| Title: |
Very low rates of culture-confirmed invasive bacterial infections in a prospective 3-year population-based surveillance in Southwest London |
| Authors: |
Le Doare, Kirsty; Nichols, Anna-Louise; Payne, Helen; Wells, Rosy; Navidnia, Sonia; Appleby, Gayle; Calton, Elizabeth; Sharland, Mike; Ladhani, Shamez N; the CABIN Network; Irwin, Adam; Segal, Laura; Riley, Peter; Handforth, Jennifer; El Rifai, Rim; Heath, Rowan; Luck, Sue |
| Publisher Information: |
BMJ Publishing Group Ltd |
| Publication Year: |
2014 |
| Collection: |
HighWire Press (Stanford University) |
| Subject Terms: |
Original article |
| Description: |
Objectives To estimate the incidence, clinical characteristics and risk factors for culture-confirmed invasive bacterial infections in England. Design Prospective, observational, study of all children with positive blood and/or cerebrospinal fluid (CSF) culture over a 3-year period (2009–2011). Setting All five hospitals within a geographically defined region in southwest London providing care for around 600 000 paediatric residents. Patients Children aged 1 month to 15 years Main outcome measures Rates of community-acquired and hospital-acquired invasive bacterial infections in healthy children and those with co-morbidities; pathogens by age group, risk group and clinical presentation. Results During 2009–2011, 44 118 children had 46 039 admissions, equivalent to 26 admissions per 1000 children. Blood/CSF cultures were obtained during 44.7% of admissions, 7.4% were positive but only 504 were clinically significant, equivalent to 32.9% of positive blood/CSF cultures, 2.4% of all blood/CSF cultures and 1.1% of hospital admissions. The population incidence of culture-confirmed invasive bacterial infection was 28/100 000. One-third of infections were hospital acquired and, of the community-acquired infections, two-thirds occurred in children with pre-existing co-morbidities. In previously healthy children, therefore, the incidence of community-acquired invasive bacterial infection was only 6.4/100 000. Conclusions Although infection was suspected in almost half the children admitted to hospital, a significant pathogen was cultured from blood or CSF in only 2.4%, mainly among children with pre-existing co-morbidities, who may require a more broad-spectrum empiric antibiotic regime compared to previously healthy children. Invasive bacterial infection in previously healthy children is now very rare. Improved strategies to manage low-risk febrile children are required. |
| Document Type: |
text |
| File Description: |
text/html |
| Language: |
English |
| Relation: |
http://adc.bmj.com/cgi/content/short/99/6/526; http://dx.doi.org/10.1136/archdischild-2013-305565 |
| DOI: |
10.1136/archdischild-2013-305565 |
| Availability: |
http://adc.bmj.com/cgi/content/short/99/6/526; https://doi.org/10.1136/archdischild-2013-305565 |
| Rights: |
Copyright (C) 2014, BMJ Publishing Group Ltd |
| Accession Number: |
edsbas.58BD4F77 |
| Database: |
BASE |