Evaluating blood culture collection practice in children hospitalized with acute illness at a tertiary hospital in Malawi

Background

Blood culture collection practice in low-resource settings where routine blood culture collection is available has not been previously described.

Methodology

We conducted a secondary descriptive analysis of children aged 2-23 months enrolled in the Malawi Childhood Acute Illness and Nutrition (CHAIN) study, stratified by whether an admission blood culture had been undertaken and by nutritional status. Chi-square test was used to compare the differences between groups.

Results

A total of 347 children were included, of whom 161 (46%) had a blood culture collected. Children who had a blood culture collected, compared to those who did not, were more likely to present with sepsis (43% vs. 20%, p<0.001), gastroenteritis (43% vs. 26%, p<0.001), fever (86% vs. 73%, p=0.004), and with poor feeding/weight loss (30% vs. 18%, p=0.008). In addition, hospital stay in those who had a blood culture was, on average, 2 days longer (p=0.019). No difference in mortality was observed between those who did or did not have a blood culture obtained.

Conclusion

Blood culture collection was more frequent in children with sepsis and gastroenteritis, but was not associated with mortality. In low-resource settings, developing criteria for blood culture based on risk factors rather than clinician judgement may better utilise the existing resources.