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Hosp Pediatr. 2019 Oct;9(10):770-778. doi: 10.1542/hpeds.2019-0149. Epub 2019 Sep 13.

Predictors of Bacteremia in Children Hospitalized With Community-Acquired Pneumonia.

Author information

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

Abstract

BACKGROUND AND OBJECTIVES:

The yield of blood cultures in children hospitalized with community-acquired pneumonia (CAP) is low. Characteristics of children at increased risk of bacteremia remain largely unknown.

METHODS:

We conducted a secondary analysis of a retrospective cohort study of children aged 3 months to 18 years hospitalized with CAP in 6 children's hospitals from 2007 to 2011. We excluded children with complex chronic conditions and children without blood cultures performed at admission. Clinical, laboratory, microbiologic, and radiologic data were assessed to identify predictors of bacteremia.

RESULTS:

Among 7509 children hospitalized with CAP, 2568 (34.2%) had blood cultures performed on the first day of hospitalization. The median age was 3 years. Sixty-five children with blood cultures performed had bacteremia (2.5%), and 11 children (0.4%) had bacteremia with a penicillin-nonsusceptible pathogen. The prevalence of bacteremia was increased in children with a white blood cell count >20 × 103 cells per µL (5.4%; 95% confidence interval 3.5%-8.1%) and in children with definite radiographic pneumonia (3.3%; 95% confidence interval 2.4%-4.4%); however, the prevalence of penicillin-nonsusceptible bacteremia was below 1% even in the presence of individual predictors. Among children hospitalized outside of the ICU, the prevalence of contaminated blood cultures exceeded the prevalence of penicillin-nonsusceptible bacteremia.

CONCLUSIONS:

Although the prevalence of bacteremia is marginally higher among children with leukocytosis or radiographic pneumonia, the rates remain low, and penicillin-nonsusceptible bacteremia is rare even in the presence of these predictors. Blood cultures should not be obtained in children hospitalized with CAP in a non-ICU setting.

PMID:
31519736
DOI:
10.1542/hpeds.2019-0149

Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

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