Do All Children Hospitalized With Community-Acquired Pneumonia Require Blood Cultures?

Abstract

The 2011 pediatric community-acquired pneumonia (CAP) management guideline released jointly by the Infectious Diseases Society of America and the Pediatric Infectious Diseases Society recommends blood cultures for children with moderate to severe CAP requiring hospitalization.1 However, the study featured in this issue of Hospital Pediatrics by Heine et al concludes otherwise, suggesting that a more restricted approach may be best. The authors examined >300 children from a single institution with a primary diagnosis of pneumonia; 60% required hospitalization. Among all children with a blood culture obtained ( n = 155 [47%]), the prevalence of true bacteremia was only 3% ( n = 5 [3 Streptococcus pneumoniae , 1 each of Escherichia coli and Streptococcus pyogenes ]), although just as many positive culture results were attributed to noncausative organisms (ie, contaminants). All 5 children with true bacteremia had severe illness on presentation; all were hospitalized with radiographic evidence of parapneumonic effusion, and 4 required critical care admission. Given the low prevalence of documented bacteremia and the obvious illness severity among those with bacteremia detected, the authors concluded a relative lack of clinical utility for routine blood cultures in children with CAP. Retrospectively comparing clinical management against a local practice guideline that recommends more restricted use of blood cultures (based on age, comorbid conditions, immunization status, and illness severity), the authors noted that 45% of those with cultures obtained were considered “low risk” for bacteremia; none of these children had true bacteremia detected. Of course, it is difficult to estimate the true prevalence of bacteremia because only one-half of …