Time-to-Positivity of Blood Cultures in Children With Sepsis

doi:10.3389/fped.2018.00222

. 2018 Aug 8:6:222.

doi: 10.3389/fped.2018.00222. eCollection 2018.

Time-to-Positivity of Blood Cultures in Children With Sepsis

Alexa Dierig¹, Christoph Berger², Philipp K A Agyeman³, Sara Bernhard-Stirnemann⁴, Eric Giannoni^{5

6}, Martin Stocker⁷, Klara M Posfay-Barbe⁸, Anita Niederer-Loher⁹, Christian R Kahlert⁹, Alex Donas⁷, Paul Hasters¹⁰, Christa Relly², Thomas Riedel¹¹, Christoph Aebi³, Luregn J Schlapbach^{3

12

13

14}, Ulrich Heininger¹; Swiss Pediatric Sepsis Study

Affiliations

¹ Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland.
² Division of Infectious Diseases and Hospital Epidemiology, Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.
³ Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
⁴ Cantonal Hospital Aarau, Children's Hospital, Aarau, Switzerland.
⁵ Department Mother-Woman-Child, Service of Neonatology, Lausanne University Hospital, Lausanne, Switzerland.
⁶ Infectious Diseases Service, Lausanne University Hospital, Lausanne, Switzerland.
⁷ Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland.
⁸ Pediatric Infectious Diseases Unit, Children's Hospital of Geneva, University Hospitals of Geneva, Geneva, Switzerland.
⁹ Children's Hospital of Eastern Switzerland St. Gallen, St. Gallen, Switzerland.
¹⁰ Department of Neonatology, University Hospital Zurich, Zurich, Switzerland.
¹¹ Department of Pediatrics, Cantonal Hospital Graubuenden, Chur, Switzerland.
¹² Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
¹³ Paediatric Critical Care Research Group, Mater Research Institute, University of Queensland, Brisbane, QLD, Australia.
¹⁴ Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Children's Health Queensland, Brisbane, QLD, Australia.

PMID: 30135859
PMCID: PMC6092514
DOI: 10.3389/fped.2018.00222

Free PMC article

Time-to-Positivity of Blood Cultures in Children With Sepsis

Alexa Dierig et al. Front Pediatr. 2018.

Free PMC article

. 2018 Aug 8:6:222.

doi: 10.3389/fped.2018.00222. eCollection 2018.

Authors

Affiliations

¹ Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland.
² Division of Infectious Diseases and Hospital Epidemiology, Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.
³ Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
⁴ Cantonal Hospital Aarau, Children's Hospital, Aarau, Switzerland.
⁵ Department Mother-Woman-Child, Service of Neonatology, Lausanne University Hospital, Lausanne, Switzerland.
⁶ Infectious Diseases Service, Lausanne University Hospital, Lausanne, Switzerland.
⁷ Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland.
⁸ Pediatric Infectious Diseases Unit, Children's Hospital of Geneva, University Hospitals of Geneva, Geneva, Switzerland.
⁹ Children's Hospital of Eastern Switzerland St. Gallen, St. Gallen, Switzerland.
¹⁰ Department of Neonatology, University Hospital Zurich, Zurich, Switzerland.
¹¹ Department of Pediatrics, Cantonal Hospital Graubuenden, Chur, Switzerland.
¹² Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
¹³ Paediatric Critical Care Research Group, Mater Research Institute, University of Queensland, Brisbane, QLD, Australia.
¹⁴ Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Children's Health Queensland, Brisbane, QLD, Australia.

PMID: 30135859
PMCID: PMC6092514
DOI: 10.3389/fped.2018.00222

Abstract

Background: Blood cultures are essential for the diagnosis and further appropriate treatment in children with suspected sepsis. In most hospitals, children will be empirically treated or closely monitored for at least 48 h awaiting results of blood cultures. Several studies have challenged the optimal duration of empiric treatment in the era of continuously monitored blood culture systems. The aim of our study was to investigate time-to-positivity (TTP) of blood cultures in children with proven sepsis. Methods: The Swiss Pediatric Sepsis Study prospectively enrolled children 0-16 years of age with blood culture positive sepsis between September 2011 and October 2015. TTP was prospectively assessed in six participating academic pediatric hospitals by fully automated blood culture systems. Results: In 521 (93%) of 562 bacteremia episodes (493 children, median age 103 days, range 0 days-16.9 years) a valid TTP was available. Median TTP was 12 h (IQR 8-17 h, range 0-109 h). By 24, 36, and 48 h, 460 (88%), 498 (96%), and 510 (98%) blood cultures, respectively, were positive. TTP was independent of age, sex, presence of comorbidities, site of infection and severity of infection. Median TTP in all age groups combined was shortest for group B streptococcus (8.7 h) and longest for coagulase-negative staphylococci (16.2 h). Conclusion: Growth of bacteria in blood cultures is detectable within 24 h in 9 of 10 children with blood culture-proven sepsis. Therefore, a strict rule to observe or treat all children with suspected sepsis for at least 48 h is not justified.

