Timing of positive blood samples does not differentiate pathogens causing healthcare-associated from community-acquired bloodstream infections in children in England: a linked retrospective cohort study

• Published in: Epidemiology and infection Vol. 143; no. 11; pp. 2440 - 2445
• Main Authors: HENDERSON, K. L., MÜLLER-PEBODY, B., WADE, A., SHARLAND, M., MINAJI, M., JOHNSON, A. P., GILBERT, R
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.08.2015
• Subjects: Bacteraemia; Bacteremia - blood; Bacteremia - diagnosis; Child, Preschool; Cohort Studies; Community-Acquired Infections - blood; Community-Acquired Infections - diagnosis; Cross Infection - blood; Cross Infection - diagnosis; Data Collection; Datasets; Diagnosis, Differential; England; Enterococcus - isolation & purification; Epidemiology; Etiology; Female; Gram-Positive Bacterial Infections - blood; Gram-Positive Bacterial Infections - diagnosis; Hospitals; Humans; Infant; Klebsiella - isolation & purification; Klebsiella Infections - blood; Klebsiella Infections - diagnosis; Laboratories; Male; Meningococcal Infections - blood; Meningococcal Infections - diagnosis; Neisseria meningitidis - isolation & purification; Original Papers; Pathogens; Patients; Pediatrics; Pneumococcal Infections - blood; Pneumococcal Infections - diagnosis; Public health; Retrospective Studies; Salmonella - isolation & purification; Salmonella Infections - blood; Salmonella Infections - diagnosis; Staphylococcus infections; Streptococcal Infections - blood; Streptococcal Infections - diagnosis; Streptococcus infections; Streptococcus pneumoniae - isolation & purification; Streptococcus pyogenes - isolation & purification; Surveillance; Time Factors; England; United Kingdom > UK; British Isles, England; paediatrics; Bloodstream infections; microbiology; hospital-acquired (nosocomial) infections
• ISSN: 0950-2688; 1469-4409
• DOI: 10.1017/S0950268814003306

Paediatricians recognize that using the time-dependent community-acquired vs. hospital-acquired bloodstream infection (BSI) dichotomy to guide empirical treatment no longer distinguishes between causative pathogens due to the emergence of healthcare-associated BSIs. However, paediatric epidemiological evidence of the aetiology of BSIs in relation to hospital admission in England is lacking. For 12 common BSI-causing pathogens in England, timing of laboratory reports of positive paediatric (3 months to 5 years) bacterial blood isolates were linked to in-patient hospital data and plotted in relation to hospital admission. The majority (88·6%) of linked pathogens were isolated <2 days after hospital admission, including pathogens widely regarded as hospital acquired: Enterococcus spp. (67·2%) and Klebsiella spp. (88·9%). Neisseria meningitidis, Streptococcus pneumoniae, group A streptococcus and Salmonella spp. were unlikely to cause hospital-acquired BSI. Pathogens commonly associated with hospital-acquired BSI are being isolated <2 days after hospital admission alongside pathogens commonly associated with community-acquired BSI. We confirm that timing of blood samples alone does not differentiate between bacterial pathogens. Additional factors including clinical patient characteristics and healthcare contact should be considered to help predict the causative pathogen and guide empirical antibiotic therapy.