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Very low rates of culture-confirmed invasive bacterial infections in a prospective 3-year population-based surveillance in Southwest London
  1. Kirsty Le Doare1,2,
  2. Anna-Louise Nichols1,
  3. Helen Payne1,
  4. Rosy Wells1,
  5. Sonia Navidnia1,
  6. Gayle Appleby1,
  7. Elizabeth Calton1,
  8. Mike Sharland1,
  9. Shamez N Ladhani1,3,
  10. the CABIN Network
  1. 1Paediatric Infectious Diseases Research Group, St. George's Hospital, London, UK
  2. 2Wellcome Trust/Imperial Centre for Global Health Research, Imperial College, London, UK
  3. 3Immunisation Department, Public Health England, London, UK
  1. Correspondence to Dr Shamez N Ladhani, Immunisation Department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK; shamez.ladhani{at}phe.gov.uk

Abstract

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.

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