Value of routine anaerobic blood cultures for pediatric patients

doi:10.1016/S0022-3476(95)70305-5

The Journal of Pediatrics

Volume 127, Issue 2, August 1995, Pages 263-268

https://doi.org/10.1016/S0022-3476(95)70305-5 Get rights and content

Abstract

Objective: Anaerobic bacteremia rarely occurs in children. Therefore we assessed the usefulness of routinely obtaining anaerobic blood cultures in our pediatric patients. Study design: Records of 9360 paired aerobic and anaerobic blood culture bottles (Bactec NR660 System) containing blood specimens from pediatric inpatients and outpatients at Duke University Medical Center, Durham, N.C., were reviewed retrospectively. Yield and speed of detection were calculated for each bottle and compared for statistical significance by the McNemar test. Results: A total of 723 clinically important microorganisms were isolated; only 15 (2.1%) were strict anaerobes. Significantly more microorganisms (p <0.001), especially staphylococci, nonfermenting gram-negative rods, enteric gram-negative rods, and yeasts, were detected by use of the aerobic bottle. The anaerobic bottle was important in identifying an anaerobic microorganism as the cause of sepsis in only five patients, all of whom were at increased risk of having anaerobic infection. Conclusions: Anaerobic blood cultures are rarely helpful in the majority of pediatric patients and usually show positive results only in clinical settings associated with anaerobic infection. Microorganisms that prefer an aerobic environment, such as Pseudomonas aeruginosa and yeasts, are now far more common than anaerobes in children; aerobic culturing of the entire volume of blood collected might increase the yield from pediatric blood cultures. (J PEDIATR 1995;127:263-8)

Section snippets

METHODS

Records of all inpatient and outpatient pediatric blood cultures received in the clinical microbiology laboratory at Duke University Medical Center between January 1993 and June 1994 were reviewed. This center is a tertiary-care hospital with 157 pediatric beds and provides care to a large number of children requiring both general and specialized medical attention. Blood from pediatric patients is inoculated routinely at the bedside by house officers into both aerobic (NR6A) and anaerobic

RESULTS

During the 18-month study period, a total of 9360 paired aerobic and anaerobic culture bottles containing blood from pediatric inpatients and outpatients were submitted to the clinical microbiology laboratory. Of these, 833 cultures (8.9%) showed positive results, yielding 940 isolates. A clinically important microorganism was isolated from 637 of all cultures (6.8%). Of the 940 isolates, 723 isolates from 410 septic episodes were considered clinically important and 217 were deemed contaminants.

DISCUSSION

Most series of pediatric bacteremia cases have shown the occurrence of anaerobic bacteremia in children to be a rare event.6, 7, 8, 14, 15, 16, 17 Conversely, the incidence of nosocomial sepsis caused by microorganisms preferring an aerobic environment, such as Pseudomonas aeruginosa and Candida spp., has been rising.18, 19 This should lead the clinician to ask a logical question: Should half the blood volume collected from pediatric patients be routinely inoculated into an anaerobic

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^☆: From the Clinical Microbiology Laboratory, Duke University Medical Center, and the Departments of Pathology and Medicine, Duke University School of Medicine, Durham, North Carolina

^☆☆: Supported in part by an Aga Khan Foundation scholarship award (Dr. Zaidi).

^★: Reprint requests: L. Barth Reller, MD, Clinical Microbiology Laboratory, Duke University Medical Center, Box 3938, Durham, NC 27710.

^★★: 0022-3476/95/$3.00 + 0 9/20/64850

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Value of routine anaerobic blood cultures for pediatric patients☆,☆☆,★,★★

Abstract

Section snippets

METHODS

RESULTS

DISCUSSION

Lancet

Clin Lab Med

Am J Med

J PEDIATR

Diagn Microbiol Infect Dis

Anaerobic bacteria

Mayo Clin Proc

Pathogenic anaerobes

Arch Intern Med

Color atlas and textbook of diagnostic microbiology

Bacteremia in hospitalized children

Am J Dis Child

Anaerobic bacteremia as observed in a children's hospital

Clin Pediatr

Evaluation of blood culture procedures in a pediatric hospital

J Clin Microbiol

Anaerobic bacteremia: decreasing rate over a 15-year period

Rev Infect Dis

Critical assessment of blood culture techniques: analysis of recovery of obligate and facultative anaerobes, strict aerobic bacteria, and fungi in aerobic and anaerobic blood culture bottles

J Clin Microbiol

Rationale for selective use of anaerobic blood cultures

J Clin Microbiol

Psychological statistics