Identifying optimal conditions for diagnosis of bloodstream infection in paediatric patients: A scoping review

Project overview 

This project was designed to help inform NHS best practice when identifying bloodstream infections and sepsis in infants and children. This was achieved by reviewing the published evidence on what are the optimal conditions for diagnosis of bloodstream infection in paediatric patients, when using blood cultures. An online evidence map was produced to summarise the full evidence and a narrative synthesis was performed for key concepts and themes.

Status: ongoing

Contact: mark.simmonds@york.ac.uk 

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What is the problem?

Sepsis and other bloodstream infections are a major risk to child health. In the UK, around 25,000 children are affected by sepsis every year, of which around 2,000 children die from sepsis. Blood infection is normally diagnosed by a prompt blood test, which is sent to a laboratory to test for presence of bacteria. This is called a blood culture. Although there are guidelines for blood culture in adults, a significant proportion of paediatric blood cultures fall below the minimum recommended volumes, and guidance on best practice in children is limited.  Rapid identification of sepsis is a national priority and there are concerns that blood cultures may not always be performed properly on children, so evidence-based guidance in this area is urgently required.

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What are we doing? 

This project reviewed all the available literature on taking blood cultures in children to detect blood stream infections. A scoping review was conducted to identify and broadly categorise and summarise the available evidence on blood culture collection in children. We searched medical databases to identify all relevant studies related to blood culture in children from the point at which an infection is suspected to when a blood sample is sent to a laboratory for testing. A range of themes were considered including the volume of blood to be collected, types of sample bottle, multiple and repeated testing, site preparation, storage and transportation, and education and interventions to improve practice.

The identified studies are presented and summarised in an online “Evidence Map” which categorises studies by theme, population and other characteristics so the range of evidence can be seen. A further narrative review of studies on key concepts, such as total blood volume to collect, was performed to help identify best practice when taking blood cultures.