Source:

Neuman
MI
,
Hall
M
,
Lipsett
SC
, et al
.
Utility of blood culture among children hospitalized with community-acquired pneumonia
.
Pediatrics
.
2017
;
140
(
3
). pii: e20171013; doi:
https://doi.org/10.1542/peds.2017-1013

Investigators at multiple institutions conducted a cross-sectional study to assess the prevalence and microbiology of bacteremia among children hospitalized with community-acquired pneumonia (CAP). Children aged 3 months to 18 years without complex chronic conditions who were hospitalized with CAP at 1 of 6 tertiary children’s hospitals belonging to the Pediatric Health Information System Plus database were eligible. CAP was identified by using ICD-9 codes contained in the database. Data on demographics and length of stay were also extracted.

The primary outcome was having a blood culture performed during the hospitalization, as determined via database review. Blood culture results were classified as either positive or negative, with positive results further classified as being pathogenic or contaminant. Bacteremia was defined as a blood culture result positive for a pathogen. Among these, the pathogen was classified as either susceptible or nonsusceptible to penicillin on the basis of the minimum inhibitory concentration of <2 μg/mL. Investigators determined the prevalence of bacteremia, the frequencies of pathogens, and the susceptibility to penicillin, and compared the characteristics of children who underwent blood culture with those who did not.

There were 7,509 participants included in the analysis. Overall, 2,568 children (34.2%) had a blood culture performed. Participants with a blood culture were more likely to have private insurance and have a longer length of stay.

There were 65 blood cultures that grew a pathogen, resulting in a prevalence of bacteremia of 0.9% (95% CI, 0.7%–1.1%) among all participants and 2.5% (95% CI, 2.0%–3.2%) among participants with a blood culture. The most common pathogen was Streptococcus pneumoniae (78.5%), and 92% of S pneumoniae isolates were susceptible to penicillin. Among all pathogens isolated, 82% were susceptible to penicillin. Only 0.43% (95% CI, 0.23%–0.77%) of children with a blood culture performed grew an organism resistant to penicillin.

The investigators conclude that the prevalence of bacteremia is low among children without comorbidities who are hospitalized for CAP.

Dr Winer has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Whether or not to perform blood cultures in pediatric patients who are admitted to the hospital with nonsevere, noncomplicated CAP has been an ongoing debate. The Pediatric Infectious Diseases Society and the Infectious Diseases Society of America clinical practice guideline for CAP in infants and children >3 months of age recommend blood cultures in children requiring hospitalization for presumed bacterial CAP that is moderate to severe, particularly those with complicated pneumonia. This is a strong recommendation, despite low-quality evidence.

In the evidence summary, the authors of the guideline state that the rate of bacteremia is likely to be low in patients without effusion, sepsis, or organ dysfunction. They cite 1 study in which 5 of the 6 patients with positive...

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