Article Text

other Versions

Download PDFPDF
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 25 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, 7.4% 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 6.0/100 000.

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.

Statistics from Altmetric.com

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.