title: The prevalence of bacteremia in pediatric patients with community-acquired pneumonia: guidelines to reduce the frequency of obtaining blood cultures.
abstract: OBJECTIVE
  The goal of this study was to determine the prevalence of bacteremia in pediatric patients with community-acquired pneumonia (CAP) at our institution and to test the effectiveness of newly developed guidelines for obtaining blood cultures.
  
  
  METHODS
  Using recent literature and local expert opinion, institutional guidelines for obtaining blood cultures in pediatric patients with CAP were developed. A retrospective chart review of children treated in the emergency department or admitted for CAP from January 2010 through June 2011 was conducted. Demographic and clinical data were collected, including results of blood cultures. Chi2 tests assessed for variables associated with bacteremia, whether a blood culture was obtained, and if the decision to obtain a culture was appropriate based on our guidelines.
  
  
  RESULTS
  The study included 330 patients; 155 (47%) blood cultures were obtained in our patient population. Five cultures were true-positive findings, making the prevalence of bacteremia 3.2% in patients with blood cultures and 1.5% in all patients. All 5 true positive results met criteria for blood culture based on our guidelines. Applying our guidelines retrospectively, the decision to obtain a blood culture met criteria in 55% of the cases. Bivariate analysis showed that patients discharged from the emergency department had higher rates of guideline-appropriate decisions than patients admitted. Radiographic findings were associated with making a guideline-appropriate decision regarding blood culture.
  
  
  CONCLUSIONS
  Instituting local guidelines that limit the frequency of obtaining blood cultures in pediatric patients with CAP is likely to capture any patient with bacteremia. This study suggests that blood cultures may not need to be routinely obtained in all patients admitted to the hospital with CAP.
authors: Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, Georgia Health Sciences University, 1120 15th St, BG 2123, Augusta, GA 30912, USA. dheine@gru.edu
authors: Daniel
authors: D
authors: Heine
authors: Christina
authors: C
authors: Cochran
authors: Melissa
authors: M
authors: Moore
authors: M Olivia
authors: MO
authors: Titus
authors: Annie Lintzenich
authors: AL
authors: Andrews
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015169:Colony Count, Microbial / Q000706:statistics & numerical data; D017714:Community-Acquired Infections / Q000150:complications* / Q000382:microbiology; D004926:Escherichia coli / Q000302:isolation & purification; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D011014:Pneumonia / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D013296:Streptococcus pneumoniae / Q000302:isolation & purification; D013297:Streptococcus pyogenes / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents