Time to Positive Blood Cultures Among Critically Ill Children Admitted to the PICU.

Autor:	Yasechko SM; Division of Pharmacy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH., Hillyer MM; Department of Pediatrics, Division of Critical Care Medicine, Emory University School of Medicine, Atlanta, GA., Smith AGC; Department of Internal Medicine, Duke University School of Medicine, Durham, NC., Rodenbough AL; Department of Pediatrics, Division of Critical Care Medicine, Emory University School of Medicine, Atlanta, GA., Fernandez AJ; Department of Pharmacy, Children's Healthcare of Atlanta, Atlanta, GA., Gonzalez MD; Division of Pathology, Children's Healthcare of Atlanta, Atlanta, GA., Jaggi P; Department of Pediatrics, Division of Infectious Disease, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA.
Jazyk:	angličtina
Zdroj:	Critical care explorations [Crit Care Explor] 2024 Jul 05; Vol. 6 (7), pp. e1115. Date of Electronic Publication: 2024 Jul 05 (Print Publication: 2024).
DOI:	10.1097/CCE.0000000000001115
Abstrakt:	Objectives: Our study aimed to assess the time to positivity (TTP) of clinically significant blood cultures in critically ill children admitted to the PICU. Design: Retrospective review of positive blood cultures in patients admitted or transferred to the PICU. Setting: Large tertiary-care medical center with over 90 PICU beds. Patients: Patients 0-20 years old with bacteremia admitted or transferred to the PICU. Interventions: None. Measurements and Main Results: The primary endpoint was the TTP, defined as time from blood culture draw to initial Gram stain result. Secondary endpoints included percentage of cultures reported by elapsed time, as well as the impact of pathogen and host immune status on TTP. Host immune status was classified as previously healthy, standard risk, or immunocompromised. Linear regression for TTP was performed to account for age, blood volume, and Gram stain. Among 164 episodes of clinically significant bacteremia, the median TTP was 13.3 hours (interquartile range, 10.7-16.8 hr). Enterobacterales, Staphylococcus aureus, Streptococcus agalactiae, and Streptococcus pneumoniae were most commonly identified. By 12, 24, 36, and 48 hours, 37%, 89%, 95%, and 97% of positive cultures had resulted positive, respectively. Median TTP stratified by host immune status was 13.2 hours for previously healthy patients, 14.0 hours for those considered standard risk, and 10.6 hours for immunocompromised patients (p = 0.001). Median TTP was found to be independent of blood volume. No difference was seen in TTP for Gram-negative vs. Gram-positive organisms (12.2 vs. 13.9 hr; p = 0.2). Conclusions: Among critically ill children, 95% of clinically significant blood cultures had an initial positive result within 36 hours, regardless of host immune status. Need for antimicrobial therapy should be frequently reassessed and implementation of a shorter duration of empiric antibiotics should be considered in patients with low suspicion for infection. Competing Interests: The authors have disclosed that they do not have any potential conflicts of interest. (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu