Abstract
BackgroundBlood cultures are often recommended for the evaluation of community-acquired pneumonia (CAP). However, institutions vary in their use of blood cultures, and blood cultures have unclear utility in CAP management in hospitalized children.ObjectiveTo identify clinical factors associated with obtaining blood cultures in children hospitalized with CAP, and to estimate the association between blood culture obtainment and hospital length of stay (LOS).MethodsWe performed a multicenter retrospective cohort study of children admitted with a diagnosis of CAP to any of four pediatric hospitals in the United States from January 1, 2011-December 31, 2012. Demographics, medical history, diagnostic testing, and clinical outcomes were abstracted via manual chart review. Multivariable logistic regression evaluated patient and clinical factors for associations with obtaining blood cultures. Propensity score-matched Kaplan-Meier analysis compared patients with and without blood cultures for hospital LOS.ResultsSix hundred fourteen charts met inclusion criteria; 390 children had blood cultures obtained. Of children with blood cultures, six (1.5%) were positive for a pathogen and nine (2.3%) grew a contaminant. Factors associated with blood culture obtainment included presenting with symptoms of systemic inflammatory response syndrome (OR 1.78, 95% CI 1.10–2.89), receiving intravenous hydration (OR 3.94, 95% CI 3.22–4.83), receiving antibiotics before admission (OR 1.49, 95% CI 1.17–1.89), hospital admission from the ED (OR 1.65, 95% CI 1.05–2.60), and having health insurance (OR 0.42, 95% CI 0.30–0.60). In propensity score-matched analysis, patients with blood cultures had median 0.8 days longer LOS (2.0 vs 1.2 days, P < .0001) without increased odds of readmission (OR 0.94, 95% CI 0.45–1.97) or death (P = .25).ConclusionsObtaining blood cultures in children hospitalized with CAP rarely identifies a causative pathogen and is associated with increased LOS. Our results highlight the need to refine the role of obtaining blood cultures in children hospitalized with CAP.
Highlights
Pediatric community-acquired pneumonia (CAP) is a common reason for hospitalization, and CAP is associated with substantial healthcare resource use and costs to patients and families. [1] Previous studies have documented extensive variation in the management of CAP in the emergency department[2] and in the inpatient setting.[3]
Factors associated with blood culture obtainment included presenting with symptoms of systemic inflammatory response syndrome, receiving intravenous hydration, receiving antibiotics before admission, hospital admission from the ED, and PLOS ONE | DOI:10.1371/journal.pone
Obtaining blood cultures in children hospitalized with CAP rarely identifies a causative pathogen and is associated with increased length of stay (LOS)
Summary
Pediatric community-acquired pneumonia (CAP) is a common reason for hospitalization, and CAP is associated with substantial healthcare resource use and costs to patients and families. [1] Previous studies have documented extensive variation in the management of CAP in the emergency department[2] and in the inpatient setting.[3]. [1] Previous studies have documented extensive variation in the management of CAP in the emergency department[2] and in the inpatient setting.[3] In 2011, national guidelines were developed as a means of optimizing healthcare resource use and clinical outcomes. These guidelines recommended specific measures to standardize the evaluation and treatment of CAP in children.[4] In particular, these guidelines recommend that “[b]lood cultures should be obtained in children requiring hospitalization for presumed bacterial CAP that is moderate to severe, those with complicated pneumonia.”. Institutions vary in their use of blood cultures, and blood cultures have unclear utility in CAP management in hospitalized children
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