Abstract
Background and objectivesCurrent guidelines for the management of community-acquired pneumonia (CAP) in children recommend obtaining a blood culture for children with moderate to severe pneumonia; yet, there is no guidance to assess the severity of the disease. Thus, a blood culture is obtained for the majority of children admitted with CAP, regardless of the severity of their symptoms. The study was designed to investigate and identify the prevalence of bacteremia in pediatric patients hospitalized with CAP and to evaluate the clinical and laboratory variables associated with bacteremia.MethodsWe conducted a medical record review of children aged from two months to 18 years diagnosed with CAP between January 1, 2013, and December 31, 2017, at our two urban tertiary centers. We used binary logistic regression analysis and chi-square tests to look at factors associated with blood culture positivity.ResultsA total of 464 patients were admitted with CAP. Blood cultures were obtained in 357 (76.9%) patients; 23 patients had repeated cultures. Fifteen patients had positive cultures: 5/380 (1.3%) were considered true positive results and 10/380 (2.6%) were considered contaminants. Intensive care unit (ICU) admission (OR 5.6 with 95% CI (1- 31), p<0.03), toxic appearance (OR 12.8 with 95% CI (1.3-125), p<0.01), and significantly elevated C-reactive protein (CRP) (>300 mg/L (p<0.01) were associated with bacteremia.ConclusionThe prevalence of bacteremia among children admitted for CAP is low. The use of routine blood cultures should be reserved for children with moderate to severe pneumonia. Further studies are required to better risk-stratify children with CAP.
Highlights
Community-acquired pneumonia (CAP) is one of the main causes of hospitalization of children in the United States, with an annual estimated cost exceeding one billion dollars [1,2]
The study was designed to investigate and identify the prevalence of bacteremia in pediatric patients hospitalized with community-acquired pneumonia (CAP) and to evaluate the clinical and laboratory variables associated with bacteremia
We found a significant association between pediatric intensive care unit (PICU) admission (OR 5.6 and 95% CI (1.0-31), p
Summary
Community-acquired pneumonia (CAP) is one of the main causes of hospitalization of children in the United States, with an annual estimated cost exceeding one billion dollars [1,2]. National guidelines for the management of infants and children with CAP, established in 2011 by the Infectious Diseases Society of America (IDSA), recommend "only obtaining blood culture in children with moderate and severe CAP" [7]. This statement, as mentioned in the guideline, fails to accurately define what would be considered "moderate to severe CAP." Past studies have reported a wide range in the prevalence of bacteremia in CAP (0.8%-17.4%) [8,9,10,11,12,13]. The study was designed to investigate and identify the prevalence of bacteremia in pediatric patients hospitalized with CAP and to evaluate the clinical and laboratory variables associated with bacteremia
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