A new multicenter study that was published on January 11, 2024, in The Journal of Pediatrics has reported that approximately 10% of low-risk febrile infants have contaminated cultures during their evaluation process. This cross-sectional secondary analysis involved 4042 infants and has brought to light significant insights with potential to enhance patient safety measures and reduce the number of unnecessary cultures.
The study, spearheaded by a team of researchers from prestigious institutions, assessed the prevalence of contaminated organism growth in blood, urine, and cerebrospinal fluid (CSF) cultures obtained from febrile infants identified as low risk for invasive bacterial infection. According to the findings, contamination rates were 4.9% for blood cultures, 5.0% for urine cultures, and 1.8% for cerebrospinal fluid cultures. This information is invaluable, as it underscores the need for improved sterile techniques in the evaluation of these vulnerable patients.
Febrile infants, typically defined as those under three months of age with a fever of 38°C or higher, are a significant focus for pediatric emergency measures. While the majority of these fevers are due to viral infections, a small percentage may be attributed to serious bacterial infections, necessitating the need for careful and accurate diagnostic culture procedures.
The study’s lead author Nidhi V. Singh from the Division of Pediatric Emergency Medicine at Baylor College of Medicine, along with other contributors such as Colleen K. Gutman from the University of Florida College of Medicine and a team spread across various institutions, have highlighted an issue with broad implications for pediatric health care.
The presence of contaminants in cultures can lead to unnecessary treatments, extended hospital stays, increased healthcare costs, and the mismanagement of actual bacterial infections. As such, these findings underscore the importance of maintaining sterile conditions during the collection of cultures to ensure accuracy in identifying true bacterial infections.
While contaminants in culture samples are a common problem in clinical practice, this study’s comprehensive approach provides quantifiable data to inform better practices. Researchers point out that contamination can result from several factors, including but not limited to, improper skin antisepsis, technique during specimen collection, and sample processing errors.
The study also addresses the true cost of contamination, emphasizing that not all positive cultures signify an actual infection. Misinterpreting contaminants as pathogens can lead to the overuse of antibiotics and other unnecessary interventions, which are not without risks to the patient – particularly the development of resistance to antibiotics and the distress caused by invasive procedures.
Debate continues on the best practices to reduce contamination rates, with suggestions including meticulous adherence to sterile techniques and the appropriate training of medical personnel involved in collecting cultures.
Given its significant findings, this study has vital implications for patient safety standards and can guide health policies and clinical protocols. Authorities and healthcare providers are called upon to take note of these insights and push for implementing strict guidelines to avert the potential risks that contaminated cultures pose.
References
1. Singh, N. V., Gutman, C. K., Green, R. S., et al. (2024). Contaminant Organism Growth in Febrile Infants at Low Risk for Invasive Bacterial Infection. The Journal of Pediatrics, 113910. doi:10.1016/j.jpeds.2024.113910
2. American Academy of Pediatrics Subcommittee on Urinary Tract Infection; Steering Committee on Quality Improvement and Management. (2011). The diagnosis and management of the initial urinary tract infection in febrile infants and young children. Pediatrics, 128(3), 595–610. doi:10.1542/peds.2011-1330
3. Biondi, E. A., Evans, R., Mischler, M., et al. (2013). Epidemiology of Bacteremia in Febrile Infants in the United States. Pediatrics, 132(6), 990–996. doi:10.1542/peds.2013-1751
4. Byington, C. L., Reynolds, C. C., Korgenski, K., et al. (2013). Costs and infant outcomes after implementation of a care process model for febrile infants. Pediatrics, 132(1), e34-e40. doi:10.1542/peds.2012-2634
5. Greenhow, T. L., Hung, Y. Y., Herz, A. M. (2014). The changing epidemiology of serious bacterial infections in young infants. Pediatric Infectious Disease Journal, 33(6), 595–599. doi:10.1097/INF.0000000000000233
DOI: 10.1016/j.jpeds.2024.113910
Keywords
1. Febrile infants
2. Contaminated cultures
3. Sterile technique
4. Pediatric emergency medicine
5. Invasive bacterial infection