Youssef Ahmed S, Fanous Mina, Siddiqui Faisal J, Estrada Jorge, Chorny Valeriy, Braiman Melvyn, Mayer Erick F
Pediatrics, State University of New York Downstate Medical Center, New York, USA.
Neonatology, State University of New York Downstate Medical Center, New York, USA.
Cureus. 2020 May 21;12(5):e8222. doi: 10.7759/cureus.8222.
Background and objectives Current guidelines for the management of community-acquired pneumonia (CAP) in children recommend obtaining a blood culture for children with moderate to severe pneumonia; yet, there is no guidance to assess the severity of the disease. Thus, a blood culture is obtained for the majority of children admitted with CAP, regardless of the severity of their symptoms. The study was designed to investigate and identify the prevalence of bacteremia in pediatric patients hospitalized with CAP and to evaluate the clinical and laboratory variables associated with bacteremia. Methods We conducted a medical record review of children aged from two months to 18 years diagnosed with CAP between January 1, 2013, and December 31, 2017, at our two urban tertiary centers. We used binary logistic regression analysis and chi-square tests to look at factors associated with blood culture positivity. Results A total of 464 patients were admitted with CAP. Blood cultures were obtained in 357 (76.9%) patients; 23 patients had repeated cultures. Fifteen patients had positive cultures: 5/380 (1.3%) were considered true positive results and 10/380 (2.6%) were considered contaminants. Intensive care unit (ICU) admission (OR 5.6 with 95% CI (1- 31), p<0.03), toxic appearance (OR 12.8 with 95% CI (1.3-125), p<0.01), and significantly elevated C-reactive protein (CRP) (>300 mg/L (p<0.01) were associated with bacteremia. Conclusion The prevalence of bacteremia among children admitted for CAP is low. The use of routine blood cultures should be reserved for children with moderate to severe pneumonia. Further studies are required to better risk-stratify children with CAP.
背景与目的 目前儿童社区获得性肺炎（CAP）管理指南建议，对于中重度肺炎患儿应进行血培养；然而，对于评估疾病严重程度并无指导意见。因此，大多数因CAP入院的患儿，无论症状严重程度如何，均会进行血培养。本研究旨在调查并确定因CAP住院的儿科患者中菌血症的患病率，并评估与菌血症相关的临床和实验室变量。方法 我们对2013年1月1日至2017年12月31日期间在我们两个城市三级中心诊断为CAP的2个月至18岁儿童的病历进行了回顾。我们使用二元逻辑回归分析和卡方检验来观察与血培养阳性相关的因素。结果 共有464例患者因CAP入院。357例（76.9%）患者进行了血培养；23例患者进行了重复培养。15例患者培养结果为阳性：5/380（1.3%）被认为是真正的阳性结果，10/380（2.6%）被认为是污染物。入住重症监护病房（ICU）（比值比5.6，95%可信区间（1 - 31），p<0.03）、中毒面容（比值比12.8，95%可信区间（1.3 - 125），p<0.01）以及C反应蛋白（CRP）显著升高（>300 mg/L（p<0.01））与菌血症相关。结论 因CAP入院的儿童中菌血症的患病率较低。常规血培养应仅用于中重度肺炎患儿。需要进一步研究以更好地对CAP患儿进行风险分层。
