 unique patients who were all determined to be at increased risk for anaerobic bloodstream infections.…”

Section: Blood Culture Bottlesmentioning

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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Value of routine anaerobic blood cultures for pediatric patients

Cited by 67 publications

References 25 publications

Staphylococcus Aureus- The Predominant Pathogen in the Neonatal ICU of a Tertiary Care Hospital in Amritsar, India

Staphylococcus Aureus- The Predominant Pathogen in the Neonatal ICU of a Tertiary Care Hospital in Amritsar, India

A study of the role of multiple site blood cultures in the evaluation of neonatal sepsis

Diagnosis of Bloodstream Infections in Children

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