Time to Positive Blood and Cerebrospinal Fluid Cultures in Hypothermic Young Infants

Author:

Potisek Nicholas M.12,Morrison John34,St. Ville Madeleine Elise5,Westphal Kathryn67,Wood Julie K.2,Lee Jennifer8,Combs Monica D.9,Berger Stephanie10,Lee Clifton11,Van Meurs Annalise12,Halvorson Elizabeth E.2,Sharma Meenu,McCartor Saylor,Raffaele Jenny,Doraiswamy Vignesh,

Affiliation:

1. aDepartment of Pediatrics, University of South Carolina School of Medicine Greenville, Prisma Health Children’s Hospital-Upstate, Greenville, South Carolina

2. bDepartment of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina

3. cDivision of Pediatric Hospital Medicine, Johns Hopkins All Children’s Hospital, St. Petersburg, Florida

4. dDepartment of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland

5. eSchool of Mathematical and Statistical Sciences, Clemson University, Clemson, South Carolina

6. fDivision of Hospital Medicine, Nationwide Children’s Hospital, Columbus, Ohio

7. gDepartment of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio

8. hDepartment of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian, New York, New York

9. iDepartment of Pediatrics, Keck School of Medicine of USC, Children’s Hospital Los Angeles, Los Angeles, California

10. jDepartment of Pediatrics, University of Alabama Heersink School of Medicine, Birmingham, Alabama

11. kDepartment of Pediatrics, Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia

12. lDepartment of Pediatrics, Oregon Health and Science University, Doernbecher Children’s Hospital, Portland, Oregon

Abstract

BACKGROUND AND OBJECTIVE Hypothermia in young infants may be secondary to an invasive bacterial infection. No studies have explored culture time-to-positivity (TTP) in hypothermic infants. Our objective was to compare TTP of blood and cerebrospinal fluid (CSF) cultures between pathogenic and contaminant bacteria in hypothermic infants ≤90 days of age. METHODS Secondary analysis of a retrospective cohort of 9 children’s hospitals. Infants ≤90 days of age presenting to the emergency department or inpatient setting with hypothermia from September 1, 2017, to May 5, 2021, with positive blood or CSF cultures were included. Differences in continuous variables between pathogenic and contaminant organism groups were tested using a 2-sample t test and 95% confidence intervals for the mean differences reported. RESULTS Seventy-seven infants met inclusion criteria. Seventy-one blood cultures were positive, with 20 (28.2%) treated as pathogenic organisms. Five (50%) of 10 positive CSF cultures were treated as pathogenic. The median (interquartile range [IQR]) TTP for pathogenic blood cultures was 16.8 (IQR 12.7–19.2) hours compared with 26.11 (IQR 20.5–48.1) hours for contaminant organisms (P < .001). The median TTP for pathogenic organisms on CSF cultures was 34.3 (IQR 2.0–53.7) hours, compared with 58.1 (IQR 52–72) hours for contaminant CSF organisms (P < .186). CONCLUSIONS Our study is the first to compare the TTP of blood and CSF cultures between pathogenic and contaminant bacteria in hypothermic infants. All pathogenic bacteria in the blood grew within 36 hours. No difference in TTP of CSF cultures between pathogenic and contaminant bacteria was detected.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics,General Medicine,Pediatrics, Perinatology and Child Health

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