Salih Karimeldin Mohamed Ali, El-Samani El-Fatih, Bilal Jalal Ali, Eldouch Widad, Ibrahim Salah Ahmed
Associate Professor, Deparment of Pediatrics, Bahri University, College of Medicine, Sudan and King Khalid University, College of Medicine , Abha, KSA .
Professor, Deparment of Community Medicine & Epidemiology Department, Ahfad University for Women , Khartoum, Sudan .
J Clin Diagn Res. 2015 Aug;9(8):SC04-7. doi: 10.7860/JCDR/2015/13771.6377. Epub 2015 Aug 1.
Blood culture is necessary for appropriate management of clinically severe pneumonia in children under five years of age. However, in limited resource countries it might be unduly costly and waste of valuable time because of the high negative culture rate.
This study aims to identify clinical and laboratory parameters that potentially predict a positive blood culture in cases of severe pneumonia.
A hospital based study, enrolled 189 cases satisfying the WHO definition of severe pneumonia. Age, gender, clinical history, physical examination, temperature, complete blood count, C-reactive protein, blood culture and Chest X Ray for all the patients were recorded.
Forty one patients had positive blood culture giving a prevalence of 21.7%. All variables were used in a dichotomous manner. White Blood Count (WBC) more than 20 000, very high C-reactive protein (C-RP ≥8mg/L) and Temperature more than 40(o)C, had a positive predictive value of 46.1%, 44.3% and 40.0% respectively for a positive culture as well as a Negative Predictive Value of 91.1%, 91.6% and 91.7% respectively. The WBC more than 20 000 and temperature above 40(o)C had a significant association with a positive blood culture. Their adjusted Odds Ratios were 3.9 (95% CI: 1.4-10.90) and 3.1 (95% CI: 1.2-8.4) respectively. This was not the case for C-RP (Odds Ratio=2.2, 95% CI: 0.7-2.2) or positive Chest X Ray (Odds Ratio=1.5, 95% CI: 0.6-3.6).
Temperature of more than 40(o)C, Very high C-RP and WBC of more than 20 000 are good indicators of a potential positive blood culture. It is therefore recommended that further research be undertaken to refine these predictors as screening tools before resorting to blood culture. It is also recommended that antibiotic treatment may be initiated on the basis of the high temperature and WBC, while waiting for the culture results.
血培养对于五岁以下儿童临床重症肺炎的恰当管理至关重要。然而，在资源有限的国家，由于血培养阴性率高，其成本可能过高且浪费宝贵时间。
本研究旨在确定在重症肺炎病例中可能预测血培养阳性的临床和实验室参数。
一项基于医院的研究，纳入了189例符合世界卫生组织重症肺炎定义的病例。记录了所有患者的年龄、性别、临床病史、体格检查、体温、全血细胞计数、C反应蛋白、血培养及胸部X光检查结果。
41例患者血培养呈阳性，患病率为21.7%。所有变量均以二分法使用。白细胞计数（WBC）超过20000、C反应蛋白（C-RP）非常高（C-RP≥8mg/L）以及体温超过40℃，血培养阳性的阳性预测值分别为46.1%、44.3%和40.0%，阴性预测值分别为91.1%、91.6%和91.7%。白细胞计数超过20000和体温高于40℃与血培养阳性有显著关联。其调整后的比值比分别为3.9（95%置信区间：1.4-10.90）和3.1（95%置信区间：1.2-8.4）。C反应蛋白（比值比=2.2，95%置信区间：0.7-2.2）或胸部X光阳性（比值比=1.5，95%置信区间：0.6-3.6）则并非如此。
体温超过40℃、C反应蛋白非常高以及白细胞计数超过20000是血培养可能呈阳性的良好指标。因此，建议在采用血培养之前，进一步开展研究以完善这些预测指标作为筛查工具。还建议在等待培养结果期间，可根据高温和白细胞计数开始抗生素治疗。
