blood cultures for inpatient community acquired pneumonia

1. Blood Cultures for Inpatient Community Acquired Pneumonia Ricardo Quinonez, MD Thaddeus May, MD

2. Disclosure Statement I have no disclosures or conflicts of interest to reveal Neither myself nor any of my collaborators have any disclosures or conflicts of interest to reveal. Neither myself nor any of my collaborators have any disclosures or conflicts of interest to reveal.

3. Background Blood cultures are a frequent test obtained when evaluating community acquired pneumonia (CAP) In a adults obtaining blood cultures for CAP in hospitalized patients is even considered a quality measure A recent systematic review of the literature found that in a total of 7 studies encompassing over 2700 cultures, antibiotics were narrowed due to blood culture results in less than 3% of all cases and broadened in less than 1% In most of the studies that looked at false positive cultures, these matched or exceeded the rate for true positives. Clinical decisions were almost never made due to blood cuture results

4. Background In pediatrics, outpatient studies have shown limited utility in obtaining blood cultures for patients with CAP A retrospective study evaluated the utility of blood cultures obtained in the emergency department in 409 children with radiographic evidence of pneumonia Blood cultures were positive for pathogens in 2.7% of cases and no changes in clinical management occured due to blood culture results

5. Background Blood cultures are often obtained during the evaluation on children admitted to the hospital for community acquired pneumonia National guidelines such as the British Thoracic Society Guidelines for the Management of Community Acquired Pneumonia in Childhood recommend obtaining these for children admitted to the hospital based on expert consensus There are no studies which have evaluated the positivity rate and utility of blood cultures for pediatric patients admitted to the hospital with CAP

6. Study Design OBJECTIVE: To determine the positivity rate and utility of blood cultures obtained in chidren admitted to a tertiary care children’s hospital with community acquired pneumonia METHOD: Retrospective cohort chart review Inclusion criteria: previously healthy children admitted to the hospital with discharge diagnosis of pneumonia in which a blood culture was obtained Exclusion: immunocompromised patients, patients with chronic pulmonary illness with the exception of asthma

7. Results 134 subjects Median age 19 months (range 10 days to 16 years) Median duration of hospitalization 3 days (range 1-22 days)

9. Results Blood culture results were missing from 5 patients (3.7%) Of the 129 known results: 3 were positive (2.3%, 95% CI 0.5-6.7%) 2 were pathogens (1.6%, 95% CI 0.2-5.5%)

10. Results

11. Conclusions Blood cultures are rarely positive in children admitted to the hospital for pneumonia, except those with pneumonia complicated by effusion Blood cultures do not drive clinical management decisions in children admitted the hospital for pneumonia

12. References Afshar N, Tabas J, Afshar K, Silbergleit R., Blood cultures for community-acquired pneumonia: are they worthy of two quality measures? A systematic review, J Hosp Med. 2009 Feb;4(2):112-23. Review. Hickey RW, Bowman MJ, Smith GA., Utility of blood cultures in pediatric patients found to have pneumonia in the emergency department., Ann Emerg Med. 1996 Jun;27(6):721-5. British Thoracic Society Guidelines for the Management of Community Acquired Pneumonia in Childhood, Thorax. 2002 May;57 Suppl 1:i1-24