title: Evaluating the use of blood cultures in the management of children hospitalized for community-acquired pneumonia.
abstract: BACKGROUND
  Blood cultures are often recommended for the evaluation of community-acquired pneumonia (CAP). However, institutions vary in their use of blood cultures, and blood cultures have unclear utility in CAP management in hospitalized children.
  
  
  OBJECTIVE
  To identify clinical factors associated with obtaining blood cultures in children hospitalized with CAP, and to estimate the association between blood culture obtainment and hospital length of stay (LOS).
  
  
  METHODS
  We performed a multicenter retrospective cohort study of children admitted with a diagnosis of CAP to any of four pediatric hospitals in the United States from January 1, 2011-December 31, 2012. Demographics, medical history, diagnostic testing, and clinical outcomes were abstracted via manual chart review. Multivariable logistic regression evaluated patient and clinical factors for associations with obtaining blood cultures. Propensity score-matched Kaplan-Meier analysis compared patients with and without blood cultures for hospital LOS.
  
  
  RESULTS
  Six hundred fourteen charts met inclusion criteria; 390 children had blood cultures obtained. Of children with blood cultures, six (1.5%) were positive for a pathogen and nine (2.3%) grew a contaminant. Factors associated with blood culture obtainment included presenting with symptoms of systemic inflammatory response syndrome (OR 1.78, 95% CI 1.10-2.89), receiving intravenous hydration (OR 3.94, 95% CI 3.22-4.83), receiving antibiotics before admission (OR 1.49, 95% CI 1.17-1.89), hospital admission from the ED (OR 1.65, 95% CI 1.05-2.60), and having health insurance (OR 0.42, 95% CI 0.30-0.60). In propensity score-matched analysis, patients with blood cultures had median 0.8 days longer LOS (2.0 vs 1.2 days, P < .0001) without increased odds of readmission (OR 0.94, 95% CI 0.45-1.97) or death (P = .25).
  
  
  CONCLUSIONS
  Obtaining blood cultures in children hospitalized with CAP rarely identifies a causative pathogen and is associated with increased LOS. Our results highlight the need to refine the role of obtaining blood cultures in children hospitalized with CAP.
authors: Department of Pediatrics, Children's Mercy Hospital, University of Missouri-Kansas City, Kansas City, MO, United States of America.
authors: Russell J
authors: RJ
authors: McCulloh
authors: Department of Pediatrics, Rhode Island Hospital, Providence, RI, United States of America.
authors: Michael P
authors: MP
authors: Koster
authors: Department of Pediatrics, Children's Mercy Hospital, University of Missouri-Kansas City, Kansas City, MO, United States of America.
authors: Dwight E
authors: DE
authors: Yin
authors: Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States of America.
authors: Tiffany L
authors: TL
authors: Milner
authors: Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States of America.
authors: Shawn L
authors: SL
authors: Ralston
authors: Department of Pediatrics, Children's Hospital of San Antonio, San Antonio, TX, United States of America.
authors: Vanessa L
authors: VL
authors: Hill
authors: Department of Pediatrics, Rhode Island Hospital, Providence, RI, United States of America.
authors: Brian K
authors: BK
authors: Alverson
authors: Department of Pediatrics, Rochester Medical Center, Rochester, NY, United States of America.
authors: Eric A
authors: EA
authors: Biondi
mesh_terms: D000293:Adolescent; D001419:Bacteria / Q000302:isolation & purification; D015373:Bacterial Typing Techniques / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000175:diagnosis* / Q000382:microbiology / Q000401:mortality; D003710:Demography; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D011014:Pneumonia / Q000175:diagnosis* / Q000382:microbiology / Q000401:mortality; D012189:Retrospective Studies