TIME TO POSITIVITY FOR DETECTION OF BACTEREMIA IN NEONATES
TIME TO POSITIVITY FOR DETECTION OF BACTEREMIA IN NEONATES
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DOI：
10.1128/jcm.27.5.1068-1071.1989
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发表时间：
1989-05-01
影响因子：
9.4
通讯作者：
MCGOWAN, JE
中科院分区：
文献类型：
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作者：
KURLAT, I;STOLL, BJ;MCGOWAN, JE
从佐治亚州亚特兰大市格雷迪纪念医院获得的所有新生儿样本的血培养结果，美国，在6个月的时间内进行了分析，以确定血液培养成为阳性所需的时间，培养物可以安全地被认为是阴性的时间，以及分离的微生物的谱。在研究期间，所有托儿所提交了1，248个样本，并通过自动检测仪器（BACTEC NR 660）进行处理。在1，248份样本中，98份（7.8%）在7天处理期结束时呈阳性; 98份中的29份被归类为明确的细菌病原体，52份被归类为可能的细菌病原体，9份被归类为酵母菌，8份被归类为污染物。几乎所有被归类为明确病原体的微生物（29个中的28个）在处理的第2天被鉴定，并且所有微生物在第4天被鉴定。在第2天鉴定所有B群链球菌、大肠埃希菌、克雷伯菌属和金黄色葡萄球菌的分离株。在所有阳性血培养中，79%在第2天确定，88%在第3天确定，94%在第4天确定。在第2天后确定的21个分离株中，唯一确定的病原体来自重症监护室的一名患病婴儿。在870名因母体风险因素培养的足月低风险新生儿中，在第2天后仅确定了4种可能的病原体。第2天和第4天血培养的阳性和阴性预测值分别为92%和99%。我们的结论是，在我们的机构，（i）2天的处理期足以检测无症状足月婴儿的阳性血培养，（ii）4天的处理期将检测几乎所有临床重要的感染，（iii）超过4天的持续血培养处理的临床产量不证明所涉及的时间和成本是合理的。
The blood culture results of all samples obtained from newborns at Grady Memorial Hospital, Atlanta, Ga., USA, during a 6-month period were analyzed to determine the time required for a blood culture to become positive, the time at which a culture could safely be considered negative, and the spectrum of isolated organisms. During the study period, 1,248 samples were submitted from all nurseries and processed by an automated detection instrument (BACTEC NR660). Of the 1,248 samples, 98 (7.8%) were positive by the end of a 7-day processing period; 29 of the 98 were classified as definite bacterial pathogens, 52 were classified as possible bacterial pathogens, 9 were classified as yeasts, and 8 were classified as contaminants. Virtually all organisms (28 of 29) categorized as definite pathogens were identified by day 2 of processing, and all were identified by day 4. All isolates of group B streptococcus, Escherichia coli, Klebsiella species, and Staphylococcus aureus were identified by day 2. Of all positive blood cultures, 79% were identified by day 2, 88% were identified by day 3, and 94% were identified by day 4. Of the 21 isolates identified after day 2, the only definite pathogen was from a sick baby in the intensive care unit. From among the 870 term low-risk newborns cultured because of maternal risk factors, only four possible pathogens were identified after day 2. The positive and negative predictive values of blood culture at days 2 and 4 were 92 and 99%, respectively. We conclude that, in our institution, (i) a 2-day processing period is sufficient to detect positive blood cultures in the asymptomatic term infant, (ii) a 4-day processing period will detect virtually all clinically important infections, and (iii) clinical yield from continuing blood culture processing beyond 4 days does not justify the time and cost involved.