You could be reading the full-text of this article now if you...

If you have access to this article through your institution,
you can view this article in

Predictors of Positive Cerebrospinal Fluid Cultures in Infants With Bacteremia

Beam, Kristyn S.*; Laughon, Matthew M. MD, MPH*†; Hornik, Christoph P. MD, MPH; Cohen-Wolkowiez, Michael MD, PhD; Clark, Reese H. MD; Benjamin, Daniel K. Jr. MD, PhD; Smith, P. Brian MD, MPH, MHS

Pediatric Infectious Disease Journal:
doi: 10.1097/INF.0000000000000115
Original Studies
Abstract

Background: Meningitis causes substantial morbidity and mortality in hospitalized infants. There is no consensus on the ability of blood cultures to predict results from cerebrospinal fluid (CSF) cultures in hospitalized infants.

Methods: We used the Pediatrix Medical Group database of infants discharged from 333 neonatal intensive care units between 1997 and 2011. We identified all infants with a positive blood culture and a CSF culture obtained within 3 days. We evaluated the odds of a concordant blood-CSF culture pair, controlling for severity of illness, organism type, gestational age, day of blood culture and blood-CSF culture pairing, exposure to CSF-penetrating antibiotics and the presence of a ventriculo-peritoneal shunt.

Results: We identified 8839 infants with 9408 blood-CSF culture pairs. Serratia marcescens (24/227, 11%) and Streptococcus pneumoniae (7/64, 11%) had the highest proportion of concordant blood-CSF culture pairs. The presence of a ventriculo-peritoneal shunt, as well as timing of the CSF culture on the same day as the blood culture, were associated with increased odds of blood-CSF culture pair concordance—odds ratio = 3.87 (95% confidence interval; 2.59–5.78) and 6.11 (2.81–13.24), respectively.

Conclusion: The frequency of blood-CSF culture pair concordance is related to organism type and to the timing of the CSF culture in relation to the blood culture.

Author Information

From the *Department of Pediatrics, University of North Carolina, Chapel Hill; Duke Clinical Research Institute, Duke University Medical Center, Durham, NC; and Pediatrix Medical Group, Sunrise, FL.

Accepted for publication October 3, 2013.

This work was supported by the American Recovery and Reinvestment Act, DHHS-1R18AE000028-01 (P.B.S). This work was also supported by a grant from the Doris Duke Charitable Foundation to UNC-Chapel Hill School of Medicine to fund clinical research fellow Kristyn S. Beam. Dr. Laughon receives support from the U.S. government for his work in pediatric and neonatal clinical pharmacology (Government Contract HHSN267200700051C, PI: Benjamin under the Best Pharmaceuticals for Children Act) and from NICHD (1K23HL092225-01). Dr. Cohen-Wolkowiez receives support for research from the National Institutes of Health (NIH) (1K23HD064814), the National Center for Advancing Translational Sciences of the NIH (UL1TR001117), the Food and Drug Administration (1U01FD004858-01), the Biomedical Advanced Research and Development Authority (BARDA) (HHSO100201300009C), the nonprofit organization Thrasher Research Fund (www.thrasherresearch.org), and from industry for drug development in adults and children (http://http://www.dcri.duke.edu/research/coi.jsp). Dr. Benjamin receives support from the United States government for his work in pediatric and neonatal clinical pharmacology (1R01HD057956-05, 1K24HD058735-05, and NICHD contract HHSN275201000003I) and the nonprofit organization Thrasher Research Fund for his work in neonatal candidiasis (http://www.thrasherresearch.org); he also receives research support from industry for neonatal and pediatric drug development (www.dcri.duke.edu/research/coi.jsp). Dr. Smith receives salary support for research from the National Institutes of Health (NIH), the U.S. Department of Health and Human Services, and the National Center for Advancing Translational Sciences of the NIH (DHHS-1R18AE000028-01, HHSN267200700051C, HHSN275201000003I, and UL1TR001117); he also receives research support from industry for neonatal and pediatric drug development (www.dcri.duke.edu/research/coi.jsp).

Research reported in this publication was also supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR001117. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

The funding organizations played no role in the study design; collection, analysis, and interpretation of the data; the writing of the article or the decision to submit the article for publication.

Address for correspondence: P. Brian Smith, MD, MPH, MHS, Duke Clinical Research Institute, Box 17969, Durham, NC 27715.E-mail: brian.smith@duke.edu.

© 2014 by Lippincott Williams & Wilkins, Inc.