COMMENTARY

5 Best of 2018: Pediatrics Viewpoints

William T. Basco, Jr, MD, MS

Disclosures

January 11, 2019

In This Article

Blood Cultures in Children With Pneumonia

Current guidelines recommend obtaining a blood culture in any hospitalized child whose community-acquired pneumonia (CAP) is "moderate or severe."[7]

However, existing data suggest that less than 10% of children with CAP may be bacteremic, limiting the potential utility of blood culture. If a blood culture is positive, however, the information may substantially improve antibiotic selection for the patient. Neuman and colleagues[8] used the Pediatric Health Information System-Plus, a database with both administrative and clinical data from six children's hospitals, to evaluate bacteremia and pneumonia in hospitalized children aged 3 months to 18 years. The investigators calculated the prevalence of bacteremia and then evaluated the distribution of pathogens as well as the proportion that were susceptible to penicillin.

Over a third (34.2%) of the more than 7500 hospitalized children with CAP had undergone blood culture testing. Bacteremia was diagnosed in 0.9% of all children and 2.5% of those in whom a culture was obtained. The majority (78.5%) of the pathogens were identified as Streptococcus pneumoniae. Staphylococcus aureus was a distant second at 7.7%, followed by Haemophilus influenzae (4.6%) and other bacteria (3%). Available susceptibility data showed that 82% of the pathogens were susceptible to penicillin, including 92% of the S pneumoniae isolates.

The investigators concluded that among hospitalized children with CAP without medical comorbidities, the rate of bacteremia in non-ICU patients was very low, with most pathogens being susceptible to penicillin. They argue against routine blood culture in hospitalized children with CAP.

Viewpoint

Again, this is a study that scares me if people overinterpret the results. Remember, these were not children with complicated pneumonia or any chronic medical conditions. In addition, the authors could not account for the vaccination status of the patients. Certainly, one might be more inclined to obtain cultures in a very young infant with pneumonia who is unvaccinated. These data do not suggest that clinicians should avoid obtaining cultures in patients who are ill-appearing or otherwise concerning. Rather, the study supports the notion that not every child needs a blood culture.

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