Do Pediatric CAP Patients Need a Blood Culture?

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In children without other comorbidities, with moderate to severe community acquired pneumonia requiring hospitalization, the yield of blood culture was very low.  Most isolated organisms were Streptococcus pneumoniae, 82% of which were penicillin sensitive.

Why does this matter?
National guidelines from the Pediatric Infectious Disease Society and IDSA recommend drawing blood cultures in children with community acquired pneumonia requiring hospitalization.  But blood cultures in pediatric patients require additional phlebotomy, are prone to contamination with skin flora, and add to the cost and complexity of care.  This study looked at how often the blood culture was positive and whether or not it would change empiric antibiotic treatment.

Being uncultured
This was a retrospective look at 7509 hospitalized children with moderate to severe community acquired pneumonia without chronic medical problems.  They found that only one third had blood cultures obtained.  Of these, only 2.5% were positive; 78% were Streptococcus pneumoniae, 82% sensitive to penicillin.  Only 11 (0.43%) children grew an organism not sensitive to penicillin.  Rate of contaminated blood cultures was about 1%.  Authors estimated that 667 children would need to have blood cultures to identify 1 child with a penicillin-resistant strain requiring antibiotics broader than empiric ampicillin.  Of course this does not apply to critically ill children or children with medical comorbidities.

Source
Utility of Blood Culture Among Children Hospitalized With Community-Acquired Pneumonia.  Pediatrics. 2017 Sep;140(3). pii: e20171013. doi: 10.1542/peds.2017-1013. Epub 2017 Aug 23.

Peer reviewed by Thomas Davis, MD.

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