Should I Get a Blood Culture in a Child Hospitalized With Pneumonia?
MarkNeuman, MD, MPH, Assistant Editor, Pediatrics
National guidelines recommend obtaining blood cultures in most children hospitalized
with community-acquired pneumonia, although the evidence base for this recommendation
is not strong. Blood cultures may be useful as they can identify the etiologic agent
causing pneumonia, and help to target antimicrobial therapy. However, the yield of
blood culture among children with pneumonia is low, and contaminated blood cultures
are not uncommon, often leading to further testing and treatment. As a result, pediatricians
and emergency physicians often struggle with the decision of whether the child hospitalized
with pneumonia requires a blood culture.
This week, we are early releasing a study (10.1542/peds.2018-3090) by Fritz et al. which evaluates the rate of bacteremia among children enrolled in
the multi-center Etiology of Pneumonia in the Community (EPIC) study. The article
reports the rate of positivity of blood culture, identifies the factors associated
with bacteremia, and whether clinical outcomes differ among bacteremic versus non-bacteremic
children. Given the overall low rate of bacteremia, the authors further explored
whether certain populations of children were at higher risk of bacteremia, including
children with evidence of empyema or those hospitalized in an intensive care unit.
Unlike most other studies evaluating the rate of bacteremia in children hospitalized
with pneumonia in which blood culture was performed at the discretion of the treating
clinician, all children enrolled in this study had a blood culture obtained, increasing
the generalizability of these findings. This large prospective epidemiological study
provides the strongest evidence to date of just what the prevalence of bacteremia
in children hospitalized with pneumonia really is.
Should we change our “culture” of getting a culture in children hospitalized with
pneumonia? You’ll need to read the study yourself to decide!