Time to detection of positive cultures in 28-to 90-day-old febrile infants
Time to detection of positive cultures in 28-to 90-day-old febrile infants
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DOI：
10.1542/peds.106.6.e74
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发表时间：
2000-12-01
期刊：
影响因子：
8
通讯作者：
Mandl, KD
中科院分区：
文献类型：
--
作者：
Kaplan, RL;Harper, MB;Mandl, KD
目标。目的：确定28 ~ 90日龄发热婴儿血液、尿液和脑脊液培养阳性的检测时间。研究设计。回顾性队列：连续28至90天的婴儿在城市儿科急诊科以大于或等于38摄氏度的体温就诊。记录阳性培养和检测时间。根据临床和实验室标准，将患者归类为严重细菌性疾病（SBI）高危人群。在研究期间急诊就诊的3166例发热婴儿中，2733例有血液（86%），2517例有尿液（80%），2361例有脑脊液（75%）标本进行培养，2190例全部进行了3种培养（69%）。214例患者中阳性培养224例；其中，191例（89%）全部发送了3种培养物。随后的分析仅限于那些送出了所有三种培养物的人。SBI检出率为8.7%（191/ 2190）。血培养阳性28例（1.3%），尿培养阳性165例（7.5%），脑脊液培养阳性8例（0.4%）。检测阳性培养的中位时间为血液16小时，尿液16小时，脑脊液18小时。四种血培养。1%)， 20例尿培养(。9%)，并且在获得标本24小时后发现脑脊液培养物有病原菌>生长。所有4例血培养和20例24小时后发现生长的尿培养中有17例发生在高危患者中。在所有28至90天的发热婴儿中，24小时后发现SBI的风险为1.1%。在低风险婴儿中占3%。
Objective. To determine the time to detection of positive blood, urine, and cerebrospinal fluid (CSF) cultures among febrile 28- to 90-day-old infants. Study Design. Retrospective cohort of consecutive 28- to 90-day-old infants presenting with a temperature of greater than or equal to 38 degrees C to an urban pediatric emergency department. Positive cultures and times to detection were noted. Patients were categorized as being at high risk for serious bacterial illness (SBI) based on clinical and laboratory criteria.Results. Of the 3166 febrile infants seen in the emergency department during the study, 2733 had blood (86%), 2517 had urine (80%), and 2361 had CSF (75%) specimens obtained for culture, and 2190 had all 3 cultures (69%) sent. There were 224 positive cultures in 214 patients; of these, 191 had all 3 cultures (89%) sent. Subsequent analyses were confined to those who had all 3 cultures sent. The detected rate of SBI was 8.7% (191/ 2190). There were 28 positive blood cultures (1.3%), 165 positive urine cultures (7.5%), and 8 positive CSF cultures (.4%). Median time to detection of positive cultures was 16 hours for blood, 16 hours for urine, and 18 hours for CSF. Four blood cultures (.1%), 20 urine cultures (.9%), and 0 CSF cultures were noted to have growth of a pathogen >24 hours after the specimen was obtained. All 4 blood cultures and 17 of 20 urine cultures with growth noted after 24 hours occurred among high-risk patients.Conclusions. The risk of identifying SBI after 24 hours is 1.1% among all 28- to 90-day-old febrile infants and .3% in low-risk infants.