Abstract
Background
Traditionally, clinicians would wait for the absence of growth in BC for 48 hours to consider a BC negative. A BC with a positive gram stain necessitated a repeat BC and antibiotics prior to final identification. Blood culture identification (BCID) PCR has the potential to shorten this time course, particularly with pathogens that are considered “contaminants.” There is no published data which addresses the clinical significance of more rapidly identifying contaminants.
Methods
This is a retrospective chart review of data collected from children (ages 2 months- 18 years) treated at Cohen Children’s Medical Center, who had a positive BC deemed a contaminant. A 2.5-year period prior to and after implementation of PCR technology was observed (September 2015–November 2018). A contaminant was defined as bacteria that is not considered virulent in an immunocompetent patient. Patients with indwelling catheters, those who have undergone corrective cardiac surgery or are immunocompromised were excluded from analysis. Data collected included length of stay, antibiotic duration and whether a patient received a repeat BC.
Results
136 patients during this time (49% (n = 67) pre-PCR and 51% (n = 69) post-PCR) had positive BC for nonvirulent bacteria. Patients in the pre-PCR period received BC only, while those in the post-PCR period received both BC and PCR, with all BC and PCR results being concordant. The proportion of patients who did not receive antibiotics was greater in the post-PCR group (70%, 48 of 69) compared with the pre-PCR group (45%, 30 of 67), P < 0.01. Of those who received antibiotics, the proportion of patients who received more than 1 dose was significantly lower in the post-PCR group (43%, 9 of 21) compared with the pre-PCR group (73%, 27 of 37), P < 0.025. The proportion of patients who had a repeat BC was significantly lower in the post-PCR group (58%, 40 of 69), compared with the pre-PCR group (82%, 55 of 67), P = 0.0022. The proportion of patients who were asked to return to the emergency department was significantly lower in the post-PCR group (59%, 16 of 27), compared with the pre-PCR group (88%, 23 of 26), P = 0.016.
Conclusion
With the addition of PCR technology, patients with BC positive for nonpathogenic bacteria have received less antibiotics, less repeat BCs and were less frequently asked to return for evaluation.#8232;
Disclosures
All authors: No reported disclosures.
Session: 159. Pediatric Bacterial Diseases: Diagnosis and Management
Friday, October 4, 2019: 12:15 PM