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

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

Author information

1
Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts; mark.neuman@childrens.harvard.edu.
2
Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts.
3
Children's Hospital Association, Lenexa, Kansas.
4
Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts.
5
Division of Pediatric Infectious Diseases, Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah.
6
Division of Hospital Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt, and.
7
Departments of Pediatrics and.
8
Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
9
Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
10
Division of Critical Care, Seattle Children's Hospital, Seattle, Washington.
11
Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington.
12
Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee.
13
Division of Hospital Medicine, Children's National Medical Center, Washington, District of Columbia.
14
Department of Pediatrics, School of Medicine, George Washington University, Washington, District of Columbia.
15
Divisions of Infectious Diseases and Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and.
16
Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio.

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.

PMID:
28835382
PMCID:
PMC5574722
DOI:
10.1542/peds.2017-1013
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: Dr Blaschke collaborates with BioFire Diagnostics LLC on federally funded studies, has received research funding from BioFire Diagnostics for investigator-initiated research, has intellectual property licensed to BioFire Diagnostics, receives royalties through the University of Utah, and has acted as an advisor to BioFire Diagnostics and BioFire Defense LLC regarding risk assessment for US Food and Drug Administration–cleared products; and the other authors have indicated they have no potential conflicts of interest to disclose.

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