McCulloh Russell J, Koster Michael P, Yin Dwight E, Milner Tiffany L, Ralston Shawn L, Hill Vanessa L, Alverson Brian K, Biondi Eric A
Department of Pediatrics, Children's Mercy Hospital, University of Missouri-Kansas City, Kansas City, MO, United States of America.
Department of Pediatrics, Rhode Island Hospital, Providence, RI, United States of America.
PLoS One. 2015 Feb 6;10(2):e0117462. doi: 10.1371/journal.pone.0117462. eCollection 2015.
Blood cultures are often recommended for the evaluation of community-acquired pneumonia (CAP). However, institutions vary in their use of blood cultures, and blood cultures have unclear utility in CAP management in hospitalized children.
To identify clinical factors associated with obtaining blood cultures in children hospitalized with CAP, and to estimate the association between blood culture obtainment and hospital length of stay (LOS).
We performed a multicenter retrospective cohort study of children admitted with a diagnosis of CAP to any of four pediatric hospitals in the United States from January 1, 2011-December 31, 2012. Demographics, medical history, diagnostic testing, and clinical outcomes were abstracted via manual chart review. Multivariable logistic regression evaluated patient and clinical factors for associations with obtaining blood cultures. Propensity score-matched Kaplan-Meier analysis compared patients with and without blood cultures for hospital LOS.
Six hundred fourteen charts met inclusion criteria; 390 children had blood cultures obtained. Of children with blood cultures, six (1.5%) were positive for a pathogen and nine (2.3%) grew a contaminant. Factors associated with blood culture obtainment included presenting with symptoms of systemic inflammatory response syndrome (OR 1.78, 95% CI 1.10-2.89), receiving intravenous hydration (OR 3.94, 95% CI 3.22-4.83), receiving antibiotics before admission (OR 1.49, 95% CI 1.17-1.89), hospital admission from the ED (OR 1.65, 95% CI 1.05-2.60), and having health insurance (OR 0.42, 95% CI 0.30-0.60). In propensity score-matched analysis, patients with blood cultures had median 0.8 days longer LOS (2.0 vs 1.2 days, P < .0001) without increased odds of readmission (OR 0.94, 95% CI 0.45-1.97) or death (P = .25).
Obtaining blood cultures in children hospitalized with CAP rarely identifies a causative pathogen and is associated with increased LOS. Our results highlight the need to refine the role of obtaining blood cultures in children hospitalized with CAP.
血培养常用于社区获得性肺炎（CAP）的评估。然而，不同机构在血培养的使用上存在差异，且血培养在住院儿童CAP管理中的作用尚不明确。
确定住院CAP患儿进行血培养的相关临床因素，并评估血培养与住院时长（LOS）之间的关联。
我们对2011年1月1日至2012年12月31日期间在美国四家儿童医院中任何一家因CAP诊断入院的儿童进行了一项多中心回顾性队列研究。通过人工查阅病历摘要获取人口统计学、病史、诊断检查及临床结局等信息。多变量逻辑回归分析评估患者及临床因素与血培养的相关性。倾向得分匹配的Kaplan-Meier分析比较了进行血培养和未进行血培养的患者的住院LOS。
614份病历符合纳入标准；390名儿童进行了血培养。在进行血培养的儿童中，6名（1.5%）病原体培养阳性，9名（2.3%）培养出污染物。与血培养相关的因素包括出现全身炎症反应综合征症状（比值比[OR]1.78，95%置信区间[CI]1.10 - 2.89）、接受静脉补液（OR 3.94，95% CI 3.22 - 4.83）、入院前接受抗生素治疗（OR 1.49，95% CI 1.17 - 1.89）、从急诊科入院（OR 1.65，95% CI 1.05 - 2.60）以及有医疗保险（OR 0.42，95% CI 0.30 - 0.60）。在倾向得分匹配分析中，进行血培养的患者住院LOS中位数长0.8天（2.0天对1.2天，P <.0001），再入院几率（OR 0.94，95% CI 0.45 - 1.97）或死亡几率（P =.25）未增加。
住院CAP患儿进行血培养很少能确定致病病原体，且与住院LOS延长有关。我们的结果凸显了优化住院CAP患儿血培养作用的必要性。
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