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- Title
Factors Predicting Blood Culture Positivity in Children With Enteric Fever.
- Authors
Srinivasan, Manikandan; Sindhu, Kulandaipalayam Natarajan; Ramanujam, Karthikeyan; Ramasamy, Ranjith Kumar; Subramaniam, Sathyapriya; Ganesan, Santhosh Kumar; Vajja, Swathi; David, Anita Shirley; Lankala, Pramitha; Rose, Winsley; Moses, Prabhakar D; Grassly, Nicholas C; Kang, Gagandeep; John, Jacob
- Abstract
<bold>Background: </bold>Blood culture, despite low sensitivity, is the gold standard for enteric fever diagnosis. Understanding predictors of blood culture positivity may help design strategies to optimize enteric fever diagnosis.<bold>Methods: </bold>A cohort of 6760 children aged 0.5-15 years was followed for 3 years for enteric fever with blood cultures in an automated system, for fevers >3 days. Factors affecting test positivity in fevers and participant-level predictors for culture refusals were analyzed using regression models.<bold>Results: </bold>Overall, 6097 suspected typhoid/paratyphoid fever (STF) episodes were reported, of which 5703 (93.5%) STFs had sampling for blood cultures, with 394 (6.5%) refusals. Salmonella enterica serovar Typhi/Paratyphi positivity was culture-confirmed in 3.8% (218/5703) of STF episodes. Older children (odds ratio [OR], 1.96 [95% CI, 1.39-2.77]), larger blood volume inoculated (OR, 2.82 [95% CI, 1.71-4.66]), higher temperatures during fever (OR, 3.77 [95% CI, 2.89-4.91]), and fevers diagnosed as suspected typhoid or acute undifferentiated fever (OR, 6.06 [95% CI, 3.11-11.78]) had a higher probability of culture positivity. Antibiotics before culture did not decrease culture positivity. Blood culture refusals were higher for children from wealthier households or with milder illness.<bold>Conclusions: </bold>Performing blood cultures in older children with fever, especially those fevers with toxic presentation and increasing blood volume for inoculation are strategies to improve enteric fever detection in surveillance settings.
- Subjects
TYPHOID fever; SALMONELLA enterica serovar Typhi; BLOOD volume; OPTIMISM
- Publication
Journal of Infectious Diseases, 2021, Vol 224, pS484
- ISSN
0022-1899
- Publication type
journal article
- DOI
10.1093/infdis/jiab357