Positive blood cultures in sickle cell disease: Time to positivity and clinical outcome
Positive blood cultures in sickle cell disease: Time to positivity and clinical outcome
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DOI：
10.1097/00043426-200305000-00008
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发表时间：
2003-05-01
影响因子：
1.2
通讯作者：
McGowan, KL
中科院分区：
文献类型：
--
作者：
Norris, CF;Smith-Whitley, K;McGowan, KL
目的：为了前瞻性地确定所有的病例菌血症儿童镰状细胞病（SCD），建立时间阳性的各种微生物，相关的临床表现与微生物学数据，并确定抗生素耐药模式的肺炎球菌isolations.Methods：所有阳性的血液培养从儿童SCD随后在费城儿童医院从1993年1月至2001年5月被列入。分离株被归类为病原体或污染物。从病历中提取人口统计学和临床信息。在微生物laboratory.Results：一百四十一个阳性血培养瓶，在不同的发热事件中产生的阳性和抗生素耐药性的数据。39%含有病原体，61%含有污染物。病原体组平均阳性时间为17.1小时，污染物组平均阳性时间为29.5小时（P < 0.0001）。肺炎链球菌是最常见的病原体（占总数的42%），平均患者年龄为3.5岁。革兰氏阴性杆菌是第二常见的微生物（占总数的28%），平均患者年龄为8.1岁。31%的肺炎球菌分离株对青霉素耐药。35%的肺炎球菌分离株来自有感染病灶的儿童。血培养阳性的患者中有26%出现急性胸部综合征。肺炎。67%的沙门氏菌菌株和50%的金黄色葡萄球菌菌株生长的患者谁开发的骨髓炎。结论：平均时间阳性病原体可以与其他因素结合使用，以确定所需的观察时间长度SCD的儿童谁目前与发热性疾病。患有SCD的儿童如果有S.肺炎。患有SCD且患有沙门氏菌或沙门氏菌菌血症的儿童应进行骨扫描。金黄色。
Purpose: To prospectively identify all cases of bacteremia in children with sickle cell disease (SCD), establish time to positivity for various microorganisms, correlate clinical findings with microbiology data, and determine the antibiotic resistance pattern of the pneumococcal isolates.Methods: All positive blood cultures from children with SCD followed at the Children's Hospital of Philadelphia from January 1993 through May 2001 were included. Isolates were classified as pathogen or contaminant. Demographic and clinical information was abstracted from the medical records. Time to positivity and antibiotic resistance data were generated in the microbiology laboratory.Results: One hundred forty-one positive blood culture bottles were obtained during distinct febrile episodes. Thirty-nine percent contained pathogens and 61% contained contaminants. The average time to positivity was 17.1 hours in the pathogen group and 29.5 hours in the contaminant group (P < 0.0001). Streptococcus pneumoniae was the most common pathogen (42% of total), with a mean patient age of 3.5 years. Gram-negative rods were the second most common organism (28% of total), with a mean patient age of 8.1 years. Thirty-one percent of the pneumococcal isolates were resistant to penicillin. Thirty-five percent of the pneumococcal isolates grew from children with a focus of infection. Acute chest syndrome was noted in 26% of patients with a positive blood culture for S. pneumoniae. Sixty-seven percent of Salmonella isolates and 50% of Staphylococcus aureus isolates grew from patients who developed osteomyelitis.Conclusions: The average time to positivity for pathogens can be used in conjunction with other factors to determine the length of observation required for children with SCD who present with febrile illness. Chest radiographs should be obtained on children with SCD who are bacteremic with S. pneumoniae. Bone scans should be obtained on children with SCD who are bacteremic with Salmonella or S. aureus.