Prevalence of Bacteremia in Hospitalized Pediatric Patients With Community-acquired Pneumonia

Abstract

Background National guidelines recommend obtaining blood cultures in children hospitalized with moderate or severe community-acquired pneumonia (CAP). The objectives of this study were to determine the prevalence of bacteremia in children, identify factors associated with bacteremia and quantify the influence of positive blood cultures on clinical management in children hospitalized with CAP. Methods This multicenter retrospective study included children from 60 days to 18 years of age requiring hospitalization for CAP. Categories analyzed were bacteremia, culture negative and no culture. Results Blood cultures were performed in 369 (56%) of 658 children with CAP. The prevalence of bacteremia was 7% (4.7–10.1%) in patients with a blood culture obtained. Bacteremia occurred in 21% of patients with a pleural drainage procedure and 75% of patients with distant site of infection (eg, osteomyelitis). Patients with bacteremia had longer duration of fever before admission and higher C-reactive protein values compared with those with negative or no blood culture. However, differences in white blood cell count and erythrocyte sedimentation rate between those with bacteremia and those without were not significant. Contamination rates were low and similar across institutions, ranging from 1% to 3.8% (P = 0.63). Blood culture–directed changes in antibiotic management occurred in 33% of patients with a contaminated culture and 65% of bacteremic patients. Antibiotic therapy was narrowed in 26% of bacteremic patients at hospital discharge. Conclusion The prevalence of bacteremia was higher than previously reported in children hospitalized with CAP and consistent across children’s hospitals. Positive blood cultures should prompt change to narrow-spectrum antibiotic therapy.

Blood Culture in Evaluation of Pediatric Community-Acquired Pneumonia: A Systematic Review and Meta-analysis

“…32 Two studies examined radiographic features in CAP, 33,34 1 evaluated antimicrobial use in the treatment of CAP, 35 and 1 examined infl ammatory markers in CAP. 36 Four studies evaluated bacteremia in children with CAP, [37][38][39][40] 1 study examined management of CAP, 41 and another focused on severe CAP admissions to the ICU. 42 The majority of studies used observational cohort design, except for 1 study that used a nested case-control design.…”

“…Contaminants accounted for 14.7% of isolates, which in individual studies ranged from 5.9%-75% of positive BCs. 27,28,35,[38][39][40][41] However, reporting varied across studies, with contaminants documented in all US studies but reported in only 3 studies conducted outside of the United States.…”

“…40 In the second, a change in antimicrobial management occurred in more than two-thirds of the positive BCs, as well as in a third of falsepositive BCs. 39 The third study, which reviewed BCs drawn on 409 pediatric patients in the ED and relied solely on radiographic criteria for the diagnosis of pneumonia, nevertheless found that a positive BC identifi ed in 11 patients did not lead to any changes in their management. 38 Overall, combining the data in these 3 studies, BCs led to antimicrobial management changes in 53.5% of the patients for whom BC were positive, and 2.2% of the aggregate population who had BCs drawn.…”

“…[26][27][28]30,36,37,41 However, these studies did not all clearly indicate whether antimicrobial therapy was given before or after BC collection, and only 3 studies documented whether BC results led to antimicrobial narrowing or broadening. [38][39][40] In the fi rst study, children were evaluated in the ED and appropriate changes in antimicrobial management occurred in all 6 cases of positive BCs. 40 In the second, a change in antimicrobial management occurred in more than two-thirds of the positive BCs, as well as in a third of falsepositive BCs.…”

Management of Community-Acquired Pneumonia in Hospitalized Children

“…Furthermore, less than 10 % of children hospitalized for uncomplicated CAP have documented bacteremia [33, 34••]. When a pathogen is isolated, culture results may not change antibiotic selection [35,32]. Others have suggested a strategy that limits blood cultures to children at risk for severe or complicated bacterial disease [31••, 32].…”