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Published on: February 23, 2014
Risk factors of bacteremia in children hospitalized with community-acquired pneumonia: A nested case-control study
Shogo Akahoshi1, Yoshihiko Morikawa2, Hiroshi Sakakibara1
1Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan.
Insights
Bacteremia risk factors in children with community-acquired pneumonia (CAP) include high white blood cell counts. Blood cultures are recommended for children with leukocytosis or requiring ventilator support.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Microbiology
Background:
- Community-acquired pneumonia (CAP) is a common childhood illness.
- Bacteremia, a bloodstream infection, can complicate CAP, necessitating identification of risk factors for timely intervention.
Purpose of the Study:
- To identify risk factors associated with bacteremia in pediatric patients hospitalized with CAP.
- To inform clinical decisions regarding blood culture collection in children with CAP.
Main Methods:
- A nested case-control study was conducted involving hospitalized children (<18 years) with CAP.
- Patients with bacteremia (cases) were matched with controls based on facility, underlying disease, and age.
- Conditional logistic regression analysis was used to determine odds ratios for risk factors.
Main Results:
- Of 2,853 CAP patients, 2,383 had blood cultures drawn, revealing bacteremia in 34 (1.4%).
- Key bacteremia pathogens were Streptococcus pneumoniae and Haemophilus influenzae.
- A white blood cell count > 16,000/μL (OR: 5.90) was a significant risk factor for bacteremia.
Conclusions:
- Elevated white blood cell count is a significant indicator for bacteremia in children with CAP.
- Blood culture collection should be considered for pediatric CAP patients presenting with leukocytosis or requiring ventilator support upon admission.
Objective:
To assess the risk factors of bacteremia in children hospitalized with community-acquired pneumonia (CAP).
Study Design:
The present, nested, case-control study enrolled a cohort of patients with CAP aged < 18 years who were hospitalized at Tokyo Metropolitan Children's Medical Center or Tama-Hokubu Medical Center between March 2010 and February 2018. Among the cohort with blood cultures (BCs), patients with bacteremia were identified and matched with five control patients based on their treatment facility, underlying disease, and age. Conditional logistic regression was used to calculate the odds ratios (ORs) of bacteremia for risk factor candidates.
Results:
BCs were obtained for 2,383 (84%) of the 2,853 patients in the CAP cohort. Of those with BCs, 34 (1.4%) had bacteremia. S. pneumoniae and H. influenzae accounted for 26 (76%) and four (12%) instances of the bacteremia pathogens, respectively. Bacteremia occurred more frequently among patients hospitalized in the spring than during other seasons (P = 0.022). On multivariate analysis, the severity of pneumonia was not associated with bacteremia incidence (OR: 0.92 [0.30-2.85]) while a white blood cell count > 16,000/μL (OR: 5.90 [2.14-16.3]) was shown to be a significant risk factor. The OR of the need for a ventilator on admission day was significantly high (28.4 [3.02-1374]) on univariate analysis, but the subject pool was too small to determine its significance on multivariate analysis.
Conclusions:
The results of the present study supported BC collection in patients with leukocytosis and in those requiring ventilator use on admission.
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