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Published on: October 15, 2014
Value of Blood Cultures in the Management of Children Hospitalized with Community-Acquired Pneumonia
Ahmed S Youssef1, Mina Fanous1, Faisal J Siddiqui2
1Pediatrics, State University of New York Downstate Medical Center, New York, USA.
Insights
The prevalence of bacteremia in children hospitalized with community-acquired pneumonia (CAP) is low. Blood cultures are recommended only for pediatric CAP patients with moderate to severe symptoms, not routine use.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Microbiology
Background:
- Current guidelines recommend blood cultures for moderate to severe pediatric community-acquired pneumonia (CAP).
- Lack of clear severity assessment criteria leads to frequent blood culture use in hospitalized CAP patients.
- This study aimed to determine bacteremia prevalence and associated factors in pediatric CAP.
Purpose of the Study:
- To identify the prevalence of bacteremia in hospitalized pediatric patients with CAP.
- To evaluate clinical and laboratory variables associated with bacteremia in this population.
- To inform guidelines on the appropriate use of blood cultures for pediatric CAP.
Main Methods:
- Retrospective medical record review of pediatric CAP patients (2 months to 18 years).
- Inclusion criteria: CAP diagnosis between January 2013 and December 2017 at two urban tertiary centers.
- Statistical analysis included binary logistic regression and chi-square tests to identify factors associated with positive blood cultures.
Main Results:
- Out of 464 CAP admissions, blood cultures were obtained in 357 (76.9%).
- True positive bacteremia was low (1.3%), with contaminants noted in 2.6%.
- Factors associated with bacteremia included ICU admission (OR 5.6), toxic appearance (OR 12.8), and elevated C-reactive protein (CRP >300 mg/L).
Conclusions:
- Bacteremia prevalence is low in children hospitalized with CAP.
- Routine blood cultures may not be necessary for all pediatric CAP cases.
- Further research is needed for better risk stratification of pediatric CAP patients requiring blood cultures.
Abstract:
Background and objectives Current guidelines for the management of community-acquired pneumonia (CAP) in children recommend obtaining a blood culture for children with moderate to severe pneumonia; yet, there is no guidance to assess the severity of the disease. Thus, a blood culture is obtained for the majority of children admitted with CAP, regardless of the severity of their symptoms. The study was designed to investigate and identify the prevalence of bacteremia in pediatric patients hospitalized with CAP and to evaluate the clinical and laboratory variables associated with bacteremia. Methods We conducted a medical record review of children aged from two months to 18 years diagnosed with CAP between January 1, 2013, and December 31, 2017, at our two urban tertiary centers. We used binary logistic regression analysis and chi-square tests to look at factors associated with blood culture positivity. Results A total of 464 patients were admitted with CAP. Blood cultures were obtained in 357 (76.9%) patients; 23 patients had repeated cultures. Fifteen patients had positive cultures: 5/380 (1.3%) were considered true positive results and 10/380 (2.6%) were considered contaminants. Intensive care unit (ICU) admission (OR 5.6 with 95% CI (1- 31), p<0.03), toxic appearance (OR 12.8 with 95% CI (1.3-125), p<0.01), and significantly elevated C-reactive protein (CRP) (>300 mg/L (p<0.01) were associated with bacteremia. Conclusion The prevalence of bacteremia among children admitted for CAP is low. The use of routine blood cultures should be reserved for children with moderate to severe pneumonia. Further studies are required to better risk-stratify children with CAP.
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