Time to Pathogen Detection for Non-ill Versus Ill-Appearing Infants ≤60 Days Old With Bacteremia and Meningitis

Creator(s)

Paul L. Aronson, Yale School of Medicine
Marie E. Wang, Stanford University School of Medicine
Lise E. Nigrovic, Harvard University
Samir S. Shah, Divisions of Hospital Medicine and
Sanyukta Desai, Divisions of Hospital Medicine and
Christopher M. Pruitt, The University of Alabama at Birmingham
Fran Balamuth, University of Pennsylvania
Laura Sartori, Monroe Carell Jr. Children's Hospital at Vanderbilt
Richard D. Marble, Northwestern University Feinberg School of Medicine
Sahar N. Rooholamini, University of Washington School of Medicine
Rianna C. Leazer, Children's Hospital of The King's Daughters
Christopher Woll, Yale School of Medicine
Adrienne G. DePorre, Children's Mercy HospitalFollow
Mark I. Neuman, Harvard University

Document Type

Article

Publication Date

7-2018

Identifier

DOI: 10.1542/hpeds.2018-0002; PMCID: PMC6145376

Abstract

Copyright © 2018 by the American Academy of Pediatrics.

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.

Journal Title

Hospital pediatrics

Volume

8

Issue

7

First Page

379

Last Page

384

Recommended Citation

Aronson PL, Wang ME, Nigrovic LE, et al. Time to Pathogen Detection for Non-ill Versus Ill-Appearing Infants ≤60 Days Old With Bacteremia and Meningitis. Hosp Pediatr. 2018;8(7):379-384. doi:10.1542/hpeds.2018-0002