476. Evaluation of Pediatric Blood Culture Ordering Practice in Post-Pneumococcal Vaccination Era in Emergency Department
Session: Poster Abstract Session: Pediatric Infections: Bacterial and Parasite
Thursday, October 18, 2012
Room: SDCC Poster Hall F-H
  • IDSA poster (final version).jpg (761.1 kB)
  • Background:

    The rate of occult bacteremia in pediatric patients is at < 1% after the introduction of effective Haemophilus influenzaetype B (Hib) and Pneumococcal (PCV7) vaccines. Despite published guidelines and consensus reports, there is a lot of variability in predicting pediatric patients at risk of bacteremia presenting to the emergency department (ED). We evaluated the current practice of blood cultures ordered in the ED at our institution


    This was a single center, retrospective study of 200 randomly selected patients’ ≤ 17 years old with a blood culture order in the ED between August 2009 to August 2011. Outcomes such as appropriateness of blood culture and empiric therapy were assessed. Appropriate blood culture was based on predictors of bacteremia and time to antibiotics administration. Appropriate empiric therapy in our study was defined as antibiotic administered after obtaining blood cultures, appropriate dose, coverage and duration

    Results: Blood cultures were done in 86.5% (173/200) of pediatric patients in the ED. The rate of bacteremia was 3.3 % in patients who had predictor of bacteremia present (N=148) and 3.8% in patients with absence of predictor (N=52). The rate of bacteremia in patients with appropriate blood culture (N=77) was 3.8 %. Out of 109 patients who received empiric therapy, only 69 (63%) patients received appropriate empiric therapy. Of the 61 patients who received appropriate empiric therapy based on the predictors of bacteremia, 3 yielded pathogenic bacteria (S. Pneumoniae, Methicillin Resistant S. aureus) with up-to date vaccinations. Majority of the patients were African-American males between 3 yrs -17 yrs (47.5%), with mean vaccination rate of 86.5%. Predictors of bacteremia used to rule out patients between 3 months-36 months who did not qualify for blood culture had high specificity and negative predictive value


    In the PCV7 era, up-to date vaccinations has resulted in low yield of occult bacteremia (4.3 %) in pediatric patients at our institution but is relatively higher compared to other institutions (< 1%). Routine practice of obtaining blood cultures in healthy, well appearing, age 3 months-36 months (in absence of predictors of bacteremia) and up-to date vaccinations should be re-assessed

    Gargi Patel, Pharm D1, Stephan Kohlhoff, MD2, Nooruddin Tejani, MD3 and Roopali Sharma, PharmD2, (1)Pharmacy, State University of New York, Downstate Medical Center, Brooklyn, NY, (2)SUNY Downstate Medical Center, Brooklyn, NY, (3)Emergency Pediatric Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY


    G. Patel, None

    S. Kohlhoff, None

    N. Tejani, None

    R. Sharma, None

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