title: Timing of positive blood samples does not differentiate pathogens causing healthcare-associated from community-acquired bloodstream infections in children in England: a linked retrospective cohort study.
abstract: Paediatricians recognize that using the time-dependent community-acquired vs. hospital-acquired bloodstream infection (BSI) dichotomy to guide empirical treatment no longer distinguishes between causative pathogens due to the emergence of healthcare-associated BSIs. However, paediatric epidemiological evidence of the aetiology of BSIs in relation to hospital admission in England is lacking. For 12 common BSI-causing pathogens in England, timing of laboratory reports of positive paediatric (3 months to 5 years) bacterial blood isolates were linked to in-patient hospital data and plotted in relation to hospital admission. The majority (88·6%) of linked pathogens were isolated <2 days after hospital admission, including pathogens widely regarded as hospital acquired: Enterococcus spp. (67·2%) and Klebsiella spp. (88·9%). Neisseria meningitidis, Streptococcus pneumoniae, group A streptococcus and Salmonella spp. were unlikely to cause hospital-acquired BSI. Pathogens commonly associated with hospital-acquired BSI are being isolated <2 days after hospital admission alongside pathogens commonly associated with community-acquired BSI. We confirm that timing of blood samples alone does not differentiate between bacterial pathogens. Additional factors including clinical patient characteristics and healthcare contact should be considered to help predict the causative pathogen and guide empirical antibiotic therapy.
authors.affiliation: Department of Healthcare-Associated Infection and Antimicrobial Resistance,Centre for Infectious Disease Surveillance and Control, Public Health England,London,UK.
authors.forename: K L
authors.initials: KL
authors.lastname: Henderson
authors.affiliation: Department of Healthcare-Associated Infection and Antimicrobial Resistance,Centre for Infectious Disease Surveillance and Control, Public Health England,London,UK.
authors.forename: B
authors.initials: B
authors.lastname: Müller-Pebody
authors.affiliation: Paediatric Epidemiology and Biostatistics,UCL Institute of Child Health,London,UK.
authors.forename: A
authors.initials: A
authors.lastname: Wade
authors.affiliation: Paediatric Infectious Diseases Unit,St George's Hospital,London,UK.
authors.forename: M
authors.initials: M
authors.lastname: Sharland
authors.forename: M
authors.initials: M
authors.lastname: Minaji
authors.affiliation: Department of Healthcare-Associated Infection and Antimicrobial Resistance,Centre for Infectious Disease Surveillance and Control, Public Health England,London,UK.
authors.forename: A P
authors.initials: AP
authors.lastname: Johnson
authors.affiliation: Paediatric Epidemiology and Biostatistics,UCL Institute of Child Health,London,UK.
authors.forename: R
authors.initials: R
authors.lastname: Gilbert
mesh_terms: D016470:Bacteremia / Q000097:blood* / Q000175:diagnosis; D002675:Child, Preschool; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000097:blood / Q000175:diagnosis; D003428:Cross Infection / Q000097:blood* / Q000175:diagnosis; D003625:Data Collection; D003937:Diagnosis, Differential; D004739:England; D016983:Enterococcus / Q000302:isolation & purification; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000097:blood / Q000175:diagnosis; D006801:Humans; D007223:Infant; D007709:Klebsiella / Q000302:isolation & purification; D007710:Klebsiella Infections / Q000097:blood* / Q000175:diagnosis; D008297:Male; D008589:Meningococcal Infections / Q000097:blood* / Q000175:diagnosis; D009345:Neisseria meningitidis / Q000302:isolation & purification; D011008:Pneumococcal Infections / Q000097:blood* / Q000175:diagnosis; D012189:Retrospective Studies; D012475:Salmonella / Q000302:isolation & purification; D012480:Salmonella Infections / Q000097:blood* / Q000175:diagnosis; D013290:Streptococcal Infections / Q000097:blood / Q000175:diagnosis; D013296:Streptococcus pneumoniae / Q000302:isolation & purification; D013297:Streptococcus pyogenes / Q000302:isolation & purification; D013997:Time Factors
keywords: Bloodstream infections; hospital-acquired (nosocomial) infections; microbiology; paediatrics