{
  "abstract": "Background Blood culture (BC) in children has relatively low diagnostic yield and high contamination rates, limiting cost-effectiveness. We aimed to determine readily available baseline characteristics to identify hospitalised children with a likelihood of higher diagnostic yield in low- and middle-income countries.Methods We used data from ACORN2, a prospective clinical surveillance network including 19 hospitals across Africa and Asia. We included participants <18 years, hospitalised for a suspected infection, prescribed parenteral antibiotics and with a BC sample. Sociodemographic and clinical data were recorded for each infection episode and linked to routine microbiology data. We described true pathogen (non-contaminant) BC positivity proportion and performed mixed-effects logistic regression, with study site and patient as the random effect, to identify factors associated with BC positivity.Results Of the 26 407 paediatric infection episodes, 17 815 (67%) had a BC sample and 15 384 were included in the analysis. BC results were: true pathogens in 689 (4.5%), contaminants in 1399 (9%) and uncertain pathogens in 143 (0.9%). In the multivariable model, factors associated with a positive BC were age (29 days–12-month-olds OR 1.33, 95% CI 1.06 to 1.66 and 5–18 year-olds OR 1.62, 95% CI 1.30 to 2.01 vs 1–4 year-olds), number of clinical severity signs (OR 1.29, 95% CI 1.18 to 1.40 per one sign) and hospital acquired infection (OR 3.05, 95% CI 2.30 to 4.06 vs community-acquired). Suspected diagnosis of sepsis (OR 2.09, 95% CI 1.67 to 2.61), gastrointestinal/abdominal (OR 2.36, 95% CI 1.78 to 3.13), skin and soft tissue or bone (OR 3.64, 95% CI 2.57 to 5.14) and genitourinary infection (OR 2.22, 95% CI 1.39 to 3.56) were more likely to have a positive BC, compared with respiratory infections.Conclusion We confirmed the low BC yield among hospitalised children. We identified groups for which diagnostic stewardship efforts to increase BC uptake should be prioritised and others in which it could be limited in times of financial or logistic constraints.",
  "authors": [
    {
      "affiliations": [
        "Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia"
      ],
      "name": "Cristina Ardura-Garcia"
    },
    {
      "affiliations": [
        "Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia",
        "Centre for Tropical Medicine and Global Health, University of Oxford Nuffield Department of Medicine, Oxford, UK"
      ],
      "name": "Jill Hopkins"
    },
    {
      "affiliations": [
        "Centre for Tropical Medicine and Global Health, University of Oxford Nuffield Department of Medicine, Oxford, UK",
        "Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University Faculty of Tropical Medicine, Bangkok, Thailand",
        "Department of Infectious Diseases, The Alfred Hospital and School of Translational Medicine, Monash University, Melbourne, Victoria, Australia"
      ],
      "name": "Sue J Lee"
    },
    {
      "affiliations": [
        "Centre for Tropical Medicine and Global Health, University of Oxford Nuffield Department of Medicine, Oxford, UK",
        "Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University Faculty of Tropical Medicine, Bangkok, Thailand"
      ],
      "name": "Naomi Waithira"
    },
    {
      "affiliations": [
        "Centre for Tropical Medicine and Global Health, University of Oxford Nuffield Department of Medicine, Oxford, UK",
        "Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University Faculty of Tropical Medicine, Bangkok, Thailand",
        "Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, เวียงจันทน์, Lao People’s Democratic Republic"
      ],
      "name": "Chris Painter"
    },
    {
      "affiliations": [
        "Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia",
        "Centre for Tropical Medicine and Global Health, University of Oxford Nuffield Department of Medicine, Oxford, UK"
      ],
      "name": "Clare L Ling"
    },
    {
      "affiliations": [
        "Centre for Tropical Medicine and Global Health, University of Oxford Nuffield Department of Medicine, Oxford, UK",
        "Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, เวียงจันทน์, Lao People’s Democratic Republic"
      ],
      "name": "Tamalee Roberts"
    },
    {
      "affiliations": [
        "Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia"
      ],
      "name": "Thyl Miliya"
    },
    {
      "affiliations": [
        "Department of Microbiology, University of Ghana School of Biomedical and Allied Health Sciences, Accra, Ghana"
      ],
      "name": "Noah Obeng-Nkrumah"
    },
    {
      "affiliations": [
        "Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana"
      ],
      "name": "Japheth A Opintan"
    },
    {
      "affiliations": [
        "Paediatric Division, 37 Military Hospital, Accra, Ghana"
      ],
      "name": "Emmanuel P Abbeyquaye"
    },
    {
      "affiliations": [
        "Centre for Tropical Medicine and Global Health, University of Oxford Nuffield Department of Medicine, Oxford, UK",
        "Oxford University Clinical Research Unit Indonesia, Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, Jawa Barat, Indonesia"
      ],
      "name": "Raph L. Hamers"
    },
    {
      "affiliations": [
        "Department of Microbiology, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National Hospital, Jakarta, Indonesia",
        "PT PELNI Hospital, Jakarta, Jakarta, Indonesia"
      ],
      "name": "Yulia R Saharman"
    },
    {
      "affiliations": [
        "PT PELNI Hospital, Jakarta, Jakarta, Indonesia",
        "Division of Tropical and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National Hospital, Jakarta, Indonesia"
      ],
      "name": "Robert Sinto"
