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J Korean Soc Emerg Med > Volume 24(1); 2013 > Article
Journal of The Korean Society of Emergency Medicine 2013;24(1): 77-82.
Usefulness of Blood Cultures in Children Aged Under 3 Years with Fever at the Emergency Department
Tae Sin Kang, Seong Chun Kim, Sang Min Jung, Sang Bong Lee, Dong Hoon Kim, In Sung Park, Jin Hee Jeong, Chang Woo Kang, Soo Hoon Lee, Kyung Woo Lee
1Department of Emergency Medicine, Gyeongsang National University Hospital, Jinju, Korea. gsimem@naver.com
2Department of Neurosurgery, Gyeongsang National University Hospital, Jinju, Korea.
3Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
4Department of Emergency Medicine, Catholic University of Daegu, Daegu, Korea.
Blood cultures are commonly performed in evaluation of febrile children without an obvious source of infection. Pediatric clinicians treat patients with a positive blood culture before final identification of the organism. This study sought to determine the yield and the clinical usefulness of blood cultures in pediatric patients younger than 3 years with fever at the emergency department.
We conducted a retrospective review of all children between the ages of 1 and 36 months with a body temperature of at least 38.0degrees C who underwent blood culture in the emergency department (ED) from January 2008 to December 2010.
Bacteria growth occurred in 126(10.3%) out of 1,219 blood cultures. True positives (TPs), defined as true pathogens, were observed in 2.5% of cultures, representing 23.8% of positives. False positives (FPs), defined as contaminants, were observed in 7.9% of cultures, representing 76.2% of positives. Patients with TP cultures had lower mean pH (7.36+/-0.17 vs 7.41+/-0.08, p=0.031), higher mean base deficit (4.9+/-6.0 mmol/L vs 2.9+/-2.5 mmol/L, p=0.012), and higher mean C-reactive protein (CRP) level (3.3+/-3.7 mg/dL vs 1.8+/-3.2 mg/dL, p=0.034) than those with FP cultures.
True positive results were observed relatively infrequently in blood cultures of febrile children younger than 3 years in the ED; therefore, changes in treatment of pediatric patients with fever are uncommon. However, bacteria identified by blood cultures are likely to be the true pathogen in a pediatric patient with a large base deficit or a high CRP level.
Key words: Fever, Bacteremia, Blood, Child
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