Factors associated with positive blood cultures in children in nine African and Asian countries: the ACORN2 surveillance network

Cristina Ardura-Garcia; Jill Hopkins; Sue J Lee; Naomi Waithira; Chris Painter; Clare L Ling; Tamalee Roberts; Thyl Miliya; Noah Obeng-Nkrumah; Japheth A Opintan; Emmanuel P Abbeyquaye; Raph L. Hamers; Yulia R Saharman; Robert Sinto; Mulya R Karyanti; R Fera Ibrahim; Samuel O Akech; Anousone Duangnouvong; Khamla Choumlivong; Nicholas A Feasey; Diana Kululanga; Samantha Lissauer; Abhilasha Karkey; Narayan Kunwar; Justice E Erakhaiwu; Iruka N Okeke; Ini Adebiyi; Abiodun B Oduola; Babatunde O Ogunbosi; Olukemi O Tongo; Ifeoma A Ude; Oladipo Aboderin; Adeyemi T Adeyemo; Sylvester S Edward; Ugowe Osagie; Hoa Nguyen Thi; Pham Ngoc Thach; Tran Van Giang; Lan Huong Hoang Thi; Huu Tung Trinh; H. Rogier van Doorn; Elizabeth A Ashley; Paul Turner

doi:10.1136/bmjgh-2025-020448

Factors associated with positive blood cultures in children in nine African and Asian countries: the ACORN2 surveillance network

Cristina Ardura-Garcia^*, Jill Hopkins, Sue J Lee, Naomi Waithira, Chris Painter, Clare L Ling, Tamalee Roberts, Thyl Miliya, Noah Obeng-Nkrumah, Japheth A Opintan, Emmanuel P Abbeyquaye, Raph L. Hamers, Yulia R Saharman, Robert Sinto, Mulya R Karyanti, R Fera Ibrahim, Samuel O Akech, Anousone Duangnouvong, Khamla Choumlivong, Nicholas A FeaseyDiana Kululanga, Samantha Lissauer, Abhilasha Karkey, Narayan Kunwar, Justice E Erakhaiwu, Iruka N Okeke, Ini Adebiyi, Abiodun B Oduola, Babatunde O Ogunbosi, Olukemi O Tongo, Ifeoma A Ude, Oladipo Aboderin, Adeyemi T Adeyemo, Sylvester S Edward, Ugowe Osagie, Hoa Nguyen Thi, Pham Ngoc Thach, Tran Van Giang, Lan Huong Hoang Thi, Huu Tung Trinh, H. Rogier van Doorn, Elizabeth A Ashley, Paul Turner

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

Background Blood culture (BC) in children has relatively low diagnostic yield and high contamination rates, limiting cost-effectiveness. We aimed to determine readily available baseline characteristics to identify hospitalised children with a likelihood of higher diagnostic yield in low- and middle-income countries.

Methods We used data from ACORN2, a prospective clinical surveillance network including 19 hospitals across Africa and Asia. We included participants <18 years, hospitalised for a suspected infection, prescribed parenteral antibiotics and with a BC sample. Sociodemographic and clinical data were recorded for each infection episode and linked to routine microbiology data. We described true pathogen (non-contaminant) BC positivity proportion and performed mixed-effects logistic regression, with study site and patient as the random effect, to identify factors associated with BC positivity.

Results Of the 26 407 paediatric infection episodes, 17 815 (67%) had a BC sample and 15 384 were included in the analysis. BC results were: true pathogens in 689 (4.5%), contaminants in 1399 (9%) and uncertain pathogens in 143 (0.9%). In the multivariable model, factors associated with a positive BC were age (29 days–12-month-olds OR 1.33, 95% CI 1.06 to 1.66 and 5–18 year-olds OR 1.62, 95% CI 1.30 to 2.01 vs 1–4 year-olds), number of clinical severity signs (OR 1.29, 95% CI 1.18 to 1.40 per one sign) and hospital acquired infection (OR 3.05, 95% CI 2.30 to 4.06 vs community-acquired). Suspected diagnosis of sepsis (OR 2.09, 95% CI 1.67 to 2.61), gastrointestinal/abdominal (OR 2.36, 95% CI 1.78 to 3.13), skin and soft tissue or bone (OR 3.64, 95% CI 2.57 to 5.14) and genitourinary infection (OR 2.22, 95% CI 1.39 to 3.56) were more likely to have a positive BC, compared with respiratory infections.

