Utility of Blood Culture Among Children Hospitalized With Community-Acquired Pneumonia

Pediatrics. 2017 Sep;140(3):e20171013. doi: 10.1542/peds.2017-1013. Epub 2017 Aug 23.

Abstract

Background and objectives: National guidelines recommend blood cultures for children hospitalized with presumed bacterial community-acquired pneumonia (CAP) that is moderate or severe. We sought to determine the prevalence of bacteremia and characterize the microbiology and penicillin-susceptibility patterns of positive blood culture results among children hospitalized with CAP.

Methods: We conducted a cross-sectional study of children hospitalized with CAP in 6 children's hospitals from 2007 to 2011. We included children 3 months to 18 years of age with discharge diagnosis codes for CAP using a previously validated algorithm. We excluded children with complex chronic conditions. We reviewed microbiologic data and classified positive blood culture detections as pathogens or contaminants. Antibiotic-susceptibility patterns were assessed for all pathogens.

Results: A total of 7509 children hospitalized with CAP were included over the 5-year study period. Overall, 34% of the children hospitalized with CAP had a blood culture performed; 65 (2.5% of patients with blood cultures; 95% confidence interval [CI]: 2.0%-3.2%) grew a pathogen. Streptococcus pneumoniae accounted for 78% of all detected pathogens. Among detected pathogens, 50 (82%) were susceptible to penicillin. Eleven children demonstrated growth of an organism nonsusceptible to penicillin, representing 0.43% (95% CI: 0.23%-0.77%) of children with blood cultures obtained and 0.15% (95% CI: 0.08%-0.26%) of all children hospitalized with CAP.

Conclusions: Among children without comorbidities hospitalized with CAP in a non-ICU setting, the rate of bacteremia was low, and isolated pathogens were usually susceptible to penicillin. Blood cultures may not be needed for most children hospitalized with CAP.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Anti-Bacterial Agents / therapeutic use
  • Bacteremia / diagnosis*
  • Bacteremia / drug therapy
  • Bacteremia / microbiology
  • Bacteria / drug effects
  • Blood Culture / statistics & numerical data*
  • Child
  • Child, Preschool
  • Community-Acquired Infections / diagnosis*
  • Community-Acquired Infections / drug therapy
  • Community-Acquired Infections / microbiology
  • Cross-Sectional Studies
  • Female
  • Hospitalization
  • Humans
  • Infant
  • Male
  • Microbial Sensitivity Tests
  • Penicillins / therapeutic use
  • Pneumonia, Bacterial / diagnosis*
  • Pneumonia, Bacterial / drug therapy
  • Pneumonia, Bacterial / microbiology
  • Retrospective Studies

Substances

  • Anti-Bacterial Agents
  • Penicillins