Follow-up Blood Cultures in Children With Staphylococcus aureus Bacteremia.

BACKGROUND: Staphylococcus aureus is a common pathogen seen in pediatric bloodstream infections. Currently, no evidence-based recommendations are used to guide decisions on the number of follow-up blood cultures (FUBCs) needed to demonstrate infection clearance. Unnecessary cultures increase the risk of false-positives, add to health care costs, and create additional trauma to children and their families. In this study, we examined risk factors for persistent S aureus bacteremia (SAB) and intermittent positive blood cultures (positive cultures obtained after a documented negative FUBC result) to determine the number of FUBCs needed to demonstrate infection clearance in children. METHODS: Patients ≤18 years who were hospitalized with SAB at Texas Children's Hospital in 2018 were reviewed. We assessed the impact of an infectious disease diagnosis (central line-associated bloodstream infection, osteomyelitis, soft tissue infection, endocarditis, etc) and medical comorbidities on bacteremia duration. Patients with intermittent positive blood cultures were studied to determine the characteristics of this group and overall frequency of reversion to positive cultures. RESULTS: A total of 122 subjects met the inclusion criteria. The median duration of bacteremia was 1 day (interquartile range: 1-2 days). Only 19 patients (16%) had bacteremia lasting ≥3 days, all of whom had a diagnosis of central line-associated bloodstream infection, osteomyelitis, or endocarditis. Intermittent positive cultures occurred in 5% of patients, with positive cultures after 2 negative FUBC results seen in <1% of patients. Intermittent positive cultures were strongly associated with osteomyelitis and endocarditis. CONCLUSIONS: On the basis of our sample of children with SAB, additional blood cultures to document sterility are not necessary after 2 FUBC results are negative in well-appearing patients.

Laws About Transparent School Vaccination Reporting: Public Health Context and Ethics.

In response to a recent surge in vaccine exemptions for school-aged children, advocacy for transparency regarding school vaccination rates has gained momentum in the sphere of public policy and legislation. We explore the public health context for transparency-focused school vaccination reporting laws and recent legislative successes and failures. We then provide an ethical analysis of policy that mandates publicly accessible, granular reporting of school vaccination rates.The ethical justification for this type of policy is robust. Although there is no evidence demonstrating its effects on public health, transparent school vaccination reporting has the potential to enhance individual and public decision-making, especially concerning the protection of children with compromised immune systems. This policy also offers the benefit of preserving the autonomy of parents who choose not to vaccinate their children.Policymakers in all states should support passage of this type of legislation along with other effective vaccination policies, including evidence-based vaccine education for parents who seek exemptions and reimbursement for clinicians who provide vaccine-related counseling.