발열이 있는 3세 미만 소아환자에서 응급실 혈액배양 검사의 유용성 (Usefulness of Blood Cultures in Children Aged Under 3 Years with Fever at the Emergency Department)

서지정보

· 발행기관 : 대한응급의학회
· 수록지 정보 : 대한응급의학회지 / 24권 / 1호 / 77 ~ 82페이지
· 저자명 : 강태신, 정상민, 이상봉, 김동훈, 박인성, 정진희, 강창우, 이수훈, 이경우, 김성춘

초록

Purpose: 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.
Methods: We conducted a retrospective review of all children between the ages of 1 and 36 months with a body temperature of at least 38.0 C who underwent blood culture in the emergency department (ED) from January 2008to December 2010.
Results: 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.
Conclusion: 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.

영어초록

Purpose: 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.
Methods: We conducted a retrospective review of all children between the ages of 1 and 36 months with a body temperature of at least 38.0 C who underwent blood culture in the emergency department (ED) from January 2008to December 2010.
Results: 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.
Conclusion: 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.

참고자료

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