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Updated: Sep 25, 2026
Experimental Human Pneumococcal Carriage
Published on: February 15, 2013
Predictors for a positive blood culture in African children with pneumonia
W A Banya1, T J O'Dempsey, T Mcardle
1Medical Research Council Laboratories, Banjul, Gambia.
Insights
Identifying children with pneumonia who are more likely to have a positive blood culture can improve diagnostic efficiency. Clinical signs like high temperature and rapid breathing help predict positive results, aiding in targeted testing.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Microbiology
Background:
- Blood culture sensitivity in pediatric pneumonia is often low.
- Identifying children at higher risk for positive blood cultures is crucial for effective diagnosis and research.
Purpose of the Study:
- To investigate simple clinical and laboratory predictors of positive blood cultures in young children with pneumonia.
- To inform strategies for reducing unnecessary blood cultures without compromising diagnostic yield.
Main Methods:
- A study involving 1222 children under 5 years old with pneumonia in rural West Africa.
- Analysis of clinical signs (temperature, respiratory rate, wheezing) and laboratory findings (malaria parasitemia) as predictors.
Main Results:
- High temperature, rapid respiratory rate, dehydration, nasal flaring, grunting, dullness to percussion, bronchial breathing, and diminished breath sounds were positive predictors.
- Wheezing and malaria parasitemia were negative predictors.
- Excluding children with temperature < 38.0°C, respiratory rate < 50/min, or wheezing could reduce cultures by 55.6% with only a 31.3% loss of positive results.
Conclusions:
- Clinical assessment can effectively identify children with pneumonia who are more likely to have a positive blood culture.
- Selective blood culturing can reduce workload, particularly in vaccine trials.
- This approach supports more efficient diagnostic strategies in resource-limited settings.
Background:
Blood culture isolation rates for children with pneumonia are generally low. Therefore it would be helpful if epidemiologic studies could identify children who have a higher than average chance of yielding a positive culture.
Methods:
Simple clinical and laboratory predictors of a positive blood culture were investigated in 1222 children younger than 5 years of age with pneumonia who presented at rural dispensaries in The Gambia, West Africa.
Results:
A high temperature (chi square for linear trend, 24.1; P < 0.0001), a rapid respiratory rate (chi square for linear trend, 6.33; P = 0.010), dehydration (odds ratio, 2.33; P < 0.001), nasal flaring (odds ratio, 2.06; P = 0.001), grunting (odds ratio, 4.01; P < 0.001), dullness to percussion (odds ratio, 2.31; P < 0.001), bronchial breathing (odds ratio, 2.61; P < 0.001) and diminished breath sounds (odds ratio, 2.07; P < 0.001) were positive predictors for a positive blood culture. Wheezing (odds ratio, 0.16; P < 0.001) and malaria parasitemia (odds ratio, 0.26; P = 0.008) were negative predictors. A combination of these findings were used to assess how the number of cultures taken might be reduced without substantially reducing the yield of positive cultures. For example it was found that exclusion of children with a temperature of < 38.0 degrees C and/or a respiratory rate of < 50/min and/or wheezing would have reduced the number of cultures taken by 55.6% but would have led to a loss of only 31.3% of positive cultures.
Conclusion:
Careful selection of children investigated by blood culture could help to reduce the work required during the preparations for and conduct of pneumococcal vaccine trials.
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