Clinical Medicine Insights: Pediatrics

Background: It is believed to be the standard of care to obtain a blood culture in a child who is hospitalized for pneumonia. In recent years, many studies have questioned the utility of this practice in the presence of age appropriate immunization. We conducted this study to determine the current prevalence of bacteremia in children with uncomplicated pneumonia and the utility of obtaining blood cultures in these children.

Objective: To evaluate the risk of bacteremia in hospitalized young children with pneumonia.

Methods: This was a retrospective review from July 2003 until July 2008. The setting was the pediatric emergency department of an urban teaching hospital. The study population included children under 36 months of age who had been fully immunized and who had been hospitalized with radiographic evidence of uncomplicated pneumonia. Excluded were children who were currently using antibiotics or who had used antibiotics within the previous 48 hours, as well as children with immunodeficiency status such as sickle cell anemia, immunoglobulin deficiency, or children on steroid therapy.

The radiologist’s interpretation of each chest radiograph was reviewed and recorded. The variables studied were age (in months), gender, race, birth history, pneumococcal vaccination status, appearance on arrival, temperature on arrival, respiratory rate, oxygen saturation, white blood cell (WBC) count, neutrophil count, band count, and urine culture. The chi-square test and logistic regression were used to analyze the data.

Results: A blood culture was obtained in 535 children hospitalized with radiographic pneumonia. Bacteremia was present in 12 children (2.2%). All organisms isolated from the blood cultures were considered contaminants.

Conclusion: Children hospitalized with uncomplicated pneumonia have a low rate of positive blood cultures. None of the variables studied predicted bacteremia. The absence of true-positive cultures among the organisms isolated suggests little value in obtaining blood cultures in children hospitalized due to uncomplicated pneumonia.