Time to Positive Blood and Cerebrospinal Fluid Cultures in Febrile Infants ≤60 Days of Age.
Time to Positive Blood and Cerebrospinal Fluid Cultures in Febrile Infants ≤60 Days of Age.
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DOI：
10.1542/hpeds.2020-0045
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发表时间：
2020-09-01
影响因子：
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通讯作者：
Mahajan, Prashant
中科院分区：
文献类型：
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作者：
Alpern, Elizabeth R;Kuppermann, Nathan;Mahajan, Prashant
目的：确定≤60天发热婴儿队列血液和脑脊液（CSF）培养细菌病原体和污染物阳性的时间。方法：这是一项前瞻性观察性多中心研究的二次分析，研究对象为≤60天体温≥38°C的非危重婴儿和血培养（2008年12月至2013年5月）。主要结果是细菌病原体和污染物阳性的时间。结果：303例血培养阳性患者中有256例（84.49%），88例脑脊液培养阳性患者中有73例（82.95%）符合入选标准。细菌病原体（n = 74）和污染物（n = 182）血培养阳性的中位时间（四分位距[IQR]）分别为16.6小时（IQR 12.6-21.9）和25.1小时（IQR 19.8-33.0）; P <0.001。0至28日龄婴儿（15.8小时[IQR 12.6-21.0]）和29至60日龄婴儿（17.2 [IQR 12.9-24.3]; P = 0.328）的细菌病原体阳性时间相似。脑脊液细菌性病原体（n = 22）阳性的中位时间为14.0小时（IQR 1.5-21.0），污染物（n = 51）为40.5小时（IQR 21.2-62.6）; P <0.001。总共有82.4%（95%置信区间，71.8-90.3）和81.8%（95%置信区间，59.7%-94.8%）的血液和脑脊液培养显示细菌病原体阳性24 hours.CONCLUSIONS：在发热婴儿≤60天的年龄，血液和脑脊液阳性的时间显着较短的细菌病原体比污染物。大多数血液和脑脊液细菌病原体培养在24小时内呈阳性。根据我们的研究结果，有可能减少住院时间并避免不必要的抗生素。
OBJECTIVES: To determine the time to positivity for bacterial pathogens and contaminants in blood and cerebrospinal fluid (CSF) cultures in a cohort of febrile infants ≤60 days of age.METHODS: This was a secondary analysis of prospective observational multicenter study of noncritically ill infants ≤60 days of age with temperatures ≥38°C and blood cultures (December 2008 to May 2013). The main outcome was time to positivity for bacterial pathogens and contaminants.RESULTS: A total of 256 of 303 (84.49%) patients with positive blood cultures, and 73 of 88 (82.95%) with positive CSF cultures met inclusion criteria. Median time (interquartile range [IQR]) to positivity for blood cultures was 16.6 hours (IQR 12.6-21.9) for bacterial pathogens (n = 74) and 25.1 hours (IQR 19.8-33.0) for contaminants (n = 182); P < .001. Time to bacterial pathogen positivity was similar in infants 0 to 28 days of age (15.8 hours [IQR 12.6-21.0]) and 29 to 60 days of age (17.2 [IQR 12.9-24.3]; P = .328). Median time to positivity for CSF was 14.0 hours (IQR 1.5-21.0) for bacterial pathogens (n = 22) and 40.5 hours (IQR 21.2-62.6) for contaminants (n = 51); P < .001. A total of 82.4% (95% confidence interval, 71.8-90.3) and 81.8% (95% confidence interval, 59.7%-94.8%) of blood and CSF cultures showed bacterial pathogen positivity within 24 hours.CONCLUSIONS: Among febrile infants ≤60 days of age, time to blood and CSF positivity was significantly shorter for bacterial pathogens than contaminants. Most blood and CSF cultures for bacterial pathogens were positive within 24 hours. With our findings, there is potential to reduce duration of hospitalization and avoid unnecessary antibiotics.