    },
    {
      "affiliations": [
        "Department of Child Health, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National Hospital, Jakarta, Indonesia"
      ],
      "name": "Mulya R Karyanti"
    },
    {
      "affiliations": [
        "Department of Microbiology, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National Hospital, Jakarta, Indonesia",
        "University of Indonesia Hospital, Jakarta, Indonesia"
      ],
      "name": "R Fera Ibrahim"
    },
    {
      "affiliations": [
        "KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya"
      ],
      "name": "Samuel O Akech"
    },
    {
      "affiliations": [
        "Microbiology Laboratory, Mahosot Hospital, Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Lao People’s Democratic Republic"
      ],
      "name": "Anousone Duangnouvong"
    },
    {
      "affiliations": [
        "Setthathirath Hospital, Vientiane, Lao People’s Democratic Republic"
      ],
      "name": "Khamla Choumlivong"
    },
    {
      "affiliations": [
        "Malawi Liverpool Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi",
        "University of St Andrews School of Medicine, St Andrews, UK",
        "Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK"
      ],
      "name": "Nicholas A Feasey"
    },
    {
      "affiliations": [
        "Malawi Liverpool Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi"
      ],
      "name": "Diana Kululanga"
    },
    {
      "affiliations": [
        "Malawi Liverpool Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi",
        "University of Liverpool Institute of Infection and Global Health, Liverpool, UK"
      ],
      "name": "Samantha Lissauer"
    },
    {
      "affiliations": [
        "Oxford University Clinical Research Unit Nepal, Lalitpur, Nepal"
      ],
      "name": "Abhilasha Karkey"
    },
    {
      "affiliations": [
        "Oxford University Clinical Research Unit Nepal, Lalitpur, Nepal"
      ],
      "name": "Narayan Kunwar"
    },
    {
      "affiliations": [
        "Department of Medical Microbiology and Parasitology, University of Ibadan College of Medicine, Ibadan, Nigeria"
      ],
      "name": "Justice E Erakhaiwu"
    },
    {
      "affiliations": [
        "Department of Pharmaceutical Microbiology, Faculty of Pharmacy / Department of Medical Microbiology and Parasitology, University of Ibadan College of Medicine, Ibadan, Nigeria"
      ],
      "name": "Iruka N Okeke"
    },
    {
      "affiliations": [
        "Department of Medical Microbiology and Parasitology, University College Hospital Ibadan, Ibadan, Nigeria"
      ],
      "name": "Ini Adebiyi"
    },
    {
      "affiliations": [
        "Department of Medical Microbiology and Parasitology, University College Hospital Ibadan, Ibadan, Nigeria"
      ],
      "name": "Abiodun B Oduola"
    },
    {
      "affiliations": [
        "University College Hospital Ibadan, Ibadan, Nigeria",
        "University of Ibadan, Ibadan, Nigeria"
      ],
      "name": "Babatunde O Ogunbosi"
    },
    {
      "affiliations": [
        "Department of Padiatrics, University of Ibadan College of Medicine, Ibadan, Nigeria"
      ],
      "name": "Olukemi O Tongo"
    },
    {
      "affiliations": [
        "Paediatric Infectious Diseases Unit, University College Hospital Ibadan, Ibadan, Nigeria"
      ],
      "name": "Ifeoma A Ude"
    },
    {
      "affiliations": [
        "Obafemi Awolowo University College of Health Sciences, Ile-Ife, Nigeria"
      ],
      "name": "Oladipo Aboderin"
    },
    {
      "affiliations": [
        "Obafemi Awolowo University College of Health Sciences, Ile-Ife, Nigeria"
      ],
      "name": "Adeyemi T Adeyemo"
    },
    {
      "affiliations": [
        "Obafemi Awolowo University College of Health Sciences, Ile-Ife, Nigeria"
      ],
      "name": "Sylvester S Edward"
    },
    {
      "affiliations": [
        "Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria"
      ],
      "name": "Ugowe Osagie"
    },
    {
      "affiliations": [
        "Oxford University Clinical Research Unit, Hanoi, Viet Nam"
      ],
      "name": "Hoa Nguyen Thi"
    },
    {
      "affiliations": [
        "National Hospital of Tropical Diseases, Hanoi, Viet Nam"
      ],
      "name": "Pham Ngoc Thach"
    },
    {
      "affiliations": [
        "National Hospital of Tropical Diseases, Hanoi, Viet Nam",
        "Hanoi Medical University, Hanoi, Viet Nam"
      ],
      "name": "Tran Van Giang"
    },
    {
      "affiliations": [
        "Hue Central Hospital, Hue, Viet Nam"
      ],
      "name": "Lan Huong Hoang Thi"
    },
    {
      "affiliations": [
        "Children’s Hospital 2, Ho Chi Minh City, Viet Nam"
      ],
      "name": "Huu Tung Trinh"
    },
    {
      "affiliations": [
        "Centre for Tropical Medicine and Global Health, University of Oxford Nuffield Department of Medicine, Oxford, UK",
        "Oxford University Clinical Research Unit, Hanoi, Viet Nam"
      ],
      "name": "H. Rogier van Doorn"
    },
    {
      "affiliations": [
        "Centre for Tropical Medicine and Global Health, University of Oxford Nuffield Department of Medicine, Oxford, UK",
        "Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, เวียงจันทน์, Lao People’s Democratic Republic"
      ],
      "name": "Elizabeth A Ashley"
    },
    {
      "affiliations": [
        "Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia",
        "Centre for Tropical Medicine and Global Health, University of Oxford Nuffield Department of Medicine, Oxford, UK"
      ],
      "name": "Paul Turner"
    }
  ],
  "title": "Factors associated with positive blood cultures in children in nine African and Asian countries: the ACORN2 surveillance network",
  "uid": "7d66b18e-d6dd-5226-8452-2c176dd815f6"
}