Neuman Mark I, Hall Matthew, Lipsett Susan C, Hersh Adam L, Williams Derek J, Gerber Jeffrey S, Brogan Thomas V, Blaschke Anne J, Grijalva Carlos G, Parikh Kavita, Ambroggio Lilliam, Shah Samir S
Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts;
Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts.
Pediatrics. 2017 Sep;140(3). doi: 10.1542/peds.2017-1013. Epub 2017 Aug 23.
National guidelines recommend blood cultures for children hospitalized with presumed bacterial community-acquired pneumonia (CAP) that is moderate or severe. We sought to determine the prevalence of bacteremia and characterize the microbiology and penicillin-susceptibility patterns of positive blood culture results among children hospitalized with CAP.
We conducted a cross-sectional study of children hospitalized with CAP in 6 children's hospitals from 2007 to 2011. We included children 3 months to 18 years of age with discharge diagnosis codes for CAP using a previously validated algorithm. We excluded children with complex chronic conditions. We reviewed microbiologic data and classified positive blood culture detections as pathogens or contaminants. Antibiotic-susceptibility patterns were assessed for all pathogens.
A total of 7509 children hospitalized with CAP were included over the 5-year study period. Overall, 34% of the children hospitalized with CAP had a blood culture performed; 65 (2.5% of patients with blood cultures; 95% confidence interval [CI]: 2.0%-3.2%) grew a pathogen. accounted for 78% of all detected pathogens. Among detected pathogens, 50 (82%) were susceptible to penicillin. Eleven children demonstrated growth of an organism nonsusceptible to penicillin, representing 0.43% (95% CI: 0.23%-0.77%) of children with blood cultures obtained and 0.15% (95% CI: 0.08%-0.26%) of all children hospitalized with CAP.
Among children without comorbidities hospitalized with CAP in a non-ICU setting, the rate of bacteremia was low, and isolated pathogens were usually susceptible to penicillin. Blood cultures may not be needed for most children hospitalized with CAP.
国家指南建议，对于因疑似中度或重度细菌性社区获得性肺炎（CAP）而住院的儿童应进行血培养。我们试图确定菌血症的患病率，并描述因CAP住院儿童血培养结果呈阳性时的微生物学特征及青霉素敏感性模式。
我们对2007年至2011年期间在6家儿童医院因CAP住院的儿童进行了一项横断面研究。我们纳入了年龄在3个月至18岁之间、使用先前验证的算法得出出院诊断代码为CAP的儿童。我们排除了患有复杂慢性病的儿童。我们回顾了微生物学数据，并将血培养检测呈阳性分类为病原体或污染物。对所有病原体的抗生素敏感性模式进行了评估。
在为期5年的研究期间，共有7509名因CAP住院的儿童被纳入研究。总体而言，34%因CAP住院的儿童进行了血培养；65名（占血培养患者的2.5%；95%置信区间[CI]：2.0%-3.2%）培养出病原体。 占所有检测到的病原体的78%。在检测到的病原体中，50种（82%）对青霉素敏感。11名儿童的血培养结果显示有对青霉素不敏感的微生物生长，占进行血培养儿童的0.43%（95%CI：0.23%-0.77%），占所有因CAP住院儿童的0.15%（95%CI：0.08%-0.26%）。
在非重症监护病房环境下因CAP住院且无合并症的儿童中，菌血症发生率较低，分离出的病原体通常对青霉素敏感。大多数因CAP住院的儿童可能无需进行血培养。