Conclusion We confirmed the low BC yield among hospitalised children. We identified groups for which diagnostic stewardship efforts to increase BC uptake should be prioritised and others in which it could be limited in times of financial or logistic constraints.

Original language	English
Article number	e020448
Pages (from-to)	1-13
Number of pages	13
Journal	BMJ Global Health
Volume	10
Issue number	10
Early online date	20 Oct 2025
DOIs	https://doi.org/10.1136/bmjgh-2025-020448
Publication status	Published - Oct 2025

Keywords

Global Health
Africa South of the Sahara
Paediatrics
Blood disorders
Other diagnostic or tool

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Ardura-Garcia, C., Hopkins, J., Lee, S. J., Waithira, N., Painter, C., Ling, C. L., Roberts, T., Miliya, T., Obeng-Nkrumah, N., Opintan, J. A., Abbeyquaye, E. P., Hamers, R. L., Saharman, Y. R., Sinto, R., Karyanti, M. R., Ibrahim, R. F., Akech, S. O., Duangnouvong, A., Choumlivong, K., ... Turner, P. (2025). Factors associated with positive blood cultures in children in nine African and Asian countries: the ACORN2 surveillance network. BMJ Global Health, 10(10), 1-13. Article e020448. https://doi.org/10.1136/bmjgh-2025-020448

@article{86cbb0b7265e49ab801da3084e842ead,

title = "Factors associated with positive blood cultures in children in nine African and Asian countries: the ACORN2 surveillance network",

abstract = "Background Blood culture (BC) in children has relatively low diagnostic yield and high contamination rates, limiting cost-effectiveness. We aimed to determine readily available baseline characteristics to identify hospitalised children with a likelihood of higher diagnostic yield in low- and middle-income countries.Methods We used data from ACORN2, a prospective clinical surveillance network including 19 hospitals across Africa and Asia. We included participants <18 years, hospitalised for a suspected infection, prescribed parenteral antibiotics and with a BC sample. Sociodemographic and clinical data were recorded for each infection episode and linked to routine microbiology data. We described true pathogen (non-contaminant) BC positivity proportion and performed mixed-effects logistic regression, with study site and patient as the random effect, to identify factors associated with BC positivity.Results Of the 26 407 paediatric infection episodes, 17 815 (67%) had a BC sample and 15 384 were included in the analysis. BC results were: true pathogens in 689 (4.5%), contaminants in 1399 (9%) and uncertain pathogens in 143 (0.9%). In the multivariable model, factors associated with a positive BC were age (29 days–12-month-olds OR 1.33, 95% CI 1.06 to 1.66 and 5–18 year-olds OR 1.62, 95% CI 1.30 to 2.01 vs 1–4 year-olds), number of clinical severity signs (OR 1.29, 95% CI 1.18 to 1.40 per one sign) and hospital acquired infection (OR 3.05, 95% CI 2.30 to 4.06 vs community-acquired). Suspected diagnosis of sepsis (OR 2.09, 95% CI 1.67 to 2.61), gastrointestinal/abdominal (OR 2.36, 95% CI 1.78 to 3.13), skin and soft tissue or bone (OR 3.64, 95% CI 2.57 to 5.14) and genitourinary infection (OR 2.22, 95% CI 1.39 to 3.56) were more likely to have a positive BC, compared with respiratory infections.Conclusion We confirmed the low BC yield among hospitalised children. We identified groups for which diagnostic stewardship efforts to increase BC uptake should be prioritised and others in which it could be limited in times of financial or logistic constraints.",

keywords = "Global Health, Africa South of the Sahara, Paediatrics, Blood disorders, Other diagnostic or tool",

author = "Cristina Ardura-Garcia and Jill Hopkins and Lee, {Sue J} and Naomi Waithira and Chris Painter and Ling, {Clare L} and Tamalee Roberts and Thyl Miliya and Noah Obeng-Nkrumah and Opintan, {Japheth A} and Abbeyquaye, {Emmanuel P} and Hamers, {Raph L.} and Saharman, {Yulia R} and Robert Sinto and Karyanti, {Mulya R} and Ibrahim, {R Fera} and Akech, {Samuel O} and Anousone Duangnouvong and Khamla Choumlivong and Feasey, {Nicholas A} and Diana Kululanga and Samantha Lissauer and Abhilasha Karkey and Narayan Kunwar and Erakhaiwu, {Justice E} and Okeke, {Iruka N} and Ini Adebiyi and Oduola, {Abiodun B} and Ogunbosi, {Babatunde O} and Tongo, {Olukemi O} and Ude, {Ifeoma A} and Oladipo Aboderin and Adeyemo, {Adeyemi T} and Edward, {Sylvester S} and Ugowe Osagie and {Nguyen Thi}, Hoa and Thach, {Pham Ngoc} and Giang, {Tran Van} and {Hoang Thi}, {Lan Huong} and Trinh, {Huu Tung} and {van Doorn}, {H. Rogier} and Ashley, {Elizabeth A} and Paul Turner",

