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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.

Henderson, KL; Müller-Pebody, B; Wade, A; Sharland, M; Minaji, M; Johnson, AP; Gilbert, R (2015) 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. Epidemiol Infect, 143 (11). pp. 2440-2445. ISSN 1469-4409
SGUL Authors: Sharland, Michael Roy

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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.

Item Type: Article
Additional Information: © Cambridge University Press 2014 This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: Bloodstream infections, hospital-acquired (nosocomial) infections, microbiology, paediatrics, Bacteremia, Child, Preschool, Cohort Studies, Community-Acquired Infections, Cross Infection, Data Collection, Diagnosis, Differential, England, Enterococcus, Female, Gram-Positive Bacterial Infections, Humans, Infant, Klebsiella, Klebsiella Infections, Male, Meningococcal Infections, Neisseria meningitidis, Pneumococcal Infections, Retrospective Studies, Salmonella, Salmonella Infections, Streptococcal Infections, Streptococcus pneumoniae, Streptococcus pyogenes, Time Factors, Humans, Neisseria meningitidis, Klebsiella, Salmonella, Enterococcus, Streptococcus pneumoniae, Streptococcus pyogenes, Bacteremia, Klebsiella Infections, Salmonella Infections, Meningococcal Infections, Gram-Positive Bacterial Infections, Streptococcal Infections, Pneumococcal Infections, Community-Acquired Infections, Cross Infection, Diagnosis, Differential, Data Collection, Retrospective Studies, Cohort Studies, Time Factors, Child, Preschool, Infant, England, Female, Male, Bloodstream infections, hospital-acquired (nosocomial) infections, microbiology, paediatrics, 1117 Public Health and Health Services, Epidemiology
SGUL Research Institute / Research Centre: Academic Structure > Infection and Immunity Research Institute (INII)
Journal or Publication Title: Epidemiol Infect
ISSN: 1469-4409
Language: eng
August 2015Published
8 December 2014Published Online
13 November 2014Accepted
Publisher License: Creative Commons: Attribution 3.0
Project IDFunderFunder ID
MR/K006584/1Medical Research Council
PubMed ID: 25483268
Web of Science ID: WOS:000357313600020
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