title: Very low rates of culture-confirmed invasive bacterial infections in a prospective 3-year population-based surveillance in Southwest London.
abstract: OBJECTIVE
  To estimate the incidence, clinical characteristics and risk factors for culture-confirmed invasive bacterial infections in England.
  
  
  METHODS
  Prospective, observational, study of all children with positive blood and/or cerebrospinal fluid (CSF) culture over a 3-year period (2009-2011).
  
  
  METHODS
  All five hospitals within a geographically defined region in southwest London providing care for around 600 000 paediatric residents.
  
  
  METHODS
  Children aged 1 month to 15 years
  
  
  METHODS
  Rates of community-acquired and hospital-acquired invasive bacterial infections in healthy children and those with co-morbidities; pathogens by age group, risk group and clinical presentation.
  
  
  RESULTS
  During 2009-2011, 44 118 children had 46 039 admissions, equivalent to 26 admissions per 1000 children. Blood/CSF cultures were obtained during 44.7% of admissions, 7.4% were positive but only 504 were clinically significant, equivalent to 32.9% of positive blood/CSF cultures, 2.4% of all blood/CSF cultures and 1.1% of hospital admissions. The population incidence of culture-confirmed invasive bacterial infection was 28/100 000. One-third of infections were hospital acquired and, of the community-acquired infections, two-thirds occurred in children with pre-existing co-morbidities. In previously healthy children, therefore, the incidence of community-acquired invasive bacterial infection was only 6.4/100 000.
  
  
  CONCLUSIONS
  Although infection was suspected in almost half the children admitted to hospital, a significant pathogen was cultured from blood or CSF in only 2.4%, mainly among children with pre-existing co-morbidities, who may require a more broad-spectrum empiric antibiotic regime compared to previously healthy children. Invasive bacterial infection in previously healthy children is now very rare. Improved strategies to manage low-risk febrile children are required.
authors.affiliation: Paediatric Infectious Diseases Research Group, St. George's Hospital, London, UK Wellcome Trust/Imperial Centre for Global Health Research, Imperial College, London, UK.
authors.forename: Kirsty
authors.initials: K
authors.lastname: Le Doare
authors.affiliation: Paediatric Infectious Diseases Research Group, St. George's Hospital, London, UK.
authors.forename: Anna-Louise
authors.initials: AL
authors.lastname: Nichols
authors.affiliation: Paediatric Infectious Diseases Research Group, St. George's Hospital, London, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Payne
authors.affiliation: Paediatric Infectious Diseases Research Group, St. George's Hospital, London, UK.
authors.forename: Rosy
authors.initials: R
authors.lastname: Wells
authors.affiliation: Paediatric Infectious Diseases Research Group, St. George's Hospital, London, UK.
authors.forename: Sonia
authors.initials: S
authors.lastname: Navidnia
authors.affiliation: Paediatric Infectious Diseases Research Group, St. George's Hospital, London, UK.
authors.forename: Gayle
authors.initials: G
authors.lastname: Appleby
authors.affiliation: Paediatric Infectious Diseases Research Group, St. George's Hospital, London, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Calton
authors.affiliation: Paediatric Infectious Diseases Research Group, St. George's Hospital, London, UK.
authors.forename: Mike
authors.initials: M
authors.lastname: Sharland
authors.affiliation: Paediatric Infectious Diseases Research Group, St. George's Hospital, London, UK Immunisation Department, Public Health England, London, UK.
authors.forename: Shamez N
authors.initials: SN
authors.lastname: Ladhani
mesh_terms: D000293:Adolescent; D001419:Bacteria / Q000302:isolation & purification; D001424:Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D001769:Blood / Q000382:microbiology; D002555:Cerebrospinal Fluid / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008131:London / Q000453:epidemiology; D008297:Male; D011159:Population Surveillance; D011446:Prospective Studies; D012307:Risk Factors