دانلود مجله اطفال – آوریل 2024

In this volume of The Journal Singh et al perform a secondary analysis of a study of low-risk febrile infants evaluated in the emergency department (ED). The authors focused on contaminated cultures using specific criteria to define contamination in blood, urine, and cerebrospinal fluid (CSF) specimens. Surprisingly, nearly 10% had contaminated cultures, 4.9% of blood cultures, 5.0% of urine cultures, and 1.8% of CSF cultures. These findings are concerning and speak to some foundational practices that still hold true. First, ensuring sterile technique is both possible and necessary. The authors’ own data illustrate wide institution-by-institution variability in proportion of cultures that were contaminated, and the rates exceed those attained in centers with initiatives aimed at reducing blood culture contamination. Moreover, given the increased healthcare utilization including emergency department (ED) visits and hospitalizations for those with contaminant growth in blood or CSF, the impact of proper technique on both family stress and healthcare costs cannot be overstated. Second, the authors underscore the imperative to be mindful of why a culture is sent. Too often it is convenient to send a sample “because we had enough urine when we sent the urinalysis” or “because we happen to have the blood.” Guidelines are developed accounting for the risks of both false negative and false positive findings. The most recent AAP guidelines1 would stipulate that among these 29 to 60 days old infants urine cultures are no longer recommended if the urinalysis is normal. It is telling 3710 of 4042, or 91.8%, had a urine culture in the present study. It is unlikely that urinary tract infection was believed to be the likely diagnosis in these patients. These practices are neither earth-shattering nor radical expectations. Sometimes the most foundational principles centered on proper technique, mindful practice, and appropriate intent when ordering testing are the most important.