Time to Positivity of Blood Cultures and Clinical Outcomes in Pediatric Sepsis: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Background: Time to positivity (TTP) of blood cultures reflects bacterial burden and growth kinetics and may have prognostic value in sepsis. While adult data suggest that shorter TTP is associated with adverse outcomes, its clinical significance in pediatric and neonatal sepsis remains less clearly defined. Objectives: To synthesize current evidence on (1) the distribution of blood-culture TTP in pediatric sepsis and (2) the association between TTP and clinical outcomes, including mortality and illness severity. Methods: A systematic review and meta-analysis was conducted according to PRISMA principles. MEDLINE, Embase, Scopus, and Web of Science were searched from inception to June 2025 for studies including patients aged 0–18 years with suspected or confirmed sepsis that reported TTP using automated blood-culture systems. Eligible designs were observational cohort or case–control studies reporting at least one clinical outcome. Risk of bias was assessed using the Newcastle–Ottawa Scale. Random-effects meta-analysis was performed for comparable effect estimates. Results: Fifty-five studies were included in the qualitative synthesis, of which 18 contributed quantitative outcome data. Across studies, 70–85% of clinically significant cultures became positive within 24 h, 90–95% within 36 h, and >95% within 48 h. Neonatal cohorts-particularly very-low-birth-weight (VLBW) infants-demonstrated shorter TTP in Gram-negative sepsis and a consistent association between short TTP and adverse outcomes. Meta-analysis showed that short TTP was significantly associated with higher neonatal mortality (pooled OR 1.86, 95% CI 1.32–2.61; I² = 48%), with similar results in sensitivity analysis. In older children, short TTP showed a stronger association with illness severity than mortality (pooled OR for severity 2.07, 95% CI 1.51–2.84; I² = 42%), with heterogeneous mortality effects across cohorts. Conclusions: Most clinically meaningful pediatric blood cultures flag positive within 24–36 hours, supporting earlier review of empirical antibiotics in clinically improving, culture-negative patients. Short TTP is a clinically relevant prognostic marker, strongly associated with mortality in neonatal sepsis and with illness severity in older children. Standardized TTP thresholds, sampling practices, and prospective multicenter validation are needed to support routine integration of TTP into pediatric sepsis risk stratification and stewardship pathways
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.034 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.020 | 0.043 |
| Bibliometrics | 0.007 | 0.009 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 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 source (direct Gemma or distilled Codex), 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".