title: Blood cultures in sick children.
abstract: BACKGROUND
  Blood cultures (BCs) are frequently performed in sick children. A recent audit of BCs among adult patients documented high rates of contamination by coagulase-negative staphylococci (CoNS).
  
  
  OBJECTIVE
  To describe BC contamination rates and common pathogenic organisms causing bloodstream infection in children at a tertiary- level children's hospital.
  
  
  METHODS
  BC results for children admitted to Red Cross War Memorial Children's Hospital from 2008 to 2012 were extracted from the National Health Laboratory Service database. Pathogenic and non-pathogenic (contaminated) growth on BCs in children <1 year of age and >1 year of age, were analysed. Data analysis was performed using Epi Info version 3.5.1.
  
  
  RESULTS
  A total of 47 677 BCs were performed in the 5-year period. The proportion of contaminated specimens ranged between 5.9% and 7.2% per year (p=0.4). CoNS was the predominant isolate in 53.8% of all contaminated BCs. Children <1 year of age experienced higher contamination rates than children >1 year of age (8.7% v. 4.7%; relative risk 1.84; 95% confidence interval (CI) 1.71 - 1.97). Pathogenic organisms were isolated in 6.2% (95% CI 6.0 - 6.4) of all BC specimens. Among Gram-positive organisms, the proportion of Streptococcus pneumoniae isolates declined from 14.3% to 4.7% (p<0.00001), while there was a significant increase in Gram-negative organisms (51.8% - 57.9%; p=0.04) over the 5-year period. Klebsiella pneumoniae, the predominant Enterobacteriaceae isolated, decreased from 45.8% to 31.7% (p=0.004).
  
  
  CONCLUSIONS
  This study identified unacceptably high BC contamination rates, emphasising the importance of collecting BC specimens under sterile conditions.
authors.affiliation: Paediatric Infectious Diseases Unit, Red Cross War Memorial Children's Hospital, and Department of Paediatrics and Child Health, University of Cape Town, South Africa. harsha.lochan@uct.ac.za.
authors.forename: Harsha
authors.initials: H
authors.lastname: Lochan
authors.forename: Colleen
authors.initials: C
authors.lastname: Bamford
authors.forename: Brian
authors.initials: B
authors.lastname: Eley
mesh_terms: D000367:Age Factors; D016470:Bacteremia / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification; D001431:Bacteriological Techniques / Q000379:methods / Q000592:standards; D001800:Blood Specimen Collection / Q000009:adverse effects / Q000592:standards / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D004866:Equipment Contamination / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology