RT Journal Article
SR Electronic
T1 Very low rates of culture-confirmed invasive bacterial infections in a prospective 3-year population-based surveillance in Southwest London
JF Archives of Disease in Childhood
JO Arch Dis Child
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP 526
OP 531
DO 10.1136/archdischild-2013-305565
VO 99
IS 6
A1 Kirsty Le Doare
A1 Anna-Louise Nichols
A1 Helen Payne
A1 Rosy Wells
A1 Sonia Navidnia
A1 Gayle Appleby
A1 Elizabeth Calton
A1 Mike Sharland
A1 Shamez N Ladhani
A1 the CABIN Network
YR 2014
UL http://adc.bmj.com/content/99/6/526.abstract
AB 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.