title: Blood culture sampling rates at a German pediatric university hospital and incidence of invasive pneumococcal disease.
abstract: BACKGROUND
  Recent pediatric surveillance studies suggest the incidence of pneumococcal bacteremia, but not meningitis, is lower in Germany than in most developed countries. Suboptimal case assessment in routine clinical practice has been suspected of contributing to this apparent discrepancy.
  
  
  METHODS
  We aimed to assess the blood culture sampling rate at a German pediatric university hospital and the disease burden associated with pneumococcal bacteremia in children under 5 years of age. The study design was retrospective, based on data-linkage and chart review.
  
  
  RESULTS
  Blood cultures were frequently obtained in sepsis (96%; CI 78-99%) and meningitis (95%; CI 77-99%), but less commonly in pneumonia (49%; CI 43-54%) and fever without focus (48%; CI 38-59%). Pneumococci were the most common source of clinically significant bacteremia in previously healthy children.
  
  
  CONCLUSIONS
  These blood culture sampling rates may be insufficient for the sensitive detection of pneumococcal bacteremia. Epidemiological surveillance based on poorly standardized diagnostic practices is prone to under-assessment.
authors.affiliation: Pediatric Infectious Diseases, Clinic for General Pediatrics, Heinrich Heine University, Moorenstr. 5, D-40225, Düsseldorf, Germany. rueggeberg@uni-duesseldorf.de
authors.forename: J U
authors.initials: JU
authors.lastname: Rüggeberg
authors.forename: K
authors.initials: K
authors.lastname: Ketteler
authors.forename: C R
authors.initials: CR
authors.lastname: MacKenzie
authors.forename: R
authors.initials: R
authors.lastname: Von Kries
authors.forename: R R
authors.initials: RR
authors.lastname: Reinert
authors.forename: H
authors.initials: H
authors.lastname: Schroten
mesh_terms: D017677:Age Distribution; D016470:Bacteremia / Q000175:diagnosis / Q000453:epidemiology*; D001769:Blood / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D006776:Hospitals, Pediatric; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D011008:Pneumococcal Infections / Q000175:diagnosis / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012494:Sampling Studies; D017678:Sex Distribution; D015996:Survival Rate