Association between time to gram stain positivity and true bacteremia in pediatric emergency department patients
Bibliographic record
Abstract
STUDY OBJECTIVE: Febrile children with positive blood cultures require prompt intervention due to the risk of true bacteremia. However, approximately half of the pediatric positive blood cultures are contaminants. To aid decision-making, we investigated the relationship between time to Gram stain positivity and the likelihood of true bacteremia among children with positive blood cultures in the emergency department (ED). METHODS: This was a secondary analysis of a retrospective cohort study using data from 2018 to 2024. Participants included all children with positive blood cultures from a tertiary pediatric ED. True bacteremia was defined using a standardized two-step approach, involving identification of the bacteria responsible and assessing clinical outcomes by two independent examiners. We investigated the correlation between time to Gram stain positivity and the likelihood of true bacteremia by comparing median time to positivity for both groups and reporting the probability of bacteremia based on timing. RESULTS: Of the 487,222 children presenting to the ED, 746 had positive blood cultures out of 38,541 blood cultures performed, of which 368 were classified as true bacteremia. Median time to Gram stain positivity was significantly shorter for true bacteremia (14 h) compared to contaminants (19 h) (difference: 5 h; 95 % CI: 4-6 h). The probability of bacteremia varied from 94 % for cultures positive in less than 10 h to 19 % for cultures positive after 48 h. Nearly 90 % of true bacteremia cases tested positive within 24 h. CONCLUSION: Time to Gram stain positivity is a strong indicator for distinguishing true bacteremia from contaminants, potentially optimizing patient management and reducing unnecessary hospital stays.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".