G89 Very Low Rates of Serious Invasive Bacterial Infections Identified in a Prospective Three-Year South West London and Surrey Population-Based Surveillance Programme. (4th June 2013)

• Record Type: Journal Article
• Authors: Doare, K Le; Nicholls, AL; Payne, H; Navidnia, S; Appleby, G; Carlton, E; Sharland, M; Ladhani, S
• Is Part Of: Archives of disease in childhood. Volume 98:Supplement 1(2013)
• Page Start: A44
• Page End: A44
• Publication Date: 2013-06-04
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2013-304107.101
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Aims: Following the introduction of conjugate childhood vaccines and declining trends in meningococcal disease over the past decade, community-acquired serious invasive bacterial infections in children have become less common but hospital admissions continue to rise. The objective of this study was to estimate the incidence of serious culture-confirmed invasive bacterial infections in children within a geographically-defined population over a three-year period. Methods: Blood and cerebrospinal fluid culture (CSF) results for all children aged 1 month to 16 years admitted to five South-West London (SWL) and Surrey hospitals during 2009–11 were obtained at regular intervals from each hospital microbiology department and a web-based questionnaire completed for all children with a positive culture. Hospital-acquired infection was defined as a significant pathogen isolated from a blood/CSF culture taken >48 hours after hospital admission. Results: During 2009–11, 44, 118 children had 46, 039 admissions to one of the five Hospitals, equivalent to 25.8 admissions per 1, 000 children resident in SWL and Surrey. Blood/CSF cultures were obtained during 44.7% (n = 20, 578) of admissions and 7.4% (n = 1, 530) had a positive culture. Of these, only 571 were defined as a clinically significant serious bacterial infection (SBI), equivalent to 37.3% of positive blood/CSF cultures, 2.8% of all blood/CSF cultures taken and 1.2% of all hospital admissions. The population incidence of SBI in SWL and Surrey was, therefore, 31.9/100, 000, with the highest incidence among 1–11 month-olds (172/100, 000), followed by 1–4 year-olds (34.3/100, 000) and 5–15 year-olds (16.4/100, 000). A third of the SBI (208/571, 36.4%), however, were hospital-acquired and, of the community-acquired infections, more than two-thirds (252/363, 69.4%) occurred in children with co-morbidities. The incidence of community-acquired SBI in previously healthy children in SWL and Surrey was, therefore, only 6.2/100, 000, with the highest incidence among 1–11 month-olds (33.9/100, 000), followed by 1–4 year-olds (6.5/100, 000) and 5–15 year-olds (3.2/100, 000). Conclusions: Although a SBI was suspected in almost half of all childhood hospital admissions in SWL and Surrey, a significant pathogen was identified in only 3%, mainly among children with pre-existing co-morbidities. Improved targeting of children at very low risk of a SBI at presentation will facilitate increased management of unw.