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Factors Predicting Blood Culture Positivity in Children With Enteric Fever

BACKGROUND: Blood culture, despite low sensitivity, is the gold standard for enteric fever diagnosis. Understanding predictors of blood culture positivity may help design strategies to optimize enteric fever diagnosis. METHODS: A cohort of 6760 children aged 0.5–15 years was followed for 3 years for...

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Autores principales: Srinivasan, Manikandan, Sindhu, Kulandaipalayam Natarajan, Ramanujam, Karthikeyan, Ramasamy, Ranjith Kumar, Subramaniam, Sathyapriya, Ganesan, Santhosh Kumar, Vajja, Swathi, David, Anita Shirley, Lankala, Pramitha, Rose, Winsley, Moses, Prabhakar D, Grassly, Nicholas C, Kang, Gagandeep, John, Jacob
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8892536/
https://www.ncbi.nlm.nih.gov/pubmed/35238358
http://dx.doi.org/10.1093/infdis/jiab357
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author Srinivasan, Manikandan
Sindhu, Kulandaipalayam Natarajan
Ramanujam, Karthikeyan
Ramasamy, Ranjith Kumar
Subramaniam, Sathyapriya
Ganesan, Santhosh Kumar
Vajja, Swathi
David, Anita Shirley
Lankala, Pramitha
Rose, Winsley
Moses, Prabhakar D
Grassly, Nicholas C
Kang, Gagandeep
John, Jacob
author_facet Srinivasan, Manikandan
Sindhu, Kulandaipalayam Natarajan
Ramanujam, Karthikeyan
Ramasamy, Ranjith Kumar
Subramaniam, Sathyapriya
Ganesan, Santhosh Kumar
Vajja, Swathi
David, Anita Shirley
Lankala, Pramitha
Rose, Winsley
Moses, Prabhakar D
Grassly, Nicholas C
Kang, Gagandeep
John, Jacob
author_sort Srinivasan, Manikandan
collection PubMed
description BACKGROUND: Blood culture, despite low sensitivity, is the gold standard for enteric fever diagnosis. Understanding predictors of blood culture positivity may help design strategies to optimize enteric fever diagnosis. METHODS: A cohort of 6760 children aged 0.5–15 years was followed for 3 years for enteric fever with blood cultures in an automated system, for fevers >3 days. Factors affecting test positivity in fevers and participant-level predictors for culture refusals were analyzed using regression models. RESULTS: Overall, 6097 suspected typhoid/paratyphoid fever (STF) episodes were reported, of which 5703 (93.5%) STFs had sampling for blood cultures, with 394 (6.5%) refusals. Salmonella enterica serovar Typhi/Paratyphi positivity was culture-confirmed in 3.8% (218/5703) of STF episodes. Older children (odds ratio [OR], 1.96 [95% CI, 1.39–2.77]), larger blood volume inoculated (OR, 2.82 [95% CI, 1.71–4.66]), higher temperatures during fever (OR, 3.77 [95% CI, 2.89–4.91]), and fevers diagnosed as suspected typhoid or acute undifferentiated fever (OR, 6.06 [95% CI, 3.11–11.78]) had a higher probability of culture positivity. Antibiotics before culture did not decrease culture positivity. Blood culture refusals were higher for children from wealthier households or with milder illness. CONCLUSIONS: Performing blood cultures in older children with fever, especially those fevers with toxic presentation and increasing blood volume for inoculation are strategies to improve enteric fever detection in surveillance settings.
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spelling pubmed-88925362022-03-04 Factors Predicting Blood Culture Positivity in Children With Enteric Fever Srinivasan, Manikandan Sindhu, Kulandaipalayam Natarajan Ramanujam, Karthikeyan Ramasamy, Ranjith Kumar Subramaniam, Sathyapriya Ganesan, Santhosh Kumar Vajja, Swathi David, Anita Shirley Lankala, Pramitha Rose, Winsley Moses, Prabhakar D Grassly, Nicholas C Kang, Gagandeep John, Jacob J Infect Dis Supplement Articles BACKGROUND: Blood culture, despite low sensitivity, is the gold standard for enteric fever diagnosis. Understanding predictors of blood culture positivity may help design strategies to optimize enteric fever diagnosis. METHODS: A cohort of 6760 children aged 0.5–15 years was followed for 3 years for enteric fever with blood cultures in an automated system, for fevers >3 days. Factors affecting test positivity in fevers and participant-level predictors for culture refusals were analyzed using regression models. RESULTS: Overall, 6097 suspected typhoid/paratyphoid fever (STF) episodes were reported, of which 5703 (93.5%) STFs had sampling for blood cultures, with 394 (6.5%) refusals. Salmonella enterica serovar Typhi/Paratyphi positivity was culture-confirmed in 3.8% (218/5703) of STF episodes. Older children (odds ratio [OR], 1.96 [95% CI, 1.39–2.77]), larger blood volume inoculated (OR, 2.82 [95% CI, 1.71–4.66]), higher temperatures during fever (OR, 3.77 [95% CI, 2.89–4.91]), and fevers diagnosed as suspected typhoid or acute undifferentiated fever (OR, 6.06 [95% CI, 3.11–11.78]) had a higher probability of culture positivity. Antibiotics before culture did not decrease culture positivity. Blood culture refusals were higher for children from wealthier households or with milder illness. CONCLUSIONS: Performing blood cultures in older children with fever, especially those fevers with toxic presentation and increasing blood volume for inoculation are strategies to improve enteric fever detection in surveillance settings. Oxford University Press 2021-11-23 /pmc/articles/PMC8892536/ /pubmed/35238358 http://dx.doi.org/10.1093/infdis/jiab357 Text en © The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Supplement Articles
Srinivasan, Manikandan
Sindhu, Kulandaipalayam Natarajan
Ramanujam, Karthikeyan
Ramasamy, Ranjith Kumar
Subramaniam, Sathyapriya
Ganesan, Santhosh Kumar
Vajja, Swathi
David, Anita Shirley
Lankala, Pramitha
Rose, Winsley
Moses, Prabhakar D
Grassly, Nicholas C
Kang, Gagandeep
John, Jacob
Factors Predicting Blood Culture Positivity in Children With Enteric Fever
title Factors Predicting Blood Culture Positivity in Children With Enteric Fever
title_full Factors Predicting Blood Culture Positivity in Children With Enteric Fever
title_fullStr Factors Predicting Blood Culture Positivity in Children With Enteric Fever
title_full_unstemmed Factors Predicting Blood Culture Positivity in Children With Enteric Fever
title_short Factors Predicting Blood Culture Positivity in Children With Enteric Fever
title_sort factors predicting blood culture positivity in children with enteric fever
topic Supplement Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8892536/
https://www.ncbi.nlm.nih.gov/pubmed/35238358
http://dx.doi.org/10.1093/infdis/jiab357
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