Keywords: bacteremia; blood cultures; children; sepsis; time-to-positivity.

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Figures

**Figure 1**
**(A)** TTP of all organisms, Kaplan-Meier-Curve. **(B)** cutout of **(A)**.

**Figure 2**
Blood culture TTP in selected bacterial pathogens by age group. ^aGroup A streptococcus, viridans group streptococci, other gram positive bacteria. ^bKlebsiella species, *Neisseria meningitides, Pseudomonas aeruginosa*, other gram negative bacteria.

See this image and copyright information in PMC

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References

1. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. . Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. (2013) 39:165–228. 10.1007/s00134-012-2769-8 - DOI - PMC - PubMed
1. Davis AL, Carcillo JA, Aneja RK, Deymann AJ, Lin JC, Nguyen TC, et al. . American College of Critical Care Medicine clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock. Crit Care Med. (2017) 45:1061–93. 10.1097/CCM.0000000000002425 - DOI - PubMed
1. World Health Organization Antimicrobial Resistance, Fact Sheet. (2016). Available online at: http://www.who.int/mediacentre/factsheets/fs194/en/ (Accessed October 13, 2017).
1. Cohen-Wolkowiez M, Moran C, Benjamin DK, Cotten CM, Clark RH, Benjamin DK, et al. . Early and late onset sepsis in late preterm infants. Pediatr Infect Dis J. (2009) 28:1052–6. 10.1097/INF.0b013e3181acf6bd - DOI - PMC - PubMed
1. Escobar GJ, Puopolo KM, Wi S, Wi S, Turk BJ, Kuzniewicz MW, et al. . Stratification of risk of early-onset sepsis in newborns ≥34 weeks' gestation. Pediatrics (2014) 133:30–6. 10.1542/peds.2013-1689 - DOI - PMC - PubMed

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[1] Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. . Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. (2013) 39:165–228. 10.1007/s00134-012-2769-8 - DOI - PMC - PubMed

[2] Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. . Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. (2013) 39:165–228. 10.1007/s00134-012-2769-8 - DOI - PMC - PubMed

[3] Davis AL, Carcillo JA, Aneja RK, Deymann AJ, Lin JC, Nguyen TC, et al. . American College of Critical Care Medicine clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock. Crit Care Med. (2017) 45:1061–93. 10.1097/CCM.0000000000002425 - DOI - PubMed

[4] Davis AL, Carcillo JA, Aneja RK, Deymann AJ, Lin JC, Nguyen TC, et al. . American College of Critical Care Medicine clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock. Crit Care Med. (2017) 45:1061–93. 10.1097/CCM.0000000000002425 - DOI - PubMed

[5] World Health Organization Antimicrobial Resistance, Fact Sheet. (2016). Available online at: http://www.who.int/mediacentre/factsheets/fs194/en/ (Accessed October 13, 2017).

[6] World Health Organization Antimicrobial Resistance, Fact Sheet. (2016). Available online at: http://www.who.int/mediacentre/factsheets/fs194/en/ (Accessed October 13, 2017).

[7] Cohen-Wolkowiez M, Moran C, Benjamin DK, Cotten CM, Clark RH, Benjamin DK, et al. . Early and late onset sepsis in late preterm infants. Pediatr Infect Dis J. (2009) 28:1052–6. 10.1097/INF.0b013e3181acf6bd - DOI - PMC - PubMed

[8] Cohen-Wolkowiez M, Moran C, Benjamin DK, Cotten CM, Clark RH, Benjamin DK, et al. . Early and late onset sepsis in late preterm infants. Pediatr Infect Dis J. (2009) 28:1052–6. 10.1097/INF.0b013e3181acf6bd - DOI - PMC - PubMed

[9] Escobar GJ, Puopolo KM, Wi S, Wi S, Turk BJ, Kuzniewicz MW, et al. . Stratification of risk of early-onset sepsis in newborns ≥34 weeks' gestation. Pediatrics (2014) 133:30–6. 10.1542/peds.2013-1689 - DOI - PMC - PubMed

[10] Escobar GJ, Puopolo KM, Wi S, Wi S, Turk BJ, Kuzniewicz MW, et al. . Stratification of risk of early-onset sepsis in newborns ≥34 weeks' gestation. Pediatrics (2014) 133:30–6. 10.1542/peds.2013-1689 - DOI - PMC - PubMed

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Time-to-Positivity of Blood Cultures in Children With Sepsis

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Time-to-Positivity of Blood Cultures in Children With Sepsis

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