Growth Time for Burkholderia Blood Cultures in Children
Burkholderia species typically grow in blood cultures within 24-48 hours using modern automated continuous-monitoring blood culture systems, with the majority (62.5-93%) detected within this timeframe.
Expected Detection Timeline
- Most Burkholderia cepacia complex isolates are detected within 24-48 hours when using modern automated blood culture systems 1, 2
- Approximately 62.5% of B. pseudomallei-positive cultures are detected within 24 hours of incubation, and 93.1% within 48 hours 2
- Standard blood culture incubation for >5 days is seldom required when modern automated continuous-monitoring systems and media are used 1
Clinical Significance of Detection Speed
The speed of bacterial detection carries important prognostic implications:
- Earlier detection (within 24 hours) correlates with worse clinical outcomes, with fatalities occurring in 73.7% of cases where bacterial growth was detected within the first 24 hours, compared to only 40.9% when detection occurred after 24 hours 2
- Shorter time to detection likely reflects higher bacterial burden at the time blood was drawn, which may be responsible for poorer clinical outcomes 2
Pediatric-Specific Considerations
Blood Culture Collection
- For infants ≤1 kg: collect 2 mL total blood volume 1
- For infants 1.1-2 kg: collect 4 mL total (2 mL per set) 1
- For children 2.1-12.7 kg: collect 6 mL total (4 mL first set, 2 mL second set) 1
- For children 12.8-36.3 kg: collect 20 mL total (10 mL per set) 1
- When ≤10 mL blood is collected, inoculate into a single aerobic blood culture bottle 1
Hospital-Acquired Infection Context
- Burkholderia cepacia complex has emerged as a serious nosocomial pathogen in pediatric intensive care units, particularly in patients with indwelling catheters 3, 4
- Most pediatric patients with B. cepacia bacteremia require ICU care (86% in one series) 3
- Mortality can be significant (29% in one pediatric series) despite appropriate antibiotic therapy 3
Critical Pitfalls to Avoid
- Do not assume negative cultures rule out Burkholderia infection after only 24 hours—continue incubation for at least 48 hours, as 30-40% of cases may not be detected until the second day 2
- Avoid inadequate blood volumes, which significantly reduce detection sensitivity, particularly problematic in neonates and small infants 1
- Do not overlook environmental sources during outbreaks—B. cepacia can contaminate multiple-dose vials, disinfectant devices, and pharmaceutical products 4, 5, 6
- Recognize that sputum cultures may yield the same strain as blood cultures in approximately 45% of pediatric cases, suggesting respiratory colonization preceding bacteremia 3