Paul L Aronson1, Marie E Wang2, Lise E Nigrovic3, Samir S Shah4,5, Sanyukta Desai4, Christopher M Pruitt6, Fran Balamuth7, Laura Sartori8, Richard D Marble9, Sahar N Rooholamini10, Rianna C Leazer11, Christopher Woll12, Adrienne G DePorre13, Mark I Neuman3. 1. Section of Pediatric Emergency Medicine, Departments of Pediatrics and Emergency Medicine, Yale School of Medicine, New Haven, Connecticut; paul.aronson@yale.edu. 2. Division of Pediatric Hospital Medicine, Department of Pediatrics, Lucile Packard Children's Hospital Stanford and Stanford University School of Medicine, Palo Alto, California. 3. Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts. 4. Divisions of Hospital Medicine and. 5. Infectious Diseases, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, Ohio. 6. Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama. 7. Division of Emergency Medicine and Center for Pediatric Clinical Effectiveness, Department of Pediatrics, The Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. 8. Division of Pediatric Emergency Medicine, Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt and Vanderbilt University School of Medicine, Nashville, Tennessee. 9. Division of Emergency Medicine, Ann and Robert H Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois. 10. Division of Hospital Medicine, Department of Pediatrics, Seattle Children's Hospital and University of Washington School of Medicine, Seattle, Washington. 11. Division of Hospital Medicine, Department of Pediatrics, Children's Hospital of The King's Daughters, Norfolk, Virginia; and. 12. Section of Pediatric Emergency Medicine, Departments of Pediatrics and Emergency Medicine, Yale School of Medicine, New Haven, Connecticut. 13. Division of Hospital Medicine, Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri.
Abstract
OBJECTIVES: We sought to determine the time to pathogen detection in blood and cerebrospinal fluid (CSF) for infants ≤60 days old with bacteremia and/or bacterial meningitis and to explore whether time to pathogen detection differed for non-ill-appearing and ill-appearing infants. METHODS: We included infants ≤60 days old with bacteremia and/or bacterial meningitis evaluated in the emergency departments of 10 children's hospitals between July 1, 2011, and June 30, 2016. The microbiology laboratories at each site were queried to identify infants in whom a bacterial pathogen was isolated from blood and/or CSF. Medical records were then reviewed to confirm the presence of a pathogen and to extract demographic characteristics, clinical appearance, and the time to pathogen detection. RESULTS: Among 360 infants with bacteremia, 316 (87.8%) pathogens were detected within 24 hours and 343 (95.3%) within 36 hours. A lower proportion of non-ill-appearing infants with bacteremia had a pathogen detected on blood culture within 24 hours compared with ill-appearing infants (85.0% vs 92.9%, respectively; P = .03). Among 62 infants with bacterial meningitis, 55 (88.7%) pathogens were detected within 24 hours and 59 (95.2%) were detected within 36 hours, with no difference based on ill appearance. CONCLUSIONS: Among infants ≤60 days old with bacteremia and/or bacterial meningitis, pathogens were commonly identified from blood or CSF within 24 and 36 hours. However, clinicians must weigh the potential for missed bacteremia in non-ill-appearing infants discharged within 24 hours against the overall low prevalence of infection.
OBJECTIVES: We sought to determine the time to pathogen detection in blood and cerebrospinal fluid (CSF) for infants ≤60 days old with bacteremia and/or bacterial meningitis and to explore whether time to pathogen detection differed for non-ill-appearing and ill-appearing infants. METHODS: We included infants ≤60 days old with bacteremia and/or bacterial meningitis evaluated in the emergency departments of 10 children's hospitals between July 1, 2011, and June 30, 2016. The microbiology laboratories at each site were queried to identify infants in whom a bacterial pathogen was isolated from blood and/or CSF. Medical records were then reviewed to confirm the presence of a pathogen and to extract demographic characteristics, clinical appearance, and the time to pathogen detection. RESULTS: Among 360 infants with bacteremia, 316 (87.8%) pathogens were detected within 24 hours and 343 (95.3%) within 36 hours. A lower proportion of non-ill-appearing infants with bacteremia had a pathogen detected on blood culture within 24 hours compared with ill-appearing infants (85.0% vs 92.9%, respectively; P = .03). Among 62 infants with bacterial meningitis, 55 (88.7%) pathogens were detected within 24 hours and 59 (95.2%) were detected within 36 hours, with no difference based on ill appearance. CONCLUSIONS: Among infants ≤60 days old with bacteremia and/or bacterial meningitis, pathogens were commonly identified from blood or CSF within 24 and 36 hours. However, clinicians must weigh the potential for missed bacteremia in non-ill-appearing infants discharged within 24 hours against the overall low prevalence of infection.
Authors: Paul L Aronson; Cary Thurm; Elizabeth R Alpern; Evaline A Alessandrini; Derek J Williams; Samir S Shah; Lise E Nigrovic; Russell J McCulloh; Amanda Schondelmeyer; Joel S Tieder; Mark I Neuman Journal: Pediatrics Date: 2014-10 Impact factor: 7.124
Authors: Lise E Nigrovic; Prashant V Mahajan; Stephen M Blumberg; Lorin R Browne; James G Linakis; Richard M Ruddy; Jonathan E Bennett; Alexander J Rogers; Leah Tzimenatos; Elizabeth C Powell; Elizabeth R Alpern; T Charles Casper; Octavio Ramilo; Nathan Kuppermann Journal: Pediatrics Date: 2017-06-06 Impact factor: 7.124
Authors: Sanyukta Desai; Paul L Aronson; Veronika Shabanova; Mark I Neuman; Frances Balamuth; Christopher M Pruitt; Adrienne G DePorre; Lise E Nigrovic; Sahar N Rooholamini; Marie E Wang; Richard D Marble; Derek J Williams; Laura Sartori; Rianna C Leazer; Christine Mitchell; Samir S Shah Journal: Pediatrics Date: 2019-08-20 Impact factor: 7.124
Authors: Elizabeth R Alpern; Nathan Kuppermann; Stephen Blumberg; Genie Roosevelt; Andrea T Cruz; Lise E Nigrovic; Lorin R Browne; John M VanBuren; Octavio Ramilo; Prashant Mahajan Journal: Hosp Pediatr Date: 2020-09