title: How many sources should be cultured for the diagnosis of a blood stream infection in children with cancer?
abstract: Blood stream infection (BSI) in a child with cancer is a life-threatening condition while blood cultures (BCs) play a crucial role for the diagnosis. The current practice of obtaining a BC from all sources--peripheral vein, central venous catheter (CVC), all lumens--is controversial and therefore in this study, our aim was to evaluate the utility of obtaining BCs from all these available sources. A retrospective study of BC sets obtained from all newly diagnosed patients with malignancy was conducted. A total number of 633 BC sets from 123 boys and 88 girls (median age: 5 5/12 years) were evaluated during infection episodes from January 1, 2005, to August 31, 2010. Among these cases, 134 were classified as true BSI (21%), 468 as non-BSI, and 31 as false-positive. In 64 cases, the results from peripheral and CVC sources were discordant: 57 catheter positive-peripheral negative and seven catheter negative-peripheral positive. Consequently, seven out of 134 true BSIs (5.2%) would not have been identified if only a BC from a CVC had been obtained. Moreover, if no BCs from all lumens had been obtained we would have missed up to 25% of true-positive BSIs. In the same way, if BCs from all sources had not been drawn we would not have detected up to 52% of true-positive BSIs.
  
  
  CONCLUSIONS
  Obtaining BCs during an infection episode from all sources in a child with cancer is still mandatory.
authors.affiliation: Oncology Department, P & A Kyriakou Children's Hospital, Athens, Greece and Hematology & Oncology Division, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA. doganisd@gmail.com
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Doganis
authors.forename: Basim
authors.initials: B
authors.lastname: Asmar
authors.forename: Maxim
authors.initials: M
authors.lastname: Yankelevich
authors.forename: Ronald
authors.initials: R
authors.lastname: Thomas
authors.forename: Yaddanapudi
authors.initials: Y
authors.lastname: Ravindranath
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000032:analysis; D001769:Blood / Q000382:microbiology*; D017848:Blood-Borne Pathogens / Q000302:isolation & purification*; D055499:Catheter-Related Infections / Q000097:blood / Q000175:diagnosis* / Q000382:microbiology; D002405:Catheterization, Central Venous / Q000009:adverse effects; D002406:Catheterization, Peripheral / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000097:blood / Q000175:diagnosis* / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009369:Neoplasms / Q000150:complications* / Q000382:microbiology / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D015415:Biomarkers