Microbiological culture methods for pediatric XXXX : a guideline for optimal use.

@entity1 @entity5414 @entity4034 @entity794 @entity281 @entity85 @entity6735
BACKGROUND: Culture results affect the diagnosis and treatment of @entity1 with @entity85 . To our knowledge, no previous large-scale study has assessed the relative value of culture methods employed during the evaluation of these conditions. The purpose of this study was to identify an optimal culture strategy for pediatric @entity85 . METHODS: @entity1 with @entity85 were retrospectively studied to assess culture results from the @entity281 site or blood; culture type, including aerobic, anaerobic, fungal, and acid-fast bacteria (AFB); antibiotic exposure history; and clinical history of @entity1 with positive culture results. RESULTS: We studied 869 @entity1 , including 353 with @entity4034 , 199 with @entity5414 , forty-two with @entity6735 , and 275 with abscess. The 4537 cultures processed included 1303 aerobic, 903 anaerobic, 340 fungal, 289 AFB, and 1702 blood. Of 3004 specimens sent during initial work-up, positive results occurred in 677 of 1049 aerobic cultures (64.5%), 140 of 763 blood cultures (18.3%), eighteen of 722 anaerobic cultures (2.5%), five of 251 fungal cultures (2.0%), and two of 219 AFB cultures (0.9%). @entity794 was the most common pathogen isolated, from 428 (50.7%) of 844 @entity1 for whom blood or @entity281 -site culture material was sent (methicillin-resistant @entity794 , 252; and oxacillin-sensitive @entity794 , 176). Cultures were negative in 206 (29.0%) of the 710 @entity1 for whom culture material from the site of @entity281 was sent. @entity1 with true-positive anaerobic, fungal, or AFB cultures had a history of immunocompromise, penetrating inoculation, or failed primary treatment. Antibiotic exposure prior to culture-sample acquisition did not interfere with aerobic culture results from the site of @entity281 . CONCLUSIONS: Our findings suggest that anaerobic, fungal, and AFB cultures should not be routinely performed during the initial evaluation of @entity1 with @entity85 . These cultures should be performed for @entity1 with immunocompromise, clinical suspicion of penetrating inoculation, or failed primary treatment. LEVEL OF EVIDENCE: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
