Utility of Blood Cultures in Pediatric Patients Found to Have Pneumonia in the Emergency Department☆,☆☆,★

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Abstract

Study objective: To determine the prevalence of bacteremia in pediatric patients with radiographic evidence of pneumonia in whom blood cultures were obtained. Methods: We carried out a retrospective review of the radiology log of a tertiary care children's hospital to identify patients with radiographic evidence of pneumonia seen between August 1991 and July 1992. These patients were cross-referenced with the hospital laboratory information system, yielding results of any CBC or blood cultures. Results: We found 939 patients with chest radiography findings consistent with pneumonia. Blood culturing was performed in 409 (44%). Eleven of these cultures (2.7%) grew pathogenic bacteria. Review of the medical records revealed no changes in clinical management made on the basis of the results of the blood cultures. Conclusion: Blood cultures are uncommonly positive in outpatients diagnosed with pneumonia. [Hickey RW, Bowman MJ, Smith GA: Utility of blood cultures in pediatric patients found to have pneumonia in the emergency department. Ann Emerg Med June 1996;27:721-725.]

See related editorial, Blood Culture in Children With Pneumonia

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.

References (17)

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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

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