2018 Volume 67 Issue 5 Pages 766-771
The purpose of this study was to evaluate the effectiveness of laboratory parameters, namely, white blood cell count (WBCc), C-reactive protein (CRP) level, and endotoxin level, in children with bloodstream infection. This retrospective study included 151 cases that were divided into the true positive group (n = 126) and contaminated cultures (n = 25). All samples for bacteriological cultures were collected from children aged 0–18 years who were admitted to the Gunma Children’s Medical Center between April 2012 and March 2017. We defined day 0 as the day of the start of blood culture. CRP levels on day 0 were significantly higher in the true positive group than in the contaminated group. The cut-off CRP level on day 0 was 1.7 mg/dL to differentiate between true- and false-positive (contaminated) cultures. The sensitivity, specificity, and positive predictive values were 55.2%, 78.3%, and 93.3%, respectively. The CRP levels on day 0 may help clinicians in clinical decision making. However, normal levels of CRP should not be used to rule out culture-proven bloodstream infection. In addition, there were significant differences in the increase in CRP level from day 0 to the next day and the increase in WBCc from the previous day to day 0. These indicators seem to be references for the determination of bloodstream infection. In endotoxin assays, positive results were obtained from 9 (75.0%) of 12 patients with bloodstream infection due to Gram-negative bacilli. Endotoxin analysis should be useful as a guide to the initial management of patients suspected of having bloodstream infection due to Gram-negative bacilli.
