Blood cultures profile of children admitted in pediatrics hospital of Rio de Janeiro
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Abstract
Introduction: blood cultures are the golden standard to detect bloodstream infections. Objective: to describe results of blood cultures collected during one year of follow-up in a pediatric hospital. Methods: we carried out a cross-sectional, retrospective study at
a tertiary pediatric hospital in the state of Rio de Janeiro, Brazil, performing a descriptive analysis about positive and contaminated rate of samples, and multi-drug resistant (MDR) bacteria found. Results: in the year of 2016, 2,668 blood cultures were collected, being 1,445 (54.2%) collected from pediatric wards, 949 (35.6%) from pediatric intensive care unit (PICU) and 274 (10.3%) from neonatal intensive care unit (NICU). One hundred and seven blood cultures were positive (4% of total), with a positive rate higher in PICU (46/949 – 4.8%) [95% CI – 0.4581 to 3.7163] when compared to (41/1,445 – 2.8%) pediatric wards (p = 0.0101), and NICU (20/274 – 7.3%) [95% CI 1.7902 to 8.2775] also when compared with pediatric wards (p = 0.0002). Thirty-three positive samples (30.8% of total) presented a multi-drug resistant (MDR) profile and among them, MRSA was the most frequently isolated agent (27/33 – 81.8%). MRSA was the most common MDR bacteria isolated in both PICU and NICU, with 27 and 12 isolates, respectively. In one hundred
and fifty-one (5.7%) samples, three or more germs, or agents classified as contaminating skin germs, were found. Conclusions: we conclude that the global rate of positive blood cultures was low, with a higher rate of positive samples verified in the critical units.
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References
1. Brasil. Agência Nacional de Vigilância Sanitária. Critérios nacionais de infecções relacionadas à assistência à saúde. Série: Segurança do paciente e qualidade em serviços de saúde. Brasília: Anvisa; 2017 [acesso em 19 set 2018]. Disponível em: http://portal.anvisa.gov.br/documents/33852/3507912/Caderno+2+-+Crit%C3%A9rios+Diagn%C3%B3sticos+de+Infec%C3%A7%C3%A3o+Relacionada+%C3%A0+Assist%C3%AAncia+%C3%A0+Sa%C3%BAde/7485b45a-074f-4b34-8868-61f1e5724501
2. De SK, Shetty N, Kelsey M. How to use... blood cultures. Arch Dis Child Educ Pract Ed. 2014;99(4):144-51.
3. Venturini E, Montagnani C, Benni A, Biermann KP, De Masi S, Chiappini E et al. Central-line associated bloodstream infections in a tertiary care children's University hospital: a prospective study. BMC Infect Dis. 2016;16(1):725.
4. Ozsurekci Y, Aykac K, Cengiz AB, Basaranoglu ST, Sancak B, Karahan S et al. Bloodstream infections in children caused by carbapenem-resistant versus carbapenem-susceptible Gram-negative microorganisms: risk factors and outcome. Diagn Microbiol Infect Dis. 2017;87(4):359-64.
5. Robertson P, Russell A, Inverarity DJ. The effect of a quality improvement programme reducing blood culture contamination on the detection of bloodstream infection in an emergency department. J Infect Prev. 2015;16(2):82-7.
6. Murni IK, Duke T, Daley AJ, Kinney S, Soenarto Y. True pathogen or contamination: validation of blood cultures for the diagnosis of nosocomial infections in a developing country. J Trop Pediatr. 2017. DOI: https://doi.org/10.1093/tropej/fmx081
7. Hitzenbichler F, Simon M, Salzberger B, Hanses F. Clinical significance of coagulase-negative staphylococci other than S. epidermidis blood stream isolates at a tertiary care hospital. Infection. 2017;45(2):179-86.
8. Labi AK, Obeng-Nkrumah N, Bjerrum S, Enweronu-Laryea C, Newman MJ. Neonatal bloodstream infections in a Ghanaian Tertiary Hospital: are the current antibiotic recommendations adequate? BMC Infect Dis. 2016;16:598. DOI: https://doi.org/10.1186/s12879-016-1913-4
9. Yiş R. Evaluation of blood cultures in a children's hospital located in Southeastern Anatolia. Turk Pediatri Ars. 2015;50(2):102-7.
10. Almahadi YM, Aldeyab MA, McEnlay, Scott MG, Darwish Elhajji FW, Magee FA et al. Clinical and economic impact of contaminated blood cultures within the hospital setting. J Hosp Infect. 2011;77(3):233-6.
11. Bates DW, Goldman L, Lee TH. Contaminant blood cultures and resource utilization: the true consequences of false-positive results. JAMA. 1991;265(3):365-9.
12. Hossain B, Weber MW, Hamer DH, Hibberd PL, Ahmed AS, Marzan M et al. Classification of blood culture isolates into contaminants and pathogens on the basis of clinical and laboratory data. Pediatr Infect Dis J. 2016;35(5):S52-4.
13. O'Connor C, Philip RK, Powell J, Slevin B, Quinn C, Power L et al. Combined education and skin antisepsis intervention for persistently high blood-culture contamination rates in neonatal intensive care. J Hosp Infect. 2016;93(1):105-7.
14. Schifman RB, Strand CL, Meier FA, Howanitz PJ. Blood culture contamination: a College of American Pathologists Q-Probes study involving 640 institutions and 497134 specimens from adult patients. Arch Pathol Lab Med. 1998;122(3):216-21.
15. Clinical and Laboratory Standards Institute. M100S: performance standards for antimicrobial susceptibility testing. 26th ed. 2016 [access on Set 19, 2018]. Available from: http://ljzx.cqrmhospital.com/upfiles/201601/20160112155335884.pdf
16. Siegel JD, Rhinehart E, Jackson M, Chiarello L; Healthcare Infection Control Practices Advisory Committee. Management of multidrug-resistant organisms in healthcare settings, 2006. Am J Infect Control. 2007;35(10 Suppl 2):S165-93.
17. Crichton H, O'Connell N, Rabie H, Whitelaw A, Dramowski A. Neonatal and paediatric bloodstream infections: pathogens, antimicrobial resistance patterns and prescribing practice at Khayelitsha District Hospital, Cape Town, South Africa. S Afr Med J. 2018;108(2):99-104.
18. Ahmad A, Iram S, Hussain S, Yusuf NW. Diagnosis of paediatric sepsis by automated blood culture system and conventional blood culture. J Pak Med Assoc. 2017;67(2):192-5.
19. Hasan AS, Uppal P, Arya S, Capoor MR, Nair D, Chellani H et al. Comparison of BacT/Alert microbial detection system with conventional blood culture method in neonatal sepsis. J Pediatric Infect Dis Soc. 2008;3(1):21-5.
20. World Health Organization. WHO publishes list of bacteria for which new antibiotics are urgently needed. Geneve, 2017 [access on Mai 9, 2018]. Available from: http://www.who.int/en/news-room/detail/27-02-2017-who-publishes-list-of-bacteria-for-which-new-antibiotics-are-urgently-needed