Utility of Blood Cultures in Pediatric Patients Found to Have Pneumonia in the Emergency Department☆,☆☆,★
Section snippets
INTRODUCTION
Blood cultures are often performed as part of the evaluation of pediatric patients with pneumonia. Several standard texts support this practice, especially in patients with "suspected" bacterial pneumonia.1, 2, 3, 4 The practice has also been sanctioned by acknowledged experts; in a hypothetical case involving a "nontoxic" 21/ 2-year-old boy with lobar pneumonia and a WBC count of 22,500 cells/mm3, three of four experts recommended a blood culture.5 The rationale for this recommendation is
MATERIALS AND METHODS
Columbus Children's Hospital is a 313-bed tertiary care facility. The ED has 75,000 visits per year, with an admission rate of 10%. All radiographs obtained in the ED are read by a radiologist, who enters an abbreviated diagnosis in a handwritten log. The log is returned to the ED each day, and the radiologist's diagnosis is cross-checked with the diagnosis and disposition recorded by the emergency physicians. For this study, the log entries from August 1991 to July 1992 were reviewed
RESULTS
We found radiographic results consistent with pneumonia in 939 patients. Of these patients, 409 (44%) underwent blood culturing. Eleven of these blood cultures (2.7%) grew pathogenic organisms (Streptococcus pneumoniae in 10 cases and Haemophilus parainfluenzae in 1). The H parainfluenzae was not considered a contaminant by an infectious disease consultant involved in the patient's care. Another 33 patients had probable nonpathogenic organisms in their cultures, including coagulase-negative
DISCUSSION
In this study we found a 2.7% yield of pathogenic bacteria in blood samples obtained from patients who presented to an urban pediatric ED with radiologic evidence of pneumonia. Because blood culturing was not performed in 56% of patients who presented with pneumonia, the true prevalence of bacteremia cannot be determined from this study. It is likely that patients at lower risk for bacterial disease (normal CBC findings, healthy appearance, etc) were less likely to have blood culturing
Acknowledgements
The authors thank Sue Coe for her help in extracting data from the laboratory information system.
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Cited by (55)
Risk factors of bacteremia in children hospitalized with community-acquired pneumonia: A nested case-control study
2021, Journal of Infection and ChemotherapyCitation Excerpt :A systematic review of severity assessment in pediatric CAP pointed out that there were no formally validated criteria and placed greater importance on developing indicators to predict severe outcomes [28]. On the other hand, again, in line with the findings of previous studies, leukocytosis was associated with bacteremia [16,17]. Moreover, the odds ratio of ventilator need on admission day for bacteremia was significantly high.
Pediatric Community-Acquired Pneumonia in the United States: Changing Epidemiology, Diagnostic and Therapeutic Challenges, and Areas for Future Research
2018, Infectious Disease Clinics of North AmericaCitation Excerpt :These pathogens should also be suspected in patients who experience treatment failure for more common etiologic agents. The 2011 PIDS/IDSA CAP guideline recommends obtaining blood cultures in children hospitalized with CAP.7,23,24 In this setting, however, blood cultures identify a pathogen in only 2% to 7% of children with CAP.24–27
Community-acquired pneumonia in children: Current challenges and future directions
2014, Journal of InfectionCitation Excerpt :While progress has been made in viral diagnostics, this has not been the case for common bacterial pathogens, where we still rely heavily on traditional culture techniques. Blood cultures, while very specific, are only positive in up to 11% of hospitalized children with uncomplicated CAP,21 with some studies reporting positivity rates less than 3%.3,22,23 This number may be even lower in those treated as outpatients.24
Fever in the pediatric patient
2013, Emergency Medicine Clinics of North AmericaCommon Pediatric Respiratory Emergencies
2012, Emergency Medicine Clinics of North AmericaAsthma and pneumonia
2010, Pediatric Clinics of North AmericaCitation Excerpt :Although white blood cell counts and C-reactive protein levels have been shown to be higher in children with bacterial pneumonia, these results showed such significant variability that clinical application is unreliable and have shown little value in differentiating bacterial pneumonia from pneumonia caused by other agents.23,24 Blood cultures are positive in children with pneumonia no more than 10% of the time and their use is not recommended in outpatient management.25–28 In children hospitalized with more severe, resistant, or unusual forms of pneumonia, blood cultures may be helpful and may provide a possible opportunity for identification of a causative organism.23,29–31
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From the University of Pittsburgh, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania*; and Ohio State University, Columbus Children's Hospital, Columbus, Ohio.‡
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Address for reprints: Robert W Hickey, MD, General Academic Pediatrics/Pediatric Emergency Medicine, Children's Hospital of Pittsburgh, 3705 Fifth Avenue at DeSoto Street, Pittsburgh, Pennsylvania 15213-2583, 412-692-7972, Fax 412-692-7464
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Reprint no. 47/1/73231