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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >How long does it take to 'rule out' bacteremia in children with central venous catheters?
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How long does it take to 'rule out' bacteremia in children with central venous catheters?

机译：带中央静脉导管的儿童“排除”菌血症需要多长时间？

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BACKGROUND: Children with central venous catheters and suspected bloodstream infection are often hospitalized for 48 hours to receive empiric antibiotic therapy pending blood-culture results. Continuous monitoring blood-culture systems allow for more rapid detection of bloodstream infection than previous blood-culture systems, a feature that may facilitate earlier determination of the true presence or absence of bloodstream infection and shorten empiric antibiotic therapy and duration of hospitalization. METHODS: This retrospective cohort study included children with central venous catheters who were diagnosed with laboratory-confirmed bloodstream infection after evaluation in the ambulatory care setting. RESULTS: Two-hundred episodes of bloodstream infection were included. The median patient age was 5.5 years. Central venous catheters were in place for a median of 80.5 days. Gram-negative bacteria accounted for 51% of infections as part of either a monomicrobial (25%) or polymicrobial (26%) infection.The overall median time to blood-culture positivity was 14 hours. The predicted probability for a culture being positive at 36 hours was 99.2% for infections caused by gram-negative bacteria and 96.6% for any infection after adjusting for age, catheter type, and recent antibiotic use. In a multivariate Cox proportional-hazards regression model, polymicrobial infections with > or = 1 gram-negative bacteria and monomicrobial infections caused by gram-negative bacteria were independently associated with an earlier time to blood-culture positivity after adjusting for age, catheter type, and recent antibiotic use. CONCLUSIONS: The time to blood-culture positivity depends on bacterial category. Bloodstream infections caused by gram-negative bacteria are detected most quickly. Our data suggest that discontinuation of empiric antibiotic coverage may be warranted in clinically stable children with central venous catheters if the blood-culture results remain negative 24 to 36 hours after collection.
机译：背景：患有中心静脉导管并怀疑有血液感染的儿童通常需要住院48小时，以接受经验性抗生素治疗，直至血培养结果。与以前的血液培养系统相比，连续监测的血液培养系统可以更快速地检测出血流感染，该功能可以促进更早地确定血流感染的真实存在与否，并缩短经验性抗生素治疗和住院时间。方法：这项回顾性队列研究包括在门诊护理环境中评估后被诊断为实验室确诊的血液感染的中央静脉导管患儿。结果：包括200例血液感染。患者的中位年龄为5.5岁。中心静脉导管就位，中位时间为80.5天。革兰氏阴性细菌占单微生物（25％）或多微生物（26％）感染的一部分，占感染的51％。血液培养阳性的总体中位时间为14小时。调整年龄，导管类型和最近使用的抗生素后，在36小时内培养阳性的革兰氏阴性菌对革兰氏阴性细菌感染的预测概率为99.2％，对任何感染的感染率为96.6％。在多元Cox比例风险回归模型中，在调整了年龄，导管类型，和最近使用抗生素。结论：血液培养阳性的时间取决于细菌的种类。革兰氏阴性细菌引起的血流感染的检测最快。我们的数据表明，如果在收集后24到36小时内血液培养结果仍然为阴性，则临床上稳定的中心静脉导管患儿可能需要终止经验性抗生素覆盖。

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