note = "Funding: This research was funded in whole by the Wellcome Trust [222156/Z/20/Z]. CAG was funded by a Postdoctoral Mobility Fellowship from the Swiss National Science Foundation (grant number P500PM_217605).",

year = "2025",

month = oct,

doi = "10.1136/bmjgh-2025-020448",

language = "English",

volume = "10",

pages = "1--13",

journal = "BMJ Global Health",

issn = "2059-7908",

publisher = "BMJ Publishing Group",

number = "10",

}

Ardura-Garcia, C, Hopkins, J, Lee, SJ, Waithira, N, Painter, C, Ling, CL, Roberts, T, Miliya, T, Obeng-Nkrumah, N, Opintan, JA, Abbeyquaye, EP, Hamers, RL, Saharman, YR, Sinto, R, Karyanti, MR, Ibrahim, RF, Akech, SO, Duangnouvong, A, Choumlivong, K, Feasey, NA, Kululanga, D, Lissauer, S, Karkey, A, Kunwar, N, Erakhaiwu, JE, Okeke, IN, Adebiyi, I, Oduola, AB, Ogunbosi, BO, Tongo, OO, Ude, IA, Aboderin, O, Adeyemo, AT, Edward, SS, Osagie, U, Nguyen Thi, H, Thach, PN, Giang, TV, Hoang Thi, LH, Trinh, HT, van Doorn, HR, Ashley, EA & Turner, P 2025, 'Factors associated with positive blood cultures in children in nine African and Asian countries: the ACORN2 surveillance network', BMJ Global Health, vol. 10, no. 10, e020448, pp. 1-13. https://doi.org/10.1136/bmjgh-2025-020448

TY - JOUR

T1 - Factors associated with positive blood cultures in children in nine African and Asian countries

T2 - the ACORN2 surveillance network

AU - Ardura-Garcia, Cristina

AU - Hopkins, Jill

AU - Lee, Sue J

AU - Waithira, Naomi

AU - Painter, Chris

AU - Ling, Clare L

AU - Roberts, Tamalee

AU - Miliya, Thyl

AU - Obeng-Nkrumah, Noah

AU - Opintan, Japheth A

AU - Abbeyquaye, Emmanuel P

AU - Hamers, Raph L.

AU - Saharman, Yulia R

AU - Sinto, Robert

AU - Karyanti, Mulya R

AU - Ibrahim, R Fera

AU - Akech, Samuel O

AU - Duangnouvong, Anousone

AU - Choumlivong, Khamla

AU - Feasey, Nicholas A

AU - Kululanga, Diana

AU - Lissauer, Samantha

AU - Karkey, Abhilasha

AU - Kunwar, Narayan

AU - Erakhaiwu, Justice E

AU - Okeke, Iruka N

AU - Adebiyi, Ini

AU - Oduola, Abiodun B

AU - Ogunbosi, Babatunde O

AU - Tongo, Olukemi O

AU - Ude, Ifeoma A

AU - Aboderin, Oladipo

AU - Adeyemo, Adeyemi T

AU - Edward, Sylvester S

AU - Osagie, Ugowe

AU - Nguyen Thi, Hoa

AU - Thach, Pham Ngoc

AU - Giang, Tran Van

AU - Hoang Thi, Lan Huong

AU - Trinh, Huu Tung

AU - van Doorn, H. Rogier

AU - Ashley, Elizabeth A

AU - Turner, Paul

N1 - Funding: This research was funded in whole by the Wellcome Trust [222156/Z/20/Z]. CAG was funded by a Postdoctoral Mobility Fellowship from the Swiss National Science Foundation (grant number P500PM_217605).

PY - 2025/10

Y1 - 2025/10

N2 - Background Blood culture (BC) in children has relatively low diagnostic yield and high contamination rates, limiting cost-effectiveness. We aimed to determine readily available baseline characteristics to identify hospitalised children with a likelihood of higher diagnostic yield in low- and middle-income countries.Methods We used data from ACORN2, a prospective clinical surveillance network including 19 hospitals across Africa and Asia. We included participants <18 years, hospitalised for a suspected infection, prescribed parenteral antibiotics and with a BC sample. Sociodemographic and clinical data were recorded for each infection episode and linked to routine microbiology data. We described true pathogen (non-contaminant) BC positivity proportion and performed mixed-effects logistic regression, with study site and patient as the random effect, to identify factors associated with BC positivity.Results Of the 26 407 paediatric infection episodes, 17 815 (67%) had a BC sample and 15 384 were included in the analysis. BC results were: true pathogens in 689 (4.5%), contaminants in 1399 (9%) and uncertain pathogens in 143 (0.9%). In the multivariable model, factors associated with a positive BC were age (29 days–12-month-olds OR 1.33, 95% CI 1.06 to 1.66 and 5–18 year-olds OR 1.62, 95% CI 1.30 to 2.01 vs 1–4 year-olds), number of clinical severity signs (OR 1.29, 95% CI 1.18 to 1.40 per one sign) and hospital acquired infection (OR 3.05, 95% CI 2.30 to 4.06 vs community-acquired). Suspected diagnosis of sepsis (OR 2.09, 95% CI 1.67 to 2.61), gastrointestinal/abdominal (OR 2.36, 95% CI 1.78 to 3.13), skin and soft tissue or bone (OR 3.64, 95% CI 2.57 to 5.14) and genitourinary infection (OR 2.22, 95% CI 1.39 to 3.56) were more likely to have a positive BC, compared with respiratory infections.Conclusion We confirmed the low BC yield among hospitalised children. We identified groups for which diagnostic stewardship efforts to increase BC uptake should be prioritised and others in which it could be limited in times of financial or logistic constraints.

AB - Background Blood culture (BC) in children has relatively low diagnostic yield and high contamination rates, limiting cost-effectiveness. We aimed to determine readily available baseline characteristics to identify hospitalised children with a likelihood of higher diagnostic yield in low- and middle-income countries.Methods We used data from ACORN2, a prospective clinical surveillance network including 19 hospitals across Africa and Asia. We included participants <18 years, hospitalised for a suspected infection, prescribed parenteral antibiotics and with a BC sample. Sociodemographic and clinical data were recorded for each infection episode and linked to routine microbiology data. We described true pathogen (non-contaminant) BC positivity proportion and performed mixed-effects logistic regression, with study site and patient as the random effect, to identify factors associated with BC positivity.Results Of the 26 407 paediatric infection episodes, 17 815 (67%) had a BC sample and 15 384 were included in the analysis. BC results were: true pathogens in 689 (4.5%), contaminants in 1399 (9%) and uncertain pathogens in 143 (0.9%). In the multivariable model, factors associated with a positive BC were age (29 days–12-month-olds OR 1.33, 95% CI 1.06 to 1.66 and 5–18 year-olds OR 1.62, 95% CI 1.30 to 2.01 vs 1–4 year-olds), number of clinical severity signs (OR 1.29, 95% CI 1.18 to 1.40 per one sign) and hospital acquired infection (OR 3.05, 95% CI 2.30 to 4.06 vs community-acquired). Suspected diagnosis of sepsis (OR 2.09, 95% CI 1.67 to 2.61), gastrointestinal/abdominal (OR 2.36, 95% CI 1.78 to 3.13), skin and soft tissue or bone (OR 3.64, 95% CI 2.57 to 5.14) and genitourinary infection (OR 2.22, 95% CI 1.39 to 3.56) were more likely to have a positive BC, compared with respiratory infections.Conclusion We confirmed the low BC yield among hospitalised children. We identified groups for which diagnostic stewardship efforts to increase BC uptake should be prioritised and others in which it could be limited in times of financial or logistic constraints.

KW - Global Health

KW - Africa South of the Sahara

KW - Paediatrics

KW - Blood disorders

KW - Other diagnostic or tool

U2 - 10.1136/bmjgh-2025-020448

DO - 10.1136/bmjgh-2025-020448

M3 - Article

SN - 2059-7908

VL - 10

SP - 1

EP - 13

JO - BMJ Global Health

JF - BMJ Global Health

IS - 10

M1 - e020448

ER -

Factors associated with positive blood cultures in children in nine African and Asian countries: the ACORN2 surveillance network

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