新生児・小児医学

抽象的な

The Outcome of Blood Cultures in Febrile Children Presenting at theEmergency Department

Khalil Salameh, Awean GZ, Alkume N and Abdussalam Shah AK

Background: An unknown number of children who attend an Emergency Department may have a serious underlying, systemic infection as a cause of their fever. Blood culture (BC) remains the gold standard approach to establish the diagnosis and presence of pathogens in a child with a suspected, serious bacterial infection. This study investigated the proportion of positive blood cultures and the correlation with basic laboratory investigations (Creactive protein, white blood cell count, and absolute neutrophil count), prescription of antibiotics in patients visiting a pediatric emergency department in a primary hospital Methods: A retrospective study in Qatar- Al Wakra Hospital- Pediatric Emergency Department, over one year. Patients younger than 3 months of age and patients with any form of immune deficiency were excluded. Results: A total of 828 patients (median age 3.55 years) with fever (>38°C) or a history of fever (>38°C). 121 (14.6%) were later admitted to the pediatric ward; 10 (1.2%) to the pediatric intensive care unit and 4 (0.4%) to pediatric surgery. In total, positive blood culture was present in 20 (2.42%) children. Of these 20,4 (20%) were admitted to the pediatric ward, and 9 (45%) were observed in the hospital for less than 24 hrs and 7 (35.0%) were sent back home after a clinical assessment and the results of the initial laboratory tests. The referrals of patients with negative blood culture were similar. There were no differences in the mean value of absolute neutrophil counts or CRP measurement between patients exhibiting positive or negative BC. Conclusion: The incidence of a positive BC in routine care of febrile patients in an emergency department setting is low, 2.42%. There were no significant differences in associated clinical laboratory results (WBC, CRP or ANC) or admission to hospital wards between the groups with positive or negative BC.