Follow-up Blood Cultures in Children With Staphylococcus aureus Bacteremia

Caitlin Cardenas-Comfort; Sheldon L. Kaplan; Jesus G. Vallejo; J. Chase McNeil

doi:10.1542/peds.2020-1821

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The Skip Phenomenon in Staphylococcus aureus Bacteremia
John Raymond U Go, Larry M Baddour and Raj Palraj

Published on: 03 December 2020

Published on: (3 December 2020)

The Skip Phenomenon in Staphylococcus aureus Bacteremia
John Raymond U Go, Infectious Diseases Fellow, Mayo Clinic Rochester Minnesota
Other Contributors:
Larry M Baddour, Infectious Diseases Consultant

Raj Palraj, Infectious Diseases Consultant
Staphylococcus aureus, a leading cause of bacteremia, is associated with significant morbidity and high mortality. Management is complex, with clinicians relying on serial blood culture results to determine if additional diagnostic interventions are needed to evaluate for infectious complications, in particular infective endocarditis, timing of peripherally inserted central catheter (PICC) or a midline catheter placement, and ultimately duration of antibiotic therapy. We read with great interest the article by Cardenas-Comfort et al, which highlighted an under-recognized observation of intermittent positive blood cultures and their association with complications in pediatric patients with Staphylococcus aureus bacteremia (SAB)(1). This observation has previously been described in two different adult populations (2,3) with Fiala et al initially referring to it as the “skip phenomenon”. In all three studies, the skip phenomenon was associated with prolonged bacteremia and was seen in a minority of patients. It is also important document clearance of bacteremia prior to placement of intravenous catheter for outpatient antibiotics. Because prolonged bacteremia has been associated with more complicated infections that require longer courses of antibiotic treatment, recognition of the skip phenomenon, with documentation of blood culture clearance with serial negative results is needed to ensure optimal patient management.

1. Cardenas-Comfort C, Kaplan SL, Vallejo JG, McN...
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Staphylococcus aureus, a leading cause of bacteremia, is associated with significant morbidity and high mortality. Management is complex, with clinicians relying on serial blood culture results to determine if additional diagnostic interventions are needed to evaluate for infectious complications, in particular infective endocarditis, timing of peripherally inserted central catheter (PICC) or a midline catheter placement, and ultimately duration of antibiotic therapy. We read with great interest the article by Cardenas-Comfort et al, which highlighted an under-recognized observation of intermittent positive blood cultures and their association with complications in pediatric patients with Staphylococcus aureus bacteremia (SAB)(1). This observation has previously been described in two different adult populations (2,3) with Fiala et al initially referring to it as the “skip phenomenon”. In all three studies, the skip phenomenon was associated with prolonged bacteremia and was seen in a minority of patients. It is also important document clearance of bacteremia prior to placement of intravenous catheter for outpatient antibiotics. Because prolonged bacteremia has been associated with more complicated infections that require longer courses of antibiotic treatment, recognition of the skip phenomenon, with documentation of blood culture clearance with serial negative results is needed to ensure optimal patient management.

1. Cardenas-Comfort C, Kaplan SL, Vallejo JG, McNeil JC. Follow-up Blood Cultures in Children With Staphylococcus aureus Bacteremia. Pediatrics. 2020.
2. Fiala J, Palraj BR, Sohail MR, Lahr B, Baddour LM. Is a single set of negative blood cultures sufficient to ensure clearance of bloodstream infection in patients with Staphylococcus aureus bacteremia? The skip phenomenon. Infection. 2019;47(6):1047-1053.
3. Stewart JD, Graham M, Kotsanas D, Woolley I, Korman TM. Intermittent Negative Blood Cultures in Staphylococcus aureus Bacteremia; a Retrospective Study of 1071 Episodes. Open Forum Infect Dis. 2019;6(12):ofz494.
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Competing Interests: None